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Here we list some of the most popular and recommended articles and papers in our online library, organised by topic.

Adult life and relationships

Partnership and marriage in Down syndrome

Roy Brown

This article looks at partnership and marriage amongst persons with Down syndrome. It does so within the context of a model of quality of life. It is recognised that people with Down syndrome are living longer and if they are to experience wellbeing over their life span then, at the outset to life, parents and professionals must have a concept of this huge change in possibilities and therefore priorities in education, work and social life. The paper provides examples of marriage and partnership and discusses the resources they provide for social and personal growth. If the possibilities of such development are not set at the beginning of life and through the childhood years self-image and opportunities are likely to be denied to a group of people who increasingly have opportunities for extended adult life.

Autism and Down syndrome

Autism and Down syndrome

Sue Buckley (2005)

How many children with Down syndrome also have autism and how do we meet their needs?

Behaviour

Addressing challenging behaviour in children with Down syndrome: The use of applied behaviour analysis for assessment and intervention

Kathleen Feeley, and Emily Jones (2006)

Children with Down syndrome are at an increased risk for engaging in challenging behaviour that may be part of a behavioural phenotype characteristic of Down syndrome. The methodology of applied behaviour analysis has been demonstrated effective with a wide range of challenging behaviours, across various disabilities. Applications to children with Down syndrome and the examination of behaviourally based strategies to specifically address the unique characteristics of children with Down syndrome are limited. However, there are several studies in which a subset of the participants did have Down syndrome. A handful of these studies are reviewed within the context of functional behaviour assessment and Positive Behavioural Supports. Drawing from these studies and the behavioural literature, as well as the authors' clinical experience and research, suggestions regarding early intervention for challenging behaviour with children with Down syndrome are provided.

Strategies to address challenging behaviour in young children with Down syndrome

Kathleen Feeley, and Emily Jones (2007)

Children with Down syndrome are at an increased risk for engaging in challenging behaviour that may present problems within community, leisure, and educational settings, and, in many instances, precludes them from accessing these environments. Factors contributing to the occurrence of challenging behaviours include characteristics associated with the Down syndrome behavioural phenotype, increased incidence of illness and sleep disorders, and the way in which individuals in their environment respond to their behaviours. In this paper we describe the use of behaviourally based intervention strategies to address some of the specific challenges often seen in young children with Down syndrome. Through a series of case studies, the effectiveness of evidence-based interventions addressing challenging behaviour is demonstrated.

Preventing challenging behaviours in children with Down syndrome: Attention to early developing repertoires

Kathleen Feeley, and Emily Jones

Several characteristics associated with the Down syndrome behavioural phenotype as well as biological factors are likely to increase the presence of challenging behaviour in individuals with Down syndrome. The application of evidenced based strategies assessing and addressing challenging behaviours in individuals with developmental disabilities can be systematically applied to address such behaviours in individuals with Down syndrome. Additionally, evidence based strategies can be systematically implemented by caregivers of very young children with Down syndrome to address early communication skills (requesting, vocal imitation), escape behaviours, and self stimulatory behaviour thus diminishing early developing behaviours likely to lead to more significant challenges as the child with Down syndrome matures.

Dental care

Dental Care for the Patient with Down Syndrome

Elizabeth Pilcher (1998)

This study consists of a clinical and literature review of the special dental considerations unique to individuals with Down syndrome. The author is both a dentist and a parent of a child with Down syndrome. Physical and orofacial characteristics of Down syndrome are discussed including the teeth, gingiva, tongue, palate, and occlusion. Incidences of dental decay and periodontal disease are discussed and how best to treat these diseases in persons with Down syndrome. Most if not all persons with Down syndrome have some type of occlusal disharmony. Techniques to help prevent occlusal problems are discussed, including orthodontic therapy. Medical problems associated with Down syndrome that can affect dental treatment are discussed. Also, social and emotional factors involved in dental treatment are covered, including techniques to help children with Down syndrome become co-operative dental patients. Information on how to choose the right dentist for your child and how to communicate effectively with the dental staff is given. Finally, information on proper home care and prevention of dental disease is covered, including information on the most recent dental products.

Developmental/behavioural profile

Early learning and adaptive behaviour in toddlers with Down syndrome: Evidence for an emerging behavioural phenotype?

Deborah Fidler, Susan Hepburn, and Sally Rogers (2006)

Background: Though the Down syndrome behavioural phenotype has been described as involving relative strengths in visuo-spatial processing and sociability, and relative weaknesses in verbal skills and motor planning, the early emergence of this phenotypic pattern of strengths and weaknesses has not yet been fully explored. Method: In this study, we compared the performance of eighteen 2 to 3-year-olds with Down syndrome to an MA-matched comparison group of nineteen 2 to 3-year-olds with mixed developmental disabilities, and an MA-matched comparison group of 24 children with typical development on two developmental measures: the Mullen Scales of Early Learning and the Vineland Adaptive Behaviour Scales. Results: While the specificity of the Down syndrome profile was (for the most part) not yet evident, results showed that toddlers with Down syndrome in this study did show emerging areas of relative strength and weakness similar to that which has been described in older children and young adults with Down syndrome. This pattern included relatively stronger social skills, weaker expressive language, and poor motor coordination. When this pattern of strengths and weaknesses was compared to the developmental profiles of the two comparison groups, socialisation strengths differentiated the Down syndrome group from the mixed developmental disabilities group.

The Down syndrome behavioural phenotype: Taking a developmental approach

Deborah Fidler, David Most, and Amy Philofsky (2008)

Individuals with Down syndrome are predisposed to show a specific behavioural phenotype, or a pattern of strengths and challenges in functioning across different domains of development. It is argued that a developmental approach to researching the Down syndrome behavioural phenotype, including an examination of the dynamic process of the unfolding of the phenotype, will advance science and service for this population. Related issues including the distinction between primary and secondary phenotypic features, heterotypic continuity, and methodological implications are discussed.

Early intervention

Responsive Teaching: Early intervention for children with Down syndrome and other disabilities

Gerald Mahoney, Frida Perales, Bridgette Wiggers, and Bob Bob Herman

Responsive Teaching is an early intervention curriculum designed to address the cognitive, language, and social emotional needs of young children with developmental problems. This innovative intervention model was derived from research conducted primarily with children with Down syndrome and their mothers. Results from these studies indicated that during the early childhood years, parents promote their children's development by engaging in highly responsive interactions throughout their daily routines. The effects of responsiveness are mediated by the impact it has on children's use of several pivotal developmental behaviours, such as social play, attention, initiation and persistence. Responsive Teaching helps parents learn to use Responsive Teaching strategies to promote the pivotal developmental behaviours that are relevant to their children's developmental needs. Research with 50 children with developmental problems and their parents indicated that Responsive Teaching was highly effective at addressing children's developmental and social emotional needs. The effects of this intervention were mediated by the impact that RT strategies had on children's pivotal developmental behaviours.

Education and inclusion

A comparison of mainstream and special education for teenagers with Down syndrome: Implications for parents and teachers

Sue Buckley, Gillian Bird, Ben Sacks, and Tamsin Archer (2006)

This article presents data from a research study designed to compare the achievements of teenagers with Down syndrome educated in mainstream classrooms or in special education classrooms throughout their full-time education. Progress is reported for speech and language, literacy, socialisation, daily living skills and behaviour. For all the teenagers, there is evidence of progress with age on all the measures except for communication. Communication continued to improve through teenage years for the included children but not for those in special education classrooms. There were no significant differences in overall outcomes for daily living skills or socialisation. However, there were large significant gains in expressive language and literacy skills for those educated in mainstream classrooms. Teenagers educated in mainstream classrooms showed fewer behavioural difficulties. Further, comparison with data published by these authors in an earlier study, showed no improvements in school achievements in special education over a 13 year period in the UK (1986-1999).

Families

Families of children with Down syndrome:What we know and what we need to know

Monica Cuskelly, Penny Hauser-Cram , and Marcia Van Riper

This paper provides a brief overview of what is currently known about families of children with Down syndrome. In addition, it highlights a number of issues that require further research if we are to have a thorough understanding of the impact of a child with Down syndrome on families as a system and on the individuals who make up that system. Some of these issues include the need for: 1) a more balanced perspective - one that acknowledges both positive and negative aspects of the experience, 2) greater attention to the experiences of fathers, 3) more cross-cultural research and studies focused on cultural perspectives, 4) increased attention to the change in demands for families as the individual with Down syndrome ages, 5) more longitudinal studies, 6) greater variety in methodological approaches, for example greater use of qualitative approaches and observational methods, and 7) an increase in the use of statistical approaches that model change and test hypotheses about predictors of change in both parents and children.

Hearing

Hearing disorders in children with Down syndrome

Ben Sacks, and Amanda Wood (2003)

People with Down syndrome tend to have a significantly higher incidence of hearing problems than other groups. This article examines some of the causes and treatments of hearing loss and outlines the assessment process.

Memory

Memory training for children with Down syndrome

Frances Conners, Celia Rosenquist, and Lori Taylor (2001)

One well-established fact concerning cognitive and language development in individuals with Down syndrome is that working memory is particularly poor, with auditory working memory worse than visual working memory. Working memory serves the functions of control, regulation, and active maintenance of information and is critical in daily complex cognitive activities. Thus, there is a strong need to find effective and practical interventions targeted at improving working memory in individuals with Down syndrome. The present paper reviews research on rehearsal training and concludes that it can be used successfully to increase working memory in individuals with Down syndrome. However, there are still questions about whether auditory working memory can be improved reliably, whether improvement can be maintained over the long term, and whether improvement exists beyond any effect of increased attention. We describe our in-progress study which addresses these concerns.

Short-term memory in Down syndrome: Applying the working memory model

Christopher Jarrold, and Alan Baddeley (2001)

This paper is divided into three sections. The first reviews the evidence for a verbal short-term memory deficit in Down syndrome. Existing research suggests that short-term memory for verbal information tends to be impaired in Down syndrome, in contrast to short-term memory for visual and spatial material. In addition, problems of hearing or speech do not appear to be a major cause of difficulties on tests of verbal short-term memory. This suggests that Down syndrome is associated with a specific memory problem, which we link to a potential deficit in the functioning of the 'phonological loop' of Baddeley's (1986) model of working memory. The second section considers the implications of a phonological loop problem. Because a reasonable amount is known about the normal functioning of the phonological loop, and of its role in language acquisition in typical development, we can make firm predictions as to the likely nature of the short-term memory problem in Down syndrome, and its consequences for language learning. However, we note that the existing evidence from studies with individuals with Down syndrome does not fit well with these predictions. This leads to the third section of the paper, in which we consider key questions to be addressed in future research. We suggest that there are two questions to be answered, which follow directly from the contradictory results outlined in the previous section. These are 'What is the precise nature of the verbal short-term memory deficit in Down syndrome?', and 'What are the consequences of this deficit for learning?'. We discuss ways in which these questions might be addressed in future work.

Memory and neuropsychology in Down syndrome

Christopher Jarrold, Lynn Nadel, and Stefano Vicari (2008)

This paper outlines the strengths and weaknesses in both short-term and long-term memory in Down syndrome, and the implications of these patterns for both other aspects of cognitive development and underlying neural pathology. There is clear evidence that Down syndrome is associated with particularly poor verbal short-term memory performance, and a deficit in verbal short-term memory would be expected to negatively affect aspects of language acquisition, particularly vocabulary development. Individuals with Down syndrome also show impaired explicit long-term memory for verbal information, and may also have particular problems in explicit long-term memory for visual-object associations. However, implicit memory appears to be less affected in Down syndrome, and may therefore provide an important basis for intervention approaches. These findings are consistent with the suggestion of dysfunction within the hippocampal system in Down syndrome, and problems in verbal memory may be linked to impaired functioning of pre-frontal brain regions.

Motor skills and physical education

Physical education for the person with Down syndrome: More than playing games?

Anne Jobling (1994)

Children and adolescents with Down syndrome have a range of physical problems and difficulties that may affect their motor development. Therefore it is important that programming which is directed towards facilitating motor skill development reflect quality practices. This article presents five elements regarded as demonstrating 'quality' in physical education and some guidelines for programming. It is considered that physical education programs need to provide learning opportunities which assist the individual with Down syndrome to go beyond the playing of games to become a physically educated person.

What do we know about the movement abilities of children with Down syndrome?

Ben Sacks, and Sue Buckley (2003)

Many babies and young children with Down syndrome are late to reach the early motor milestones such as grasping, rolling, sitting, standing and walking. There is wide variability in progress, with some reaching these milestones as early as typically developing infants and some being particularly slow in achieving them. Most parents are advised that physiotherapy will help, but do we actually know the reasons for this slower progress that will provide guidelines for effective therapy? Do we know if physiotherapy actually makes any difference to progress and, if so, how? Is the motor progress of children with Down syndrome just delayed (i.e. slower but otherwise the same as in other children) or is it actually different - due to physical differences in their muscles, ligaments or central nervous systems?

Number skills and maths

Teaching numeracy

Sue Buckley (2007)

Understanding number concepts and basic mathematical skills is important for many everyday activities in modern societies. Little is understood about the numeracy abilities of people with Down syndrome. At present, it appears that numeracy is an area of relative difficulty and that progress with more complex mathematical understanding is slow. However, some teaching approaches that seek to utilise certain relative strengths to communicate number concepts seem to be useful in practice. Further research is needed to define the precise difficulties experienced by children with Down syndrome and to evaluate teaching strategies.

Teaching number skills and concepts with Numicon materials

Tony Wing, and Romey Tacon (2007)

This paper discusses the use of Numicon number teaching materials with children with Down syndrome. The theory underlying the design of the materials is discussed, the teaching approach and methodology are described and evidence supporting effectiveness is outlined.

Number and arithmetic skills in children with Down syndrome

Sophie Brigstocke, Charles Hulme, and Joanna Nye (2008)

It is clear that arithmetic and number skills are areas of particular difficulty for individuals with Down syndrome. Studies of arithmetic development in typically developing children suggest that a pre-verbal “number sense” system and counting skills provide two critical foundations for the development of arithmetic. Studies of children with Down syndrome suggest that the development of both these foundational skills present difficulties for them, though these conclusions are based on relatively small samples of children. It would seem that further studies of arithmetic and number skills in children with Down syndrome, involving larger samples of children and broader ranges of measures, are badly needed.

Prenatal screening and testing

Wrongful deaths and rightful lives - screening for Down syndrome

Frank Buckley, and Sue Buckley

Prenatal screening for Down syndrome affects millions of pregnancies every year worldwide. The vast majority of screen-positive results are false, yet encourage invasive diagnostic procedures that pose additional risks to unborn babies. As a direct consequence many babies who do not have Down syndrome are lost. We estimate that current screening practice in England and Wales reduces annual live births of babies with Down syndrome by around 660 and leads to the losses of 400 babies without Down syndrome. Although prenatal diagnoses are becoming more frequent, more babies with Down syndrome are being born (up 25% over 15 years). Considerable attention has been given to studying the performance of competing screening techniques, yet relatively little attention has been given to the consequences for the psychological and physical wellbeing of all parents and their babies. Meanwhile, quality of life for people with Down syndrome continues to improve. In many countries, people with Down syndrome are living longer and achieving more than ever before. The authors urge policymakers to note that the live birth prevalence of Down syndrome continues to rise and that average life expectancy is now approaching 60 years. Accordingly, research and practice priorities should shift from prevention to improving care, education and support for a growing and ageing population. We suggest that policies permitting genetic screening for mental or physical abilities should be reviewed through wide public debate before new prenatal diagnosis and genome sequencing technologies become more readily available.

Reading and literacy

Teaching children with Down syndrome to read

Sue Buckley, and Gillian Bird (1993)

This article describes the development of our interest and expertise in the teaching of reading to children with Down syndrome since 1980 and the insights that we have gained into the children's language learning difficulties while teaching them to read. The readers' attention is drawn to the links between spoken language skills and reading skills and the differences between the strategies an ordinary five year old can use when learning to read and those available to a child or teenager with Down syndrome. The methods of introducing and developing reading skills are outlined, emphasising the principles on which they are based. The same methods are advocated whatever the age of the child at the outset. The benefits of even limited reading instruction for developing good spoken language are emphasised.

The development of literacy skills in children with Down syndrome: Implications for intervention

Margaret Snowling, Hannah Nash, and Lisa Henderson (2008)

The cognitive profile observed in Down syndrome is typically uneven with stronger visual than verbal skills, receptive vocabulary stronger than expressive language and grammatical skills, and often strengths in reading abilities. However, there is considerable variation across the population of children with Down syndrome. We begin by outlining some of the methodological issues that surround research on literacy development in Down syndrome before surveying what is known about literacy and literacy-related skills. We proceed to review interventions to promote reading in school-age children with Down syndrome and conclude with directions for future research.

Reading interventions for children with Down syndrome

Kelly Burgoyne (2009)

Though many individuals with Down syndrome are now able to achieve useful levels of literacy skills, it is still not clear how best to support the development of reading skills with this group. Research with typically developing children has identified successful methods of teaching reading, and recent work has begun to evaluate these methods for individuals with Down syndrome. The aim of this paper is to review this work, and to highlight areas in need of further research.

Sexuality

Issues of sexuality in Down syndrome

Don Van Dyke, Dianne McBrien, and Andrea Sherbondy (1995)

As human beings, individuals with Down syndrome have the right to emotionally satisfying and culturally appropriate sexual expression. As patients, they have the right to routine reproductive health care provided to the general population. Cognitive and language disabilities may predispose this population to unwanted pregnancy, sexually transmitted disease, and sexual exploitation. Sex education tailored to cognitive level, learning style, and living arrangements is essential to the education of children and young adults with Down syndrome.

Sexuality and Relationships Education for people with Down syndrome

Amanda Wood (2004)

All children and young people should be entitled to good quality sex and relationships education that will allow them to develop the qualities, attitudes, skills and knowledge to develop into healthy, happy and fulfilled adults.

Speech and language

From theory to practice in child language development

John Clibbens (1993)

This paper addresses current theoretical perspectives on child language development, and their implications for intervention. It is argued that language is a complex system consisting of a number of distinct, interacting, components, and that no single explanation for its development is likely to be adequate: the evidence suggests, rather, that different factors predominate in the development of different parts of the system. Some recent work with deaf children - on the development of sign phonology, and on maternal strategies for presenting signs to their children in context - is then discussed together with its implications for the use of signs with other groups, focusing particularly on the use of signed input with children with Down syndrome.

Improving the speech and language skills of children and teenagers with Down syndrome

Sue Buckley (1999)

This article reviews the research on speech and language in children and adolescents with Down syndrome from a practical point of view. It identifies the typical profile of speech and language development, emphasising the variability in development for different individuals, and describes the main reasons for this profile as far as they are understood at the present time. Drawing on this information and what is known about the processes of speech and language development in typically developing children, the paper sets out principles to guide parents, teachers and speech and language therapists as they interact with the children in their care. The main difficulties experienced by children with Down syndrome can be grouped under several headings; difficulties in hearing, auditory perception and processing, difficulties with clear speech production and greater difficulty in learning grammar than vocabulary. These, in turn, are likely to effect the quality and quantity of the language learning opportunities available to the children. Babies and children with Down syndrome need more, high quality learning opportunities in order for them to learn and remember the meanings of words and sentences, yet they get less opportunities because of their slower progress. The author argues that most children and young people with Down syndrome could be helped to improve their speech and language skills if we simply applied the knowledge that we now have more effectively.

Down syndrome phonology: Developmental patterns and intervention strategies

Carol Stoel-Gammon (2001)

This paper describes phonological development in children with Down syndrome paying particular attention to underlying deficits and intervention strategies. The first section provides an overview of factors believed to influence phonological development in this population. The second section describes four aspects of Down syndrome phonology: (1) the prelinguistic stage; (2) the transition to speech; (3) the phonology of the single words; and (4) phonological characteristics of conversational speech with a focus on intelligibility. Intervention strategies associated with each aspect are also presented. Children with Down syndrome are slow to acquire the phonological system of their mother tongue. In spite of normal or nearly normal prelinguistic development, these children are delayed in the use of meaningful speech and slow to acquire a productive vocabulary. In some cases their speech remains unintelligible throughout childhood and adolescence, making it difficult to communicate with those around them. The purpose of this paper is to summarize research on phonological development of children with Down syndrome with attention to underlying deficits and to the speech characteristics of prelinguistic vocalisations as well as words and conversation. Current views on intervention are also described.

Language, cognition, and short-term memory in individuals with Down syndrome

Robin Chapman, and Linda Hesketh (2001)

The developmentally emerging phenotype of language and cognition in individuals with Down syndrome is summarized on the basis of the project's prior work. Identified are a) the emerging divergence of expressive and receptive language, b) the emerging divergence of lexical and syntactic knowledge in each process, and c) the emerging divergence within cognitive skills of auditory short-term memory and visuospatial short-term memory from other visuospatial skills. Expressive syntax and auditory short-term memory are identified as areas of particular difficulty. Evidence for the continued acquisition of language skills in adolescence is presented. The role of the two components of working memory, auditory and visual, in language development is investigated in studies of narrative and longitudinal change in language skills. Predictors of individual differences during six years of language development are evaluated through hierarchical linear modelling. Chronological age, visuospatial short-term memory, and auditory-short term memory are identified as key predictors of performance at study entry, but not individual change over time, for expressive syntax. The same predictors account for variation in comprehension skill at study outset; and change over the six years can be predicted by chronological age and the change in visuospatial short-term memory skills. (Research funded by US National Institutes of Health Grant R01-HD23352 with contributions from the National Down Syndrome Society.)

Signing and Lexical Development in Children with Down Syndrome

John Clibbens (2001)

Language development in children with Down syndrome is delayed, on average, relative to general cognitive, motor and social development, and there is also evidence for specific delays in morphology and syntax, with many adults showing persistent problems in these areas. It appears that the combined use of signed and spoken input can boost early language development significantly, this evidence coming initially from single case-studies, and more recently from larger scale controlled studies. Research with typically developing hearing and deaf children, as well as children with Down syndrome, has demonstrated the importance of establishing joint attention for vocabulary development. Furthermore, studies carried out with children with Down syndrome indicate that reducing attentional demands may be especially important in scaffolding language development in this group. The use of signing strategies which have been found to facilitate language development in deaf children when signing to children with Down syndrome is discussed, as is the need for further research on this topic and on the importance of joint attention for the use of other augmentative and alternative communication systems, such as graphic symbol and picture systems.

Can children with Down syndrome learn more than one language?

Sue Buckley

Does learning a second language affect progress in a first language? Some new evidence is beginning to indicate that children with Down syndrome can pick up a second language like other children, with no negative effect on their first language.

Speech and language therapy for children with Down syndrome

Sue Buckley, and Patricia Le Prèvost (2002)

The provision of speech and language therapy services for children with Down syndrome is a controversial issue. Families receive different services depending on where they live, and the knowledge and interest of local speech and language therapists in the specific needs of children with Down syndrome. This article is an attempt to provide guidelines for speech and language therapists, based on the best evidence of the children's speech and language needs currently available. It is a summary of the key facts about their speech and language profile and needs, followed by recommendations for service provision.

The development of oral motor control and language

Katie Alcock (2006)

Motor control has long been associated with language skill, in deficits, both acquired and developmental, and in typical development. Most evidence comes from limb praxis however; the link between oral motor control and speech and language has been neglected, despite the fact that most language users talk with their mouths. Oral motor control is affected in a variety of developmental disorders, including Down syndrome. However, its development is poorly understood. We investigated oral motor control in three groups: adults with acquired aphasia, individuals with developmental dysphasia, and typically developing children. In individuals with speech and language difficulties, oral motor control was impaired. More complex movements and sets of movements were even harder for individuals with language impairments. In typically developing children (21-24 months), oral motor control was found to be related to language skills. In both studies, a closer relationship was found between language and complex oral movements than simple oral movements. This relationship remained when the effect of overall cognitive ability was removed. Children who were poor at oral movements were not good at language, although children who were good at oral movements could fall anywhere on the distribution of language abilities. Oral motor skills may be a necessary precursor for language skills.

Speech intelligibility and childhood verbal apraxia in children with Down syndrome

Libby Kumin (2006)

Many children with Down syndrome have difficulty with speech intelligibility. The present study used a parent survey to learn more about a specific factor that affects speech intelligibility, i.e. childhood verbal apraxia. One of the factors that affects speech intelligibility for children with Down syndrome is difficulty with voluntarily programming, combining, organising, and sequencing the movements necessary for speech. Historically, this difficulty, childhood verbal apraxia, has not been identified or treated in children with Down syndrome but recent research has documented that symptoms of childhood verbal apraxia can be found in children with Down syndrome. The survey examined whether and to what extent childhood verbal apraxia is currently being identified and treated in children with Down syndrome. The survey then asked parents to identify certain speech characteristics that occur always, frequently, sometimes or never in their child's everyday speech. There were 1620 surveys received. Survey results indicated that approximately 15% of the parents responding to the survey had been told that their child has childhood verbal apraxia. Examination of the everyday speech characteristics identified by the parents indicated that many more children are showing clinical symptoms of childhood verbal apraxia although they have not been given that diagnosis. The most common characteristics displayed by the subjects included decreased intelligibility with increased length of utterance, inconsistency of speech errors, difficulty sequencing oral movements and sounds, and a pattern of receptive language superior to expressive language. The survey also examined the impact of childhood verbal apraxia on speech intelligibility. Results indicated that children with Down syndrome who have clinical symptoms of childhood verbal apraxia have more difficulty with speech intelligibility, i.e. there was a significant correlation between childhood verbal apraxia and parental intelligibility ratings. Children with apraxia often do not begin to speak until after age 5. There was a significant correlation between speech intelligibility and age at which the child began to speak, i.e. children who began to speak after age 5 had lower parental intelligibility ratings. A diagnosis of difficulty with oral motor skills is more frequently given than a diagnosis of apraxia; 60.2% of parents had been given this diagnosis. According to survey results, it is rare (2%) for a diagnosis of childhood verbal apraxia to be made without a diagnosis of difficulty with oral motor skills.

Pragmatic development

Leonard Abbeduto (2008)

I review research on the pragmatic, or social, aspects of language development in children, adolescents, and young adults with Down syndrome. Virtually all facets of pragmatic development have been found to be delayed in Down syndrome, but some facets are especially delayed relative to cognitive development. Areas of strength in pragmatics (e.g., narration), however, have also been identified. Strengths and weaknesses in pragmatics relative to other conditions associated with intellectual disabilities (e.g., fragile X syndrome) have been found as well. Next steps for research are briefly outlined.

Speech production in people with Down syndrome

Monica Bray (2008)

There is a well developed literature on the development of vocabulary and grammar in children with Down syndrome but limited information in the area of speech production. The spoken language of people with Down syndrome often leads to a lack of intelligibility which does not necessarily diminish with age, despite slow but steady development of phonology. This paper explores some of the elements in speech production which may contribute to the listeners’ perception of reduced intelligibility in the speech of people with Down syndrome.

Sleep

Overcoming sleep problems for children with Down syndrome

Amanda Wood, and Ben Sacks (2004)

This article reviews the incidence of sleep problems in children with Down syndrome and introduces readers to the link between behavioural problems and the quality of children’s sleep. Practical suggestions about how parents can improve the bedtime routine and their responses to night-time awakenings are provided. The article concludes with a brief review of evidence that supports the use of behaviour management in order to decrease learnt sleep problems. The final page provides photocopiable resources to help parents to chart each stage of the process of overcoming unacceptable bedtime behaviours and sleep problems.

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