Working memory in children with Down syndrome
Irene Broadley, John MacDonald and Sue Buckley
A group of 4 to 18 year old children with Down syndrome (N=62) was presented with a set of working memory tasks, including auditory and visual serial recall of words; standardised digit span tasks and a rhyme judgement task. The serial recall tasks involved pictures of common objects or the spoken names of these objects and the children had to recall lists which varied on a number of parameters, including word length and the acoustic similarity of the object names. It was found that contrary to expectation the children's performance showed significant effects of word length and acoustic similarity, which are normally taken to indicate phonological storage and speech based rehearsal. These effects were found in both the auditory and visual presentation conditions and for the youngest age group. In addition to this evidence for speech based storage in short-term memory there was also evidence of the children utilising visual information in the serial recall tasks. The results are discussed in terms of working memory operation and the implications for memory remediation strategies in children with Down syndrome.
Broadley I, MacDonald J, Buckley SJ. Working memory in children with Down syndrome. Down Syndrome Research and Practice. 1995;3(1);3-8.
doi:10.3104/reports.44
Introduction
The effort to explain the workings of short-term memory has led to a number
of theoretical models. One of the more popular is the `working memory' model
developed by Baddeley and Hitch (1974). This three component model, comprising
a central executive, phonological loop and visuo-spatial sketch pad has
been found to account for a wide variety of experimental findings in normal
individuals and clinical populations (Baddeley,
1986). More critically for the concerns of this paper, the model has
also been used to explain variation in everyday cognitive activities. For
example, Gathercole and Baddeley (1989), found that phonological memory
skills in four and five year olds were directly related to vocabulary learning.
Furthermore, the model has been used to describe the development of short-term
memory functioning (Hitch
and Halliday, 1983). This strategy of applying the model to a wider
set of memory phenomena and different subject populations not only allows
the other areas a potentially powerful theoretical account, but also provides
a test of the theoretical generality of the model. The subject of this paper
is to apply the `working memory' model to memory data obtained from a group
of children with Down syndrome, the important aspect being that this is
a subject population known to have poor short-term memory performance in
comparison to typically developing and mental age matched peers (Mackenzie
and Hulme, 1987). If there is a close relationship between short-term
memory functioning and performance on everyday cognitive tasks then identification
of the underlying processes that might account for these deficits could
provide a clue to either remediation or alternative teaching and learning
strategies. The remainder of this section will briefly review the working
memory model in a developmental context, outline what is known about memory
in children with Down syndrome and then derive some implications to be examined
in the experiment described.
The current version of the `working memory' model (Baddeley,
1986) proposes three components or subsystems. The first of these, the
central executive, is basically an attentional system that controls and
monitors the operation of the two other components. The second is the visuo-spatial
sketch pad which stores visual and/or spatial information and material.
The third which is of primary importance for the work described here is
the phonological loop which is specialised for the storage of verbal information.
This loop consists of two related but independent subcomponents, a phonological
store and an articulatory loop. The phonological store can receive information
from either the auditory system or from visually presented text information
recoded into a speech based form. Information in the store decays rapidly
unless it is recycled, which is the process carried out by the articulatory
loop. This is hypothesised to be an active rehearsal based process, possibly
involving subvocal articulation. This system is presumed to have a limited
capacity which is time based, i.e. it stores approximately 2 seconds worth
of verbal material.
The phonological loop mechanism accounts for a number of standard findings
from tasks involving the short-term storage and recall of verbal information,
for example the word length and acoustic similarity effects. The word length
effect is the poorer recall for lists of long words than lists of short
words. This appears to be the result of the time limited nature of the rehearsal
process; it takes longer to articulate words with more syllables therefore
fewer can be placed in the loop (Baddeley,
Thomson and Buchanan, 1975). On the other hand, the acoustic similarity
effect - poorer recall of lists of phonologically similar items than lists
of dissimilar items, is due to the coding of information in the phonological
store. Poorer recall results from the difficulty of discriminating between
decaying memory traces which are similar. Since the items are presented
verbally the coding must be based on speech sounds (Salamé
and Baddeley, 1986).
The development of short-term memory capability has had considerable research
attention over recent years. In normally developing children verbal memory
span tested with either digits or words as stimuli increases from approximately
2 to 3 items at 4 years of age to 7 to 8 items at 14 years of age (Chi,
1977). The explanation for this change from a working memory perspective
is that the younger children have slower rates of articulation, which means
slower and less efficient subvocal rehearsal therefore fewer items can be
retained in the articulatory loop, resulting in shorter spans. As the child
gets older, articulation improves, allowing more efficient and faster subvocal
rehearsal, so that more items can be maintained in the loop.
Further evidence in support of this account comes from studies that have
investigated the developmental course of the word length and acoustic similarity
effects mentioned earlier. For example, for auditory presented items significant
word length effects have been found from 4 years of age (Roodenrys,
Hulme and Brown, 1993;
Cowan, Keller, Hulme, Roodenrys, McDougall and Rack, 1994) and significant
acoustic similarity effects from the same age (Hulme,
1987). Furthermore, these studies also found that the size of the word
length and acoustic similarity effects increased with age. Two important
conclusions are drawn from these findings. The first is that even fairly
young children seem to engage in rehearsal based processes for the storage
of verbal information and are sensitive to phonological information. The
second is that the rehearsal and phonological discrimination processes improve
with age.
The situation is slightly more complicated when the verbal items are presented
visually as pictures of nameable objects.
Hitch, Halliday, Schaafstel and
Hefferman (1991) found word length effects and acoustic similarity effects
in 5 year olds, but only if the items were explicitly named by either the
experimenter or the child as the pictures were presented. If there was no
naming then word length and acoustic similarity were only observed in the
11 year old group. Similarly Hulme (1987), in the study mentioned earlier
found a small, but nevertheless significant effect of acoustic similarity
in 4, 7 and 10 year old children, but no evidence of an increase in the
size of the effect with age. Again, the pictures were named as they were
presented to the child. The explanation for the delayed appearance of word
length and acoustic similarity effects for visual presentation is attributed
to the younger children failing to consistently recode the picture to its
name. Therefore, there are no effects that rely on speech based processing,
and the appearance of word length and acoustic similarity only occur when
the pictures are named.
Research studies consistently show that children with Down syndrome have
characteristically poor short-term memory. For example,
Mackenzie and Hulme
(1987) compared groups of mental age matched typically developing children,
a learning disabled group and a group with Down syndrome. They found that
on an auditory sequential memory task the group with Down syndrome were
poorer than the typically developing children and also poorer than the other
severely learning disabled group. Furthermore, over a five year follow up
the memory spans of the group with Down syndrome did not improve as much
as their increase in mental age would have predicted. That is, for the children
with Down syndrome there was an increasing difference between mental age
and short-term memory performance.
Children and adults with Down syndrome show poor auditory memory compared
with visual memory and recognition memory (Marcell
and Armstrong, 1982). As a population they also tend to have poor articulation
skills (Dodd, 1976;
Gibson, 1978). Given
this combination of factors then it could be hypothesised that from a `working
memory' perspective they would be particularly disadvantaged in tasks that
require use of the `phonological loop'. In particular it was predicted that
they would fail to show the standard effects that rely on a fully operational
`phonological loop' system: for example, little or no word length effect
since they have poor articulation and therefore inefficient subvocal rehearsal;
and show little or no acoustic similarity effect since they have poor auditory
and phonological processing skills.
The primary aim of the present study was to assess the performance of children
with Down syndrome on a battery of working memory tasks and compare different
age groups in order to see whether there are developmental changes in the
word length and acoustic similarity effects in this population. The secondary
aims were (i) to assess the relationship between these measures of memory
and the children's phonological skill as measured by a rhyme processing
task and (ii) assess the extent to which these children were influenced
by the visual properties of the items to be recalled.
Methodology
Participants
A total of 62 children (30 male and 32 female), with Down syndrome participated
in the experiment; 22 under 7 year olds (mean age 5 years 9 months; range
4 years 4 months to 6 years 9 months), 20 7 to 11 year olds (mean age 9
years 0 months; range 7 years 4 months to 10 years 6 months) and 20 over
11 year olds (mean age 13 years 2 months; range 11 years 1 month to 18 years
1 month). The children were recruited from local schools in two different
areas of the south of England. The schools included mainstream and special
education establishments. The children came from a range of socio-economic
backgrounds.
Materials and Procedure
Individual testing took place either at the child's home or at school. As
part of a larger study (Broadley,
1994), a battery of memory and language based tasks were administered
to each child, but the focus in this paper is on the following measures.
All of the items and words used had been pre-tested with the children to
ensure that they knew both the names of the pictures and that the names
corresponded to those used by the experimenter. The sets were identical
to those used in previous studies of working memory with young children
(Hulme
et al. 1987).
Auditory word span
On each trial the experimenter spoke aloud a sequence of words taken from
different sample sets. These sets varied in the word length of the items
in the set; one syllable items (book, dog, car, pig, bus, cup), two syllable
items (tractor, flower, rocket, table, apple), three syllable items (umbrella,
banana, telephone, newspaper, elephant, kangaroo); acoustically similar
(cat, hat, bat, man, rat, bag) and acoustically dissimilar (bus, kite, bell,
book, car, pig). The words in each list were sampled randomly without replacement
from the chosen set. The number of words to be memorised started with one
word lists and increased across trials until the child failed to recall
all the items in their correct position. There were three trials at each
list length. The longest sequence recalled correctly was recorded as the
word span.
Visual word span
The word sets used here were identical to those in the auditory condition.
The stimuli were black and white line drawings of the words. On each trial
the child was presented with a sequence of pictures shown by the experimenter.
As each picture was presented it was simultaneously named by the experimenter
and placed face down in front of the child. After the last item had been
presented the child verbally recalled the list. The scoring, timing and
sequencing was as for the auditory condition.
Visual similarity
The children were also presented with a set of black and white line drawings
of words that had visually similar pictorial representations. The item lists
were (ball, wheel, apple, orange), (spade, screw, fork, rake), (television,
case, gate, box), (horse, goat, zebra, donkey), (car, ambulance, truck,
bus). The presentation procedure was the same as that used in the Visual
Word Span conditions. The score recorded was the longest list the child
could recall correctly in order.
Digit span
Auditory and visual digit span was measured using the subtests of the British
Ability Scales (Elliot
et al, 1978). These were presented and scored in the standard fashion.
In addition to these Working Memory measures a further task was introduced
to assess the children's phonological processing skills.
Phonological awareness
This was assessed by using a variant of the oddity test used by
Bryant and
Bradley (1985) for sound categorisation. Black and white line drawings of
pictures were presented to the child in sets of triples. Two of the pictures
had names that rhymed. The child's task was to pick out the picture with
the non-rhyming name. One point was given for each correct trial. The maximum
score on the test was eight.
Results
Word length
The mean values of word span were calculated for the auditory and visual
conditions for each word length and are shown for each age group in
Table
1. As can be seen, the span scores confirm the low level of memory performance
of this group.
Table 1. Mean span scores for 1, 2 and 3 syllable words as
a function of presentation modality and age.
Age
group |
Auditory |
Visual |
|
1 syll |
2 syll |
3 syll |
1 syll |
2 syll |
3 syll |
| < 7 |
1.27 |
1.27 |
0.91 |
1.54 |
1.18 |
0.96 |
| 7 - 11 |
2.20 |
1.80 |
1.45 |
2.05 |
1.70 |
1.45 |
| > 11 |
2.70 |
2.10 |
1.80 |
2.40 |
2.20 |
1.80 |
The data were analysed using a mixed four way analysis of variance, with
between subject factors of Age and Sex and within subject factors of Presentation
Modality and Word Length. There was no significant main effect for Sex and
no significant interaction with any other factor. There was a significant
effect for Age (F(2,59)=27.84,p<0.001) with the anticipated finding of the
older children having larger spans. There was a significant effect for Word
Length (F(2,118)=71.68,p<0.001) which showed that the children's mean span
scores decreased with increasing size of the item length, the standard word
length effect. There was no significant effect for Presentation Modality
and no significant interactions.
Acoustic similarity
The mean span scores in each condition for each age group are shown in Table
2.
Table 2. Mean span scores for acoustically similar (AS) and
dissimilar (AD) words as a function of modality of presentation and
age.
| Age group |
Auditory |
Visual |
|
AS |
AD |
AS |
AD |
| < 7 |
1.27 |
1.27 |
1.23 |
1.55 |
| 7 - 11 |
1.75 |
2.20 |
1.65 |
2.05 |
| > 11 |
2.05 |
2.70 |
2.00 |
2.40 |
Again the data were analysed by a mixed four way analysis of variance. There
was no significant main effect for Sex and no significant interaction with
any other factor. There was a significant effect for Age (F(2,59)=24.97,p<0.001)
with the older children having larger spans. There was also a significant
effect for Acoustic Similarity (F(1,59)=30.12,p<0.001). This showed that
the children's mean span scores were significantly larger in the acoustically
dissimilar lists (mean=2.0) than in the acoustically similar list (mean=1.65).
There was no significant effect for Presentation Modality and no significant
interactions.
British Ability Digit Span
The mean digit span scores in each condition for each age group are shown
in Table 3. The scoring of this test is done over two items at each list
length, and a point given for each item correctly recalled. The mean score
therefore is approximately double the length of list that the child could
accurately recall.
Table 3. Mean digit span scores from the British Ability Scores
as a function of modality of presentation and age.
| Age group |
Auditory |
Visual |
| < 7 |
1.91 |
2.82 |
| 7 - 11 |
5.05 |
5.25 |
| > 11 |
6.85 |
7.60 |
The results of the three way analysis of variance showed again no significant
main effect for Sex or any significant interaction with any other factors.
There were significant effects for Age (F(2,59)=15.33,p<0.001) with the
older children having larger spans. There was also a significant effect
for Presentation Modality (F(1,59)=16.54,p<0.01) with the children scoring
significantly higher in the visual condition (mean=5.15) than in the auditory
condition (mean=4.52).
Visual similarity
The mean values for word span for the visually similar items are presented
in Table 4, with the data from the 1 and 2 syllable visual word span conditions.
Unfortunately when the visually similar lists were constructed they comprised
items of 1 and 2 syllable duration. Since number of syllables was not controlled
both of the word span conditions were used as comparison for the visually
similar condition.
Table 4. Mean word span for visually similar (Vis Simm) and
dissimilar (Vis Diss) pictures as a function of age.
| Age group |
Vis Simm |
Vis Diss (1 syll) |
Vis Diss (2 syll) |
| < 7 |
0.77 |
1.55 |
1.18 |
| 7 - 11 |
1.50 |
2.05 |
1.70 |
| > 11 |
1.70 |
2.40 |
2.20 |
The data were analysed using a mixed three way analysis of variance. As
in the other analyses there was no significant main effect for Sex and no
significant interaction with any other factors. There was a significant
main effect for Age (F(2,59)=19.87, p<0.001) such that the older children
had larger spans. There was also a significant effect for Visual Similarity
(F(2,118)=36.0, p<0.001). This revealed that the children's span scores
in the visually similar condition were lower (mean = 1.31) than either of
the dissimilar conditions (1.98 and 1.68 for the 1 and 2 syllable conditions
respectively). There were no other significant effects.
Rhyme judgments
The mean rhyme scores for each age group are shown in Table 5. A one way
analysis of variance showed that there were no significant differences between
the three age groups (F(2,59)=1.21, p>0.05). Most children scored very low
on this task.
Table 5. Mean rhyme score as a function of age.
| Age group |
Rhyme score |
| < 7 |
0.23 |
| 7 - 11 |
0.70 |
| > 11 |
0.95 |
The correlations between the span scores and the rhyme oddity test are shown
in Table 6. As can be seen there is very little relationship between the
word span scores and the rhyme scores. Only the correlation between the
one syllable span measure is significantly related to rhyme judgment performance.
However, the correlations between rhyme judgment and the auditory span measures
are all higher than those between the visual word span measures and rhyme
judgment. Thus it does appear to be sensitive to verbal versus pictorial
presentation and therefore a measure of phonological processing, albeit
a rather weak one.
Table 6. Correlation of rhyme judgements with auditory and
visual word span (* - p<0.01; ** - p<0.001).
|
1 - syllable |
2 - syllable |
3 - syllable |
BAS digits |
| Auditory span |
0.39* |
0.32 |
0.26 |
0.42** |
| Visual span |
0.17 |
0.23 |
0.21 |
0.35* |
Discussion
The issues raised in the introduction to the paper were the extent to which
the short-term memory performance of children with Down syndrome could be
incorporated within the theoretical framework of working memory. While the
present results show that certain aspects of their performance can be explained
by the operation of a phonological loop, the data also show that verbal
memory span relies on more than speech based coding.
The children tested here showed that word length had a small but consistently
significant effect on memory for both words and pictures for all three age
groups. Moreover there was no change in this word length effect with age.
The standard interpretation of this would be that these children were using
a subvocal rehearsal based mechanism for storing and recalling the items.
As there was also no difference dependent on whether the items were presented
as speech or pictures, this would suggest equivalent use of a speech code
for memorising pictures. There was no indication that the children might
have been using any extra visual coding (Paivio,
1971) in the picture presentation conditions. For the auditory presentation
these data support the previous research which has found consistent word
length effects from approximately 4 years of age and no change with age
(Hitch
et al., 1989,
1991;
Roodenrys et al. 1993). The data also support the findings of
Hulme
et al. (1987), who found a word length effect, for pictorial presentation,
in children as young as 4 years old, but only when the items were named
at presentation. This was also the procedure adopted here. Hence the pattern
of results so far is consistent with an articulatory loop based account
of storage and retrieval in this group of subjects.
Further support for the hypothesis that these children were using speech
based coding to store the items comes from the acoustic similarity data.
There was again a small but significant effect with smaller spans found
for acoustically similar lists than acoustically dissimilar lists. As in
the word length data there was no evidence for differential use of a speech
based code in the auditory as opposed to the visual presentation conditions.
The acoustic similarity effect was equivalent across both modalities. There
was also no change in the size of the acoustic similarity effect with age.
This contrasts with the findings from studies of normally developing children.
Hulme (1987), using similar materials and procedures to those used here,
found that acoustic similarity had more effect in older children in an auditory
presentation condition, but no change with age in a visual presentation
condition. This implies more reliance on speech based coding with increasing
age. Ford and Silber (1994) also found a more pronounced acoustic similarity
effect in older children. Both sets of researchers attribute this to increasing
use of rehearsal in the older children. Thus span performance is sensitive
to both the efficiency of phonological coding and use of subvocal rehearsal.
The most surprising aspect of the data reported here is that the pattern
of results from this group is by and large very similar to that obtained
from typically developing children. It is obvious that this group of children
with Down syndrome have much smaller spans, and that they show less of an
increase with age than normally developing children, but otherwise their
data show the same effects. On the surface this contradicts the hypotheses
outlined earlier, where it was anticipated that given their poor articulation
and auditory memory deficits there would be no consistent word length or
acoustic similarity effects and that performance would be better in the
visual modality. The results also contrast with those found by
Raine et
al. (1991) who found no effect for word length in a group of speech-disordered
children, which was again taken as evidence for memory span being dependent
on a process of subvocal rehearsal.
The question of what form of coding the children used in the tasks carried
out here must include the possibility that visual memory mechanisms were
also used. Two pieces of evidence support this idea. The first is the lack
of any difference dependent on the modality of presentation. In the studies
that have directly compared visual and auditory presentation in typically
developing children it has been found that memory recall is poorer under
visual presentation than auditory (Hulme,
1987). The argument is that recoding the visual stimulus to a verbal
form takes up processing resources. This does not occur in the auditory
condition. For the children in this study, since there was no difference
between vision and audition, it suggests that they were able to use the
visual information to compensate for their poorer auditory information.
The second piece of evidence is the data from the visual similarity conditions.
The fact that the children were consistently poorer on the visually similar
lists, in comparison with the dissimilar lists would support the hypothesis
that they were using visual information in the encoding and storing of the
items. A similar kind of effect has been found with typically developing
children.
In the Hulme (1987) study, children from 4 to 10 years old remembered more
acoustically similar items when they were visually presented (and labelled)
than when they were spoken. The children were using the information (visual)
that discriminated between the items. It is assumed that typically developing
children increasingly use verbal recoding for remembering sequences of pictures.
It is equally possible that the converse might also take place and that
children use visual information, perhaps images for remembering verbally
presented lists. Given that the child with Down syndrome is reasoned to
have relatively better developed visual processing skills, it is entirely
possible that the lack of modality differences found here reflect two compensatory
processes - use of visual information in the visual presentation condition
and verbal to visual recoding in the auditory presentation condition. Further
research is needed to elucidate these encoding mechanisms and strategies.
In summary then the evidence from this study supports the view that children
with Down syndrome are susceptible to both word length and acoustic similarity
effects in the storage and recall of verbal items. If these phenomena reflect
the operation of rehearsal and speech based coding then it suggests some
possibility of remediation of the very poor memory spans shown by these
children. There is already some evidence that the use of rehearsal based
training programmes can lead to improved short-term memory performance in
this group of children (Belmont,
Butterfield and Borkowski, 1978;
Hulme
and Mackenzie, 1992;
Broadley and MacDonald, 1993). The question of whether phonologically
based training could, either on its own or in conjunction with rehearsal,
lead to similar improvements needs to be tested. Therapy that alleviated
these memory deficits might also be of benefit for other aspects of cognitive
functioning and development, given the widely held view that short-term
memory functions as a working memory system that is involved in a variety
of everyday cognitive activities such as language processing, reading and
reasoning.
Acknowledgements
This research was supported by a research bursary to Irene Broadley from
the Portsmouth Down Syndrome Trust (now Down Syndrome Education International).
The authors would like to thank all the children, parents and teachers who
participated in the study.
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