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2013,
Short Report
Can individuals with Down syndrome improve their grammar?
Esther Moraleda Sepulveda, Miguel Lazaro Lopez-Villasenor and Elena Garayzabal Heinze
Education Department, Camilo Jose Cela University, Villanueva de la Canada, Madrid, Spain
Psychology Department, Castilla-La Mancha University, Talavera de la Reina, Spain
Linguistic Department, Autonoma University, Madrid, Spain
Introduction
Down syndrome is one of the most common genetic
neurodevelopmental disorders (e.g. Rondal and Perera
2006), occurring in approximately one in 700 new
births. It is produced by the presence of an extra chromosome or part chromosome, chromosomal translocation (a chromosomal fragment changing position) or
mosaicism (the coexistence of two or more cell populations with different genetic composition) on chromosome 21. People with Down syndrome have moderate to severe levels of intellectual disability and a
range of associated physical and medical conditions (as
heart diseases or visual problems), including language
impairment.
Address correspondence to: Esther Moraleda Sepulveda, Camilo Jose Cela University, C/ Castillo de Alarcon, 49, CP. 28692, Villanueva de la
Canada, Madrid, Spain; e-mail: emoraleda@ucjc.edu
International Journal of Language & Communication Disorders
C 2013 Royal College of Speech and Language Therapists
ISSN 1368-2822 print/ISSN 1460-6984 online
DOI: 10.1111/1460-6984.12002
344
Typical
development
Down
syndrome
1 month
610 months
1012 months
19 months
22.5 years
2 months
1215 months
1924 months
3140 months
34 years
34 years
67 years
Even though individuals with Down syndrome constitute a very heterogeneous collective, they present a
common profile of difficulties and skills conserved in
certain areas. Among the best developed capacities, one
finds vocabulary (frequently richly developed and varied in the early stages of language development; e.g.
Cardoso-Martins et al. 1985, Chapman et al. 1991,
Fowler 1990, Vicari et al. 2000, Rodrguez and Olmo
2010). Fowler (1990) states that lexical skills in children with Down syndrome are completely preserved
in relation to their mental age. However, although the
first words of children with Down syndrome are generally understood and produced in a manner appropriate to their mental age, some studies have shown that
as they develop their lexical skills improve at a slower
pace, which would be more evident in expressive than in
comprehensive language (Cardoso-Martins et al. 1985,
Galeote et al. 2012).
In contrast with lexical skills, the level of grammar
seems to be particularly affected in Down syndrome.
Morphosyntax is an area where major impairment is
very commonly observed (e.g. Moraleda 2011, Zampini
and DOdorico 2011) and there is a considerable delay
compared with their peers (table 1).
The development of morphosyntax in children with
Down syndrome has been studied exhaustively using
different techniques and experimental procedures, such
as the analysis of mean length of utterance (MLU). This
parameter measures the average number of morphemes,
whether grammatical or lexical, in a sentence spoken in
a natural context. This technique allows one to carry
out subsequently very rich quantitative and qualitative
analyses. The results obtained from examining MLU of
children with Down syndrome and subsequent analyses of transcriptions have revealed deficiencies in their
usage of auxiliary verbs, articles, prepositions and verb
inflections (e.g. Chapman et al. 1998, Eadie et al. 2002).
Children with Down syndrome produced few subordinate sentences and showed poor organization of agreements, with problems making logical connections between statements (e.g. Rondal and Perera 2006).
345
same for both groups of children during the research
period.
Instruments and materials
We used the full version of the Batera de Lenguaje Objetiva Criterial (BLOC-C; Puyuelo et al. 1998) for the
evaluation of language, both before and after the intervention. This test evaluates four different components
of language: morphology, syntax, semantics and pragmatics, and it is validated for Spanish-speaking children
between five and 14 years. It is composed of 190 items
to assess morphology, 180 items to assess syntax, 80
items to assess semantics and 130 items to assess pragmatic development. This test provides raw scores for
each module. The results of children can be interpreted
by therapists by comparing them with those of other
children with the same chronological or mental age.
This survey employed the raw data to perform statistics.
Procedure
Each participant was evaluated individually in the room
where speech and language therapy is carried out, and
therefore in a place the children already knew. In order to
control better for attention, we took care that there were
no toys or other objects in sight of the children. Because
the administration of the test allows for pauses after each
module, tasks were ended when some tiredness in the
children was noted. Two sessions were required for each
child in order to complete the evaluations.
Before embarking on the training programme, two
preparatory sessions were carried out with the three
speech and language therapists to implement the programme. These therapists were the childrens habitual
therapists. The programme ran for 30 sessions of 30
min duration for each participant, twice weekly over
3.5 months.
The training activities were structured such that two
sessions were set aside for each of the following aspects:
inflection for the number in nouns, inflection for gender in nouns, inflection of articles for both gender and
number, correct usage of pronouns, use of interrogative
particles, use of adverbs, and use of morphosyntactically
correct adjectives. Four sessions were used to work on
verb tenses; two sessions for the present, one for the past
and one for the future. A total of five sessions were dedicated to work on sentence structures and another five
sessions on dialogues see breakdown and examples of
intervention in appendix A.
Results
All statistics performed used a significant alpha level
of p 0.05. Comparing the results of both groups of
346
Morphology
Syntax
Semantics
Pragmatics
Control
Pre-
Post-
Difference
Pre-
Post-
Difference
12.9 (7.2)
5.5 (3.5)
23.5 (10.1)
1.0 (1.24)
28.6 (10)
20 (10.19)
47.80 (12)
4.4 (3.09)
15.7
14.5
24.3
3.4
11.9 (6.72)
8.9 (10.3)
33.5 (20.4)
2.0 (4.72)
17.4 (9.98)
11 (12.3)
34.9 (23.2)
2.8 (4.94)
5.5
2.1
1.4
0.8
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348
consonant. All words used in this activity follow these
rules, avoiding irregular plurals.
Materials
Picture cards showing an object. These pictures are not
specific to any given published material. Any visually
clear image can be used, from those already published
to ad-hoc designs, catalogues, etc.
Activities
1. Activity 1: Focuses on the forming the plural using
singular nouns. We used 20 pictures for naming in
this activity. The steps to be followed in this part of
the treatment were:
1.1. Naming the object presented. The therapist asks: What is this? A response is
obtained.
1.2. Introducing the required morpheme. Using the
response given in 1.1. the therapist continues:
Good. Here we have a car. And if there were
lots? Then we would have some . . . . The target
response is obtained. If the response is not the
expected one or is wrong the therapist provides
the correct response and repeats the sentence
so that the child ends the structure correctly.
Repeat as many times as necessary.
1.3. Generalization. We attempt to generalize the
structure worked on with the same pictures put
into different context situations, even carrying
out role play.
(1) Activity 2: This task is considerably more difficult
than activity 1, given that we use the determiner
itself to evoke the corresponding noun which coincides in gender and number. The activity is presented as a game. The therapist says to the child:
Now Im going to say a word and you have that
say another word that might go with the one I said.
Shall we try an example? If I say the . . . you
can say . . . ? If the child cant think of anything,
we offer examples to help: The (masculine) . . .
tree or the (masculine) . . . pencil. Now its your
turn.
Thirty determiners were used to form the structures.
This task becomes particularly attractive if it is made
into a race. Thus, we can give an incentive for responses,
saying that the child who says more words with the
correctly matched determiner will win. We draw smiley
faces when the responses are correct.
If incorrect responses are given we draw sad faces,
which often lead to self-correction. If this does not happen, we give them the correct response without asking
349
noun and the article). As in the previous tasks, if
the child says a sentence correctly, the therapist reinforces, and if the child is still not able to say a
complex sentence, the therapist continues by saying
the object plus a verb. In the last case, the therapist
says a full sentence and the child repeats it. The
therapist also repeats the sentence.