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Introduction

In recent years, the importance of reading instruction for children and adults with Down syndrome has been increasingly recognised.^[1-11] While research evidence is still limited, it does support the view that many individuals with Down syndrome can learn to read and write to a level that will be a useful independent skill in their everyday lives, improving their ability to participate in formal education and learning, increasing employment opportunities and giving them access to books and newspapers.^[3,10-14] Research also supports the view that all children with Down syndrome will benefit from being read to and from being in reading instruction from an early age as these activities will improve their spoken language and memory skills, even if they do not become independent readers themselves.^[15,16]

This review draws on research into the reading development of typically developing children and factors which influence their progress^[17-23,24] as well as the research with individuals with Down syndrome, in order to identify effective teaching strategies. There is a small amount of published literature which documents the literacy achievements of individuals with Down syndrome and this is included to provide some indication of rates of progress and the relationships between attainments in reading and other cognitive skills.^{[12,13,25-30]} A number of these studies indicate that reading ability is often a strength for children with Down syndrome and better than might be predicted on the basis of their language skills or general mental age measures.

A number of studies also indicate that literacy achievements have improved as the children's educational opportunities have improved, and that children being educated in mainstream inclusive settings have higher levels of literacy skills than children of similar ability who are being educated in special education settings.^[11,16,28] While those children who are introduced to reading in their preschool years show the highest levels of achievement,^[11] a recent study has demonstrated that teenagers and young adults can continue to develop their reading abilities if given appropriate instruction.^[10]

The importance of reading

Reading is a fundamental life skill

Being able to read is a skill that most people take for granted and it is difficult for them to imagine what life is like for someone who cannot read. Print is all around us in our daily lives, from shop names, adverts on hoardings, street names, sign posts, departure boards in stations and airports to names and instructions on food packets, videotapes, games and equipment and names and addresses in telephone directories. We take for granted the ability to leave a note, write a card, write a shopping list, complete a form and look up TV programmes in the newspaper or magazine. Most of us also take for granted our ability to enjoy a novel or read a book for information. These different reading activities require different levels of reading ability.

A 'reading age' of eight to nine years, that is the average level of reading skill of a typical eight to nine year old, is adequate to read many daily newspapers and books and to write letters. While some individuals with Down syndrome may not achieve this level of reading, many will if they are given the opportunity to learn^[10,11] If they only achieve a limited level of socially useful literacy, this will be a benefit. The only way to find out what level of literacy each child is able to achieve is to give him or her every opportunity to learn with well planned teaching activities from preschool years to adult life.

For children and adults whose literacy skills are limited it is still important to value them and make them functional, as Christopher Kliewer argues eloquently in an article entitled Citizenship in the literate community and in his book Schooling children with Down syndrome.^[31,32] Kliewer describes teachers who made sensitive and intelligent use of the limited sight-word reading skills of some pupils with Down syndrome in their classrooms, while others dismissed this level of skill as 'not real reading'.

Reading interacts with language and memory skills

While being able to read and to write is a practical skill to be used in all the ways described above, reading ability also influences the ongoing development of language and memory skills. Research on the links between typically developing children's reading progress and other aspects of their cognitive development suggest reciprocal interactions in the following ways.

Children vary in their rates of developmental progress in their preschool years and when they start fulltime school, in any class of 30 five year olds, some children will have more language knowledge and better short-term memory skills than others. Research studies have shown that the more language knowledge and the better the phonological awareness (ability to identify the sounds that make up words) and working memory skills (short term visual and verbal memory spans) that children bring to the task of learning to read, the faster they will learn to read in the first year of reading instruction. In the second year in school, reading success appears to develop language, working memory and phonological awareness skills.^[33,34] Over the second school year, children who have better reading skills show greater gains in language learning and in increased short-term memory spans than children who are not progressing so fast with reading. Progress in reading, speech and language, and memory are interlinked and can support each other in a reciprocal way.

Being able to read opens up access to books and knowledge from print via computer programmes and newspapers and the main vocabulary learning time for typically developing children is between the ages of about 7 and 16. It has been estimated that children come into school at about 5 years with vocabularies of some 2000 words but between 7 and 16 years they typically learning on average some 3000 new words every year.^[35] In the UK, seven year olds are beginning to achieve independent literacy skills after 2-3 years of instruction in school. Reading and writing also teach children correct grammar and to consolidate their grammatical knowledge, as they identify the grammatical markers for tenses and plurals, for example.^[36,37]

Margaret Farrell, an experienced Australian teacher^[7] has also pointed out that reading instruction and the primary school curriculum includes ''the intentional development of social concepts, general knowledge, problem solving and thinking skills'' and that ''language and general cognitive development are the most serious casualties''^[7:p.280] when children are denied access to typical reading instruction and inclusion in this primary curriculum.

Evidence of the same benefits for children with Down syndrome

Preschool children

Individual case studies from the authors' work and others, also provide evidence of the beneficial effect of reading on speech and language skills.^[2-4,38-40] For the young, preschool age children, case study records suggest that early reading activities from the age of 2 to 3 years encourage progress to longer utterances and improved grammar in speech. They also suggest that reading improves articulation and speech intelligibility. For most children with Down syndrome, there is a well-documented lag between language comprehension and expressive speech skills. This means that children with Down syndrome understand more than they can say, probably due to a variety of difficulties, which may include problems with word retrieval, sentence structuring and speech-motor control.

The limited development of working memory for children with Down syndrome^[41-43] may also be implicated in their spoken language difficulties, limiting the amount that the children can organise and say clearly in a sentence, so that reading may provide the opportunity to practise saying sentences that the child is unable to generate spontaneously even though he or she understands them. When children are reading aloud, the sentence is organised for them and the print is available without having to remember it, so the demands on the working memory system are reduced and its capacity can be used to plan and articulate each word more clearly. Many early readers read and write at an age-appropriate level in primary school (see examples later in this module).

A mother's view of the benefits of early reading from a letter to the author

"I started to teach Emma to read after hearing you talk in Bristol seven years ago. She was then two years and four months of age. Emma is now nine years old and an able and avid reader. She attends our large, local, mainstream primary school and holds her own well in second year junior class. She seems to develop in leaps and bounds. Being able to read has done so much for her.

"It helped her speech. For example, when she began to read at age two, she spoke understandably but imperfectly as she left out definite and indefinite articles, prepositions, etc. The change came when she was able to sentence build in flashcards. Today her speech is mature and her teacher commented at the last parents evening that the extent of her vocabulary and her turn of phrase would leave many in the class standing.

"It helped in the way other children regarded Emma and not least her own self-esteem. They knew that in reading she was among the best in the class. This apparently less able child wasn't so less able after all!

"Emma is now an independent reader and books give her so much. She wakes early and reads for at least one hour every morning. She makes her own choice of book but everything she reads fulfils her - she chuckles when she reads 'The Twits' and cries over 'Heidi'. These are her two favourite books at the moment and she reads them over and over again. Equally she will read poems or her atlas, history book, nature book etc. from which she teaches herself. She loves her Bible. She is very proud when her five year old sister carries the newspaper to her and asks ''What time is...on television?'' she is always able to tell her and I feel that Sarah, who I feel senses rather than knows of Emma's differences, is thrilled with the sense of her big sister having the 'big sister' image for once."

School children

Data from a small longitudinal study^[15] indicates the same benefits of reading for language and memory skills for children with Down syndrome as research reports for typically developing children. The assessment data in Table 1 shows that over a four-year period, the primary school children with Down syndrome who were receiving typical reading instruction gained considerably when compared with children who were not receiving the same level of reading instruction. They were approximately 2 years ahead in language comprehension for both vocabulary and grammar when the raw scores are translated to age related ones (see Table 2). The gains in short-term auditory and visual memory spans also represent about a 2 year advantage as in typical development digit spans increase from 3 at about 5 years to 7 at about 15 years. The two groups had been at the same level on both language and memory measures 4 years earlier.

This data was collected during a memory training study and the longitudinal data shown in Table 3 indicates that the two groups benefited equally from the training, but for those not in reading instruction, the memory gains slowly disappeared. All but one of the readers were in mainstream classrooms, so part of the gains could also be due to a more stimulating language environment. However, when the researchers looked at the data collected at the start of the memory study from the large group of children who were in special schools (see Table 4), those who could score on the reading assessments show the same gains for language and memory despite being in poor spoken language environments (mainly in schools for children with significant learning difficulties).

Teenagers

The hypothesis that print influences speech and language development is also supported by the results of work with adolescents with Down syndrome.^[44,45] In a study designed to improve the spoken sentences structures of a group of 12 teenagers, teaching which used print to support the learning was more effective in teaching correct production over six different sentence structures than teaching with speech practice only. Almost all of the teenagers did better in the reading condition,^[44] but there were large individual differences. The teenagers who gained the most from the print were actually those with no independent reading ability (as measured by a reading test) and the smallest verbal short-term memory spans at the start of the study. At the end of the training year, the teenagers demonstrated a significant gain in comprehension of grammar, compared to a previous baseline year of no intervention beyond ordinary school practice, and a significant increase in the length of the sentences that they used in everyday conversation.^[45] The teenagers who could already read at the start of this study, had larger verbal memory spans than the non-readers, and they could learn the new sentence structures from listening to them or reading, though they also did better with reading to help them. These authors would argue that the readers at the start of this study had better verbal memory spans as teenagers as a result of being taught to read in their primary school years, as reading progress has been shown to influence working memory development in typically developing children.^[33]

Further data to support the view that being involved in reading and writing activities, even with maximum support from a classroom assistant, will improve the spoken language skills of young people with Down syndrome comes from a recently completed study by the author and colleagues.^[16]

Table 5 shows that the teenagers in inclusive education placements were, on average, more than 2 years ahead of their peers of similar ability in special education in spoken language skills and more than 3 years ahead on reading and writing measures. While some of the spoken language gain could be the result of being in a more stimulating and normal spoken language environment, the authors believe that reading and writing on a daily basis has also been important. All the teenagers in inclusive placements have been full members of an age appropriate class, with a learning support assistant to help them to access the curriculum and to record their work in writing. Even the teenagers in the group who cannot score on a test of independent reading ability have had the benefit of being involved in reading instruction, phonics and spelling work, putting their ideas on paper and in reading aloud grammatically correct sentences when reading their work with support.

The experience of reading

One of the major benefits of being able to read is being able to read stories, from children's books to the masterpieces of literature. Stories of all sorts engage our imaginations and provide unlimited pleasure for most of us. If children cannot read well enough to read for pleasure they should still be able to enjoy involvement in stories by being read to, by being involved in plays and by being involved in story making and story telling with friends and groups in class, however delayed their development. This point has been well argued by Nicola Grove in a book entitled Literacy for All, which contains a wealth of ideas for involving all children in the world of stories, plays and poems including the great classics such as those by Shakespeare.^[46]

Reading stories daily to children from infancy right through childhood will help them to learn to read. Children who are read to know that books are fun and full of entertainment as well as information. Children who are read to will have larger vocabularies as they will learn new words and concepts from books. Children who are read to will know that the words on the page have meaning and tell the story. One of the most important ways in which parents of children and teenagers with Down syndrome can help them to be ready to read, and interested in reading, is to read to them and talk to them about the stories they read.

One of the books that had an influence on the early work of the authors is called Cushla and her books^[47] and it describes how the family of a seriously disabled child realised that she was able to read by the way she responded to being read to over a number of years. Cushla had learned the stories 'by heart' from the repetition of being read the same story over and over and went on from this 'learning by rote' to relate her learned stories to the printed texts and to become an independent reader. She was supported by a family who immersed her in the fun of stories. Note that they did not treat her early 'rote' skill as 'not real reading' but as the first step towards being a reader.

Summary

There is evidence to support the view that all children with Down syndrome will benefit from being fully involved in the pleasures of literacy and the imaginative world of stories, regardless of their independent reading abilities. There is also evidence to support the view that all children with Down syndrome should be in active and interesting literacy instruction from their pre-school years as it will help them to overcome some of their working memory and spoken language learning difficulties. This benefit will come from being supported in reading and writing, so that involvement in literacy should not be restricted to the independent readers and the value of supporting reading and writing on a daily basis for children who are not becoming independent readers should be recognised.