Language Learning in Down Syndrome: The speech and language profile

1. Language Learning in Down Syndrome: The speech and language profile Robin S. Chapman, Ph.D. Principal Investigator Waisman Center University of Wisconsin-Madison,USA

2. Acknowledgments • Research supported by NIH grant R01-HD23353 with additional support from the National Down Syndrome Society. We thank the participants and their parents.

3. Dr. Donna M. Beaudreau Cynthia Bridge Katherine Gigstead Dr. Linda J. Hesketh Dr. Maura Johnson Dr. Mina Johnson-Glenberg Dr. Elizabeth Kay-Raining Bird Dr. Doris J. Kistler Dr. Andrea McDuffie Dr. Sally Miles Dr. Giuliana Miolo Dr. Scott E. Schwartz Dr. Hye-Kyeung Seung Dr. Elin Thordardottir Heidi Sindberg Dr. Nadia Teitler Dr. Laura Wagner Thanks to Colleagues

4. Outline • Developmental Emergence of Speech- Language Phenotype • Predictors of Individual Difference • Implications for Intervention • Evidence for Specificity of Phenotype • New Findings in Narrative

5. Modular vs. Interactionist Theory(Chapman, 2000) • Modular view of language predicts a specific language deficit in both comprehension and production • Interactionist view predicts multiple dissociations, including comprehension and production, arising developmentally

6. Person Sounds Heard Babble Object Action Developmental Emergence of Language in Down Syndrome: Evidence for Interactionist Position (Chapman, 2004)I. SOCIAL INTERACTION *slower emergence of emotional affect recognition in DS (spollak@wisc.edu) and frequent hearing impairment

7. Developmental Emergence of Language II. OBJECT INTERACTION Person Sounds Heard Babble Object Action *More prolonged attention to people than objects in DS

8. Person Sounds Heard Babble Object Action Developmental Emergence of LanguageIII. CANONICAL BABBLING * * Slower Development of Canonical Babbling, & Frequent Hearing Impairment, in DS

9. Person Sounds Heard Babble Object Action Developmental Emergence of Language IV. JOINT ATTENTION * * Slower Babbling Development & Affective Comprehension in Down Syndrome

10. Person Sounds Heard Words Object Action Developmental Emergence of Language V. COMPREHENSION OF WORDS, COMMUNICATIVE INTENT * * * Slower Development of Communicative Requesting in Down Syndrome

11. Person Sounds Heard Words Object Action Developmental Emergence of LanguageVI. USE OF WORDS * * * Slower Development of Expressive Vocabulary in Down Syndrome, including Signs

12. Person Sounds Heard Words Object Action Developmental Emergence of LanguageVII. SIMPLE SENTENCES * * * Slower Development of Sentence Production in Down Syndrome *

13. Developmental Emergence of LanguageVIII. COMPLEX SENTENCES Person Sounds Heard * * Words Object * Slower Development of Complex Syntax Production for Complex Events in Down Syndrome * Action

14. The phenotype in infancy • Learning delays accelerate at ages 2-4 • Slower transition from babbling to speech; poorer intelligibility • Delays relative to cognition in nonverbal requesting, rate of expressive vocabulary development, rate of increase in sentence length • Comprehension comparable to cognition

15. The phenotype in childhood • Selective deficits in verbal short-term memory • Longer period of phonological errors and more variability; poorer intelligibility • Expressive language delay relative to comprehension and cognition • Grammatical morphology deficit relative to sentence length in production

16. The phenotype in adolescence • Deficits in both working verbal memory and visual short-term memory • Intelligibility problems; more variability in fundamental frequency, rate, stress placement • Expressive language deficit greatest in grammatical morphemes, least in vocabulary; MLU shows longitudinal gain • Sentence comprehension begins to lag cognition, and shows longitudinal loss; vocabulary comprehension a strength on PPVT

17. Predicted Performance for Ages 7.5, 12.5 and 17.5

18. Predicted Performance when Auditory Short-term Memory Intercept is at the 25%ile, Mean, or 75%ile

19. Predicted Performance when Visual Short-term Memory Intercept is at the 25%ile, Mean, or 75%ile

20. Predicted Performance when Syntax Comprehension Intercept is at the 25%ile, Mean or 75%ile

21. Predicted Performance when Syntax Comprehension slope is at the 25%ile, Mean or 75%ile

22. Predictors of individual difference: • For Syntax Comprehension: age, auditory short-term memory, visual short-term memory • For Syntax Production (MLU): syntax comprehension • For Grammatical morpheme comprehension and fast mapping of words: hearing

23. Implications • Evidence is consistent with an interactionist account of language learning, • Multipletargets for early intervention -object play and exploration schemes -requesting -babbling/speech motor skills -intelligible communication (signing) -affective comprehension -Hearing!

24. Implications, continued • Shifting intervention targets with development • Need for continuing language intervention in adolescence, including complex syntax & literacy • Need to target BOTH comprehension and production, at different levels • Importance of hearing status for intelligibility & grammatical morpheme comprehension

25. Evidence for specificity of phenotype in adolescence • Adolescents with Down syndrome (n=20) compared to individuals with Cognitive Impairment of unknown origin (n=16) • Matched on age (12-18 yrs; X=16) and nonverbal visual cognition (X=5.1 & 5.5 yrs) • Language Samples: interview and wordless picturebook narratives • Language Comprehension Tests: PPVT-3 & TACL-3 • Working memory measures: Digit Span (K-ABC), Nonword Repetition Test, Visual short-term memory (no differences; greater variability in CI)

26. Working Memory (no signif. Differences) • Visual short-term memory DS: 4.65 (1.19) CI: 5.23 (2.29) • Phonological working memory • Digit span DS: 4.38 (1.68) CI: 5.67 (2.36) • Nonword Repetition Test: DS: 55.75 (13.47) CI: 61.94 (24.45)

27. Table 1: Language Performance (*p<.05, multivariate tests of comprehension & production raw scores) DS (n=20) CI (n=16) Comprehension * PPVT vocab 6.09 (1.76) 8.10 (2.58) * TACL vocab 5.16 (1.47) 6.77 (1.83) * gram morph 4.86 (1.16) 6.47 (1.71) * syntax 5.15 (1.23) 6.34 (1.35) * Production * Interview MLU 5.09 (1.57) 5.56 (2.30) * Narrative MLU 6.35 (2.45) 7.63 (2.11)

28. Table 2. Down syndrome (n=20): Correlations • Measures Working Memory: Hearing • K-ABC NRT • TACL-vocab .39 .49* .37 • TACL-gram morphemes .39 .21 .51* • TACL-elab phrases .25 .58** .30 • PPVT .32 .28 .18 • MLU Narrative .57** .58** .18 • MLU Interview .59** .54* .33 • *p<.05 **p<.01

29. Table 3: Cognitive impairment of unknown origin (n=16): Correlations • Measures Working Memory: Nonverbal Cognition: • K-ABC NRT Bead Pattern • TACL-vocab .50*a .23 .50*a .30 a • TACL-gram morphemes .78**b .51*a .54* .51 a • TACL-elab phrases .73**a .47 .49 .35 a • PPVT .65** .35 .28 .51* • MLU Narrative .60*c .57* b .41 .45 b • MLU Interview .52 c .42 b .32 b .41 b • a n=15; b n=14; c n=13; *p<.05 **p<.01, 2-tailed

30. DS vs. CI Profiles • Comprehension deficits in DS in adolescence, compared to CI • Production deficit in DS in adolescence in interview only • Phonological working memory plays an important role in comprehension and production performance by both groups • NRT (long-term knowledge) is more important for the DS group • K-ABC digit span & visual short-term memory more important in the CI group • Additionally, hearing status affects DS grammatical morpheme comprehension and interview-MLU

31. Narratives: Recent Findings • Event content of DS narratives of a remembered wordless film = mental age controls despite shorter MLU (Boudreau & Chapman, 2000) • More plot line and theme elements expressed in DS narratives than in MLU comparison groups (Miles & Chapman,2002) • Picture support increases DS MLU to CI and syntax comprehension control levels (Seung & Chapman, 2002; Miles, Chapman, & Sindberg, in press)

32. Narratives: Recent findings, cont. 4. Repeated retellings of a wordless picture book lead to increases in plot line/theme expression and MLU (Miles, 2005) 5. Examiner scaffolding with questions yields higher MLU & improves expression of location setting information (Miles, Sindberg, Bridge & Chapman, 2002) and later number of different words used (Miles 2005) 6. Storytelling strategies (Miles, Chapman & Sindberg, 2004): -task approached as retelling of related events -evaluations and character speech used by both DS & syntax comprehension controls -Use of inference increased across sessions -More multiple utterances in DS group

33. Implications for Narrative Skill Learning • Practice helps everyone • Picture support especially helpful to DS • Communicative Scaffolding: encouragement, confirmation, questioning • Expect: increased independence, content, MLU, lexical diversity

34. References • Abbeduto, L. & Chapman, R.S. (2005). Language and communication skills in children with Down syndrome and Fragile x. In P. Fletcher & J. Miller, Eds., Trends in language acquisition research, vol 4: Developmental theory and language disorders. Amsterdam, NL: John Benjamins. • Boudreau, D. & Chapman, R.S. (2000).The relationship between event representation and linguistic skill in narratives of children and adolescents with Down syndrome. Journal of Speech, Language, and Hearing Research, 43, 1146-1159. • Chapman, R.S. (1999). Language and cognitive development in children and adolescents with Down syndrome. In J.F. Miller, L.A. Leavitt, and M. Leddy, Eds., Improving the communication of people with Down syndrome. (Pp. 41-60). Baltimore: Brookes. • Chapman, R.S. (2000). Childrens’ language learning: An interactionist perspective. Journal of Child Psychology and Psychiatry, 41, 33-54.

35. References, continued • Chapman, R.S. (2003). Language and communication in individuals with Down syndrome. (pp. 1-34) In L. Abbeduto (Ed.,), International Review of Research in Mental Retardation: Language and Communication, vol. 27. Academic Press. • Chapman, R.S., & Hesketh, L.J. (2000). Behavioral phenotype of individuals with Down syndrome. Mental Retardation and Developmental Disability Research Reviews, 6, 84-95. • Chapman, R.S. & Hesketh, L.J. (2001). Language, cognition, and short-term memory in individuals with Down syndrome. Down Syndrome Research and Practice, 7, 1-7. • Chapman, R.S., Hesketh, L.J., & Kistler, D. (2002). Predicting longitudinal change in language production and comprehension in individuals with Down syndrome: Hierarchical linear modeling. Journal of Speech, Language, and Hearing Research, 45, 902-915.

36. References, continued • Chapman, R.S., Seung, H-K., Schwartz, S.E. & Kay-Raining Bird, E. (2000). Predicting language development in children and adolescents with Down syndrome: The role of comprehension. Journal of Speech, Language, and Hearing Research, 43, 340-350. • Chapman, R.S., Sindberg, H., Bridge, C., Gigstead, K. & Hesketh, L.J. (In press). Effect of memory support and elicited production on fast mapping of new words by adolescents with Down syndrome. Journal of Speech, Language, & Hearing Research. • . Johnson-Glenberg, M.C. & Chapman, R.S. (2004). Predictors of parent-child language during novel task play: A comparison between children who are typically developing and individuals with Down syndrome. Journal of Intellectual Disabilities Research., 48, 225-38. • Kay-Raining Bird, E., Chapman, R.S., & Schwartz, S.E. (2004). Fast mapping of words and story recall by children with Down syndrome. Journal of Speech, Language, and Hearing Research, 47, 1286-1300.

37. References, continued • Miles, S. & Chapman, R.S. (2005). The relationship between adult scaffolding and narrative expression by adolescents with Down syndrome. Poster presented at the Symposium on Research in Child Language Disorders, Madison, WI, June 10. • Miles, S. & Chapman, R.S. (2002). Narrative content as described by individuals with Down syndrome and typically developing children. Journal of Speech, Language, and Hearing Research, 45, 175-189. • Miles, S., Sindberg, H., Bridge, C. & Chapman, R.S. ( in press). Discourse context and transcription method affect MLU in sampling language of adolescents and young adults with Down syndrome. Journal of Speech, Language, and Hearing Research. • Miolo, G., Chapman, R.S., & Sindberg, H. (2005). Sentence comprehension in adolescents with Down syndrome and typically developing children: Role of sentence voice, visual context, and auditory-verbal short-term memory. Journal of Speech, Language, and Hearing Research, 48, 172-188.

38. References, continued • Seung, H-K. & Chapman, R.S. (2000). Digit span in individuals with Down syndrome and typically developing children: Temporal aspects. Journal of Speech, Language, and Hearing Research, 43, 609-620.. • Seung, H.K., & Chapman, R. S. (2003). The effect of story presentation rates on story retelling by individuals with Down syndrome. Applied Psycholinguistics, 24, 601-618. • Seung, H-K. & Chapman, R.S. (2004) Sentence memory in individuals with Down syndrome and typically developing children. Journal of Intellectual Disability Research, 48, 160-171. • Thordardottir, E., Chapman, R., & Wagner, L. (2002). Complex sentence production by adolescents with Down syndrome. Applied Psycholinguistics, 24, 163-183.