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Teaching short term memory skills to children with Down syndrome

This study investigates a range of short term memory skills and the effectiveness of memory training procedures in improving these skills. The initial sample was 63 children with Down syndrome, aged 4-18 years, from two geographical areas in the UK. Phase 1 of the study assessed each child on a battery of tests including short term memory skills in different modalities, language skills, speech rate, word identification and a number of general IQ measures. Two groups were formed, one from one geographical area identified as the experimental group (n=25). A control group was formed from a subset of the remainder of children (n=26). Analysis verified that the two groups were similar and matched in terms of age and abilities. Phase 2 of the research consisted of a longitudinal training study of two memory strategies (rehearsal and organisation) which lasted for six weeks. For the experimental group (n=25), a cross-over design was employed to assess the effect of each strategy independently. Half the group received the rehearsal training first and the other half, the organisation-based training. Fifteen children from the group were taught by the first author and the rest by 'keyworkers'. In Phase 3 the initial assessment battery was repeated. The results demonstrated that each training programme was effective and enhanced only those specific memory skills addressed.

Broadley, I, and MacDonald, J. (1993) Teaching short term memory skills to children with Down syndrome. Down Syndrome Research and Practice, 1(2), 56-62. doi:10.3104/reports.11

Research on the development of communication in children with Down syndrome indicates that language is frequently delayed relative to cognitive, motor and social ability. There is also evidence for some specific and persistent delays in certain aspects of language, particularly grammatical components [ 1-5]. However, there is now considerable evidence that the use of signed input, in combination with speech, can facilitate early language development: evidence for this coming from a substantial number of single case-studies and, more recently, from larger scale studies incorporating some experimental controls [ 4 , 6]: see refs 7 and 8 for reviews.

It is likely that the effectiveness of signed intervention is linked to the relative strength of visuospatial processing, compared to processing of auditory information, in children with Down syndrome [ 5 , 9]. An important factor underlying early language and communication development is the efficiency of attentional processes [ 8]. Research has shown that people with Down syndrome, with developmental levels of between five and six years, show similar patterns of response to typically developing children on tasks involving visual orientation [ 10,11]. A very recent study has also shown that reflexive visual orienting in people with Down syndrome develops in accordance with overall mental age, in contrast with individuals with fragile X syndrome, where this ability is delayed relative to developmental level [ 12]. These findings contrast with earlier work showing that infants with Down syndrome show difficulties in visual searching and shifting attention in free play contexts[ 13,14]. This is clearly an area that will repay further research, perhaps using a longitudinal approach.

One major influence on early language development, and particularly lexical development, in typically developing children is the relationship between the language addressed to the child and the focus of joint attention between child and adult [ 15]. There has been relatively little research on joint attention and early language in atypical groups, compared with the literature on typically developing children [ 16 ], but there has been some research with children with Down syndrome. Harris, Kasari and Sigman found that there was a significant positive association between measures of joint attention between children and caregivers and receptive language gain in the children [ 17 ]. They also found a significant positive association between receptive language and the frequency with which caregivers maintained attention to toys which had been selected by the child, and a significant negative association between receptive language and the frequency with which caregivers redirected children's attention away from toys: especially those which had been selected by the child. These findings parallel those of Tomasello and Farrar for typically developing children [ 18 ].

Harris et al. [ 17] argue that attending to the child's focus of attention, rather than redirecting attention, minimises the attentional load for the child and that this may be particularly important for children with Down syndrome in view of their apparently reduced attentional capacity [ 14 , 19]. As noted above, despite their attentional and auditory perceptual impairments, children with Down syndrome have relative strengths in visuospatial and visuomotor skills [ 5 , 20]. This, combined with the fact that these children frequently show a preference for gestural over vocal communication [ 5 , 20,21] has led to the development of interventions which make use of all available sensory modalities, with an increasing use of signing in conjunction with spoken language [ 7]. As noted above, there is a growing research literature supporting the efficacy of such approaches. However, there is still a need for more research on the effectiveness of different combinations of signs, speech, symbols and the written word, and on their appropriateness at different developmental levels [ 22]: both Miller [ 4] and Launonen [ 6] note that many children drop the use of signing as their spoken communication develops, but there are others for whom signs remain an important mode of communication, and other research has suggested that signing may improve the intelligibility of accompanying speech in adults [ 23]. As some of the recent research cited above demonstrates, that is also an urgent requirement for more basic research on perceptual and attentional processes, and their development over time, in individuals with Down syndrome, in order that interventions can be matched to developmental need.

References

  1. Rondal JA. Exceptional Language Development in Down Syndrome: Implications for the Cognition-Language Relationship. Cambridge: Cambridge University Press;1995.
  2. Rondal JA, Comblain A. Language in adults with Down syndrome. Down Syndrome: Research and Practice. 1996;4:3-14. [ Read Online]
  3. Fowler AE. Language abilities in children with Down syndrome: Evidence for a specific syntactic delay. In: Cicchetti D, Beeghly M, editors. Children with Down Syndrome: A Developmental Perspective. Cambridge: Cambridge University Press;1990.
  4. Miller JF. Development of speech and language in children with Down syndrome. In: Lott IT, McCoy EE, editors. Down Syndrome: Advances in Medical Care. Chichester: Wiley;1992.
  5. Tager-Flusberg H. Language development in atypical children. In: Barrett M, editor. T he Development of Language. Hove: Psychology Press; 1999.
  6. Launonen K. Enhancing communication skills of children with Down syndrome: Early use of manual signs. In: von Tetzchner S, Jensen MH, editors. Augmentative and Alternative Communication: European Perspectives. London: Whurr;1996.
  7. Clibbens J. Signing and lexical development in children with Down syndrome. Down Syndrome Research and Practice. 2001;7:101-105. [ Read Online]
  8. Clibbens J, Powell GG, Atkinson E. Strategies for achieving joint attention when signing to children with Down syndrome. International Journal of Language and Communication Disorders;in press.
  9. Jarrold C, Baddeley AD. Short-term memory for verbal and visuospatial information in Down's syndrome. Cognitive Neuropsychiatry . 1997;2:101-122.
  10. Goldman KJ, Flanagan T, Shulman C, Enns JY, Burack JA. Voluntary orienting among children and adolescents with Down syndrome and MA-matched typically developing children. American Journal on Mental Retardation. 2005;110:157-163.
  11. Randolph B, Burack JA. Visual filtering and covert orienting in persons with Down syndrome. International Journal of Behavioural Development. 2000;24:167-172.
  12. Flanagan T, Enns JT, Murphy MM, Russo N, Abbeduto L, Randolph B, Burack JA. Differences in visual orienting between persons with Down or fragile X syndrome. Brain and Cognition. 2007;65:128-134.
  13. Krakow JB, Kopp C. The effects of developmental delay on sustained attention in young children. Child Development. 1983;54:1143-1155.
  14. Landry SH, Chapieski ML. Joint attention and infant toy exploration: effects of Down syndrome and prematurity. Child Development . 1989;60:103-118.
  15. Harris M. Language Experience and Early Language Development: from Input to Uptake. Hove: Erlbaum;1992.
  16. Conti-Ramsden G. Language interaction with atypical language learners. In: Gallaway C, Richards B, editors. Input and Interaction in Language Acquisition. Cambridge: Cambridge University Press;1994.
  17. Harris S, Kasari C, Sigman, MD. Joint attention and language gains in children with Down syndrome. American Journal on Mental Retardation. 1996;100:608-619.
  18. Tomasello M, Farrar MJ. Joint attention and early language. Child Development. 1986;57:1454-1463.
  19. Landry SH, Chapieski ML. Joint attention at six months in Down syndrome and preterm infants: Patterns of attention to toys and to mother. American Journal on Mental Retardation. 1990;94:488-498.
  20. Caselli MC, Vicari S, Longobardi E, Lami L, Pizzoli C, Stella G. Gestures and words in early development of children with Down syndrome. Journal of Speech, Language and Hearing Research. 1998;41:1125-1135.
  21. Stefanini S, Caselli MC, Volterra V. Spoken and gestural production in a naming task by young children with Down syndrome. Brain and Language. 2007;101:208-221.
  22. Clibbens J, Powell GG, Grove N. Manual signing and AAC: issues for research and practice. Communication Matters. 1997;11(2):17-18.
  23. Powell GG, Clibbens J. Actions speak louder than words: signing and speech intelligibility in adults with Down's syndrome. Down's Syndrome: Research and Practice. 1994;2:127-129.
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A photograph of a child with Down syndrome

"The RLI programme has been a very beneficial programme for us to follow with one of our pupils in school. She has gone from having no interest in reading words only looking at pictures to reading shorter stories well and with enjoyment."

A targeted, evidence-based, one-to-one intervention designed and evaluated for children with Down syndrome.

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