Session 3: Speech Development

Stimulating Speech Production in Children with Down Syndrome

Authors: Demi Savva¹, Vesna Stojanovik^1*, Tamar Keren-Portnoy² Sue Buckley³

1. School of Psychology and Clinical Language Sciences, University of Reading, d.savva@student.reading.ac.uk

1. *School of Psychology and Clinical Language Sciences, University of Reading, v.stojanovik@reading.ac.uk

2. Language and Linguistic Science, University of York, tamar.keren-portnoy@york.ac.uk

3. Down Syndrome Education International, sue.buckley@dseinternational.org

*Corresponding author

Introduction: Children with Down Syndrome are known to have delays with speech and language development. While there is extensive research on the ages that typically developing children reach speech sound acquisition milestones, there is limited research on the acquisition of sounds in children with Down syndrome. The aim of the current pilot study was to find out if early speech production could be stimulated using the Babble Boot Camp approach (Peter et al. 2022). The research question is: Can speech production be stimulated in young children with DS if parents/caregivers are encouraged to imitate and model children's vocalisations ? Our study investigates this.

Method: Nine children with Down syndrome (aged between 12 and 18 months) and their parents were recruited into the study. Parents were provided with a manual at the start of the study which provided strategies on how to support their children's early vocalisations through imitation and modelling. Parents had access to support from a speech and language therapy assistant and from the research team. Parents were asked to practise with their children several times a week. They were also asked to provide weekly 2-min video recordings for which they got feedback from the research team, and one monthly 15-min video recording which was used for further speech analysis in terms of consonants produced.

Results: Based on the transcriptions of the parent-child weekly and monthly video recordings, we were able to derive a phonetic inventory shown in Table 1.

Table 1: Phonetic Inventory:

Key:

• Consonant included if at least 1 participant produced it > 5 times (black)
• Consonant included if at least 50% participants produced it > 5 times (blue)
• Consonant included if 100% participants produced it > 5 times (green)

Two (of the nine) parents provided ongoing weekly recordings (for 12 weeks). The parents of one child (Child A) carried out the imitation and modelling as suggested by us. The parents of the other child (Child B) did not do that, but continued to record the child on a weekly basis nonetheless. Below we present data from 2 case studies.

For Child A, 3 consonants increased in frequency over 12 weeks and 1 consonant decreased in frequency.

For Child B, 5 consonants increased in frequency over 12 weeks and there was no decrease in frequency for any consonants.

Discussion: The range of consonants produced by 12 to 18 month old infants with Down syndrome is similar to that of children who don't have Down syndrome (Smith & Oller, 1981). These pilot results also suggest that encouraging parents to imitate and model speech productions may increase the frequency and/or maintain the frequency of sounds produced in children with Down syndrome.

Using the Babbleplay App to promote vocalising in babies with Down syndrome

Authors: Tamar Keren-Portnoy¹, Sue Buckley², Kelly Burgoyne³, Helena Daffern¹, Mona Kanaan¹, Laura Boundy³, Sab Arshad¹

1. University of York
2. Down Syndrome Education International
3. University of Manchester

Corresponding author: tamar.keren-portnoy@york.ac.uk

Background

Babbling, the production of language-like syllables (e.g., 'ba'), scaffolds word learning: earlier babbling correlates with earlier word production in typically developing infants (McGillion et al., 2016). Infants with Down Syndrome tend to vocalise less than typically developing infants (Parikh & Mastergorge, 2018) and are at risk for language delay (Zampini & D'Odorico, 2013). However, infants with Down Syndrome who participated in an intensive intervention that led to an increase in prelinguistic skills (including babble) had a larger vocabulary at a later age (Yoder et al. 2014). Encouraging more vocalising in those infants may therefore support vocabulary development.

We report on a pilot of a novel parent-led intervention to encourage infants with Down Syndrome to vocalise more, using an app, BabblePlay, developed by us (Daffern et al., 2020). BabblePlay responds to vocalisations with moving shapes on a screen.

Research Questions

1. Do infants engage with the app?
2. Do parents find the app easy and enjoyable to use?
3. Do infants increase their vocalising when interacting with the app, relative to a control condition?

Methods

29 Families with babies with Down syndrome (aged 7-15 months) completed the study.

Each infant played with a mirror 5 times one week and with BabblePlay 5 times the following week. Parents filled in questionnaires to feed back their impressions of the intervention and of their infants' engagement with it.

Results

1. According to parents' reports only half of the children understood that their vocalisations caused the shapes to appear on the screen.
2. Parents reported that BabblePlay was easy and enjoyable to use.
3. The majority of infants (82%) vocalised more with BabblePlay than with the mirror.

Conclusions

BabblePlay seems to be a promising tool for encouraging vocalising in infants with DS. We end by reporting on plans for a feasibility Randomised Controlled Trial of BabblePlay with infants with Down syndrome.

References

• Daffern, H., Keren-Portnoy, T., DePaolis, R. A. & Brown, K. I. (2020). BabblePlay: An app for infants, controlled by infants, to improve early language outcomes. Applied Acoustics, 162, 107183.
• McGillion, M., Herbert, J. S., Pine, J., Vihman, M., dePaolis, R., Keren-Portnoy, T., & Matthews, D. (2017). What Paves the Way to Conventional Language? The Predictive Value of Babble, Pointing, and Socioeconomic Status. Child Development, 88(1), 156–166. https://doi.org/10.1111/cdev.12671
• Parikh, C. & Mastergorge A.M. (2018) Vocalisation patterns in young children with Down syndrome: utilizing the language environment analysis (LENA) to inform behavioural phenotypes. Journal of Intellectual Disabilities 22, 328-345.
• Yoder, P., Woynaroski, T., Fey, M., & Warren, S. (2014). Effects of dose frequency of early communication intervention in young children with and without down syndrome. American Journal on Intellectual and Developmental Disabilities, 119(1), 17–32. https://doi.org/10.1352/1944-7558-119.1.17
• Zampini, L., & D'Odorico, L. (2013). Vocabulary development in children with Down syndrome: longitudinal and cross-sectional data. Journal of Intellectual & Developmental Disability, 38(June 2014), 310–7. https://doi.org/10.3109/13668250.2013.828833

Babble Boot Camp for infants with Down syndrome: Pilot study of a proactive parent-led intervention

Beate Peter¹, Lizbeth Finestack², Susan Loveall³, Lauren Thompson⁴, Laurel Bruce¹, Nancy Scherer¹, Carol Stoel-Gammon⁵, Jennifer Davis¹, Nancy Potter⁴, Mark VanDam⁴, Linda Eng¹, Varsha Samudrala¹, Shreya Guggilla¹, Linda Tran¹, Sue Buckley^6,7

1. Arizona State University
2. University of Minnesota
3. University of Nebraska
4. Washington State University
5. University of Washington
6. University of Portsmouth
7. Down Syndrome Education International

Contact: Beate.Peter@asu.edu

Children with Down (DS) syndrome face life-long difficulties with verbal communication such as producing speech sounds and combining words to convey meaning. These risks are known at or even before birth, yet conventional speech/language interventions focus on feeding first, not addressing speech and language needs until children are 2 to 4 years old. This is the unexplored opportunity space in which we piloted Babble Boot Camp (BBC), the first proactive, systematic, and longitudinal speech/language intervention. BBC was originally developed for infants with classic galactosemia, a metabolic disease diagnosed in newborns that puts most affected children at risk for severe speech and language disorders. Here, we piloted a ten-month course of BBC in ten children with DS starting at ages 4 to 16 months. In weekly telehealth sessions, a speech-language pathologist coached caregivers in strategies to increase child vocalization rates, boost babble skills, foster emergence of first words, and build vocabulary skills. As caregivers incorporated the strategies in their daily home lives, children heard more words, produced more utterances, and experienced more conversational turns than children receiving conventional care. Babble complexity and receptive and expressive vocabulary increased over time. Caregivers rated their BBC experience as feasible, convenient, and beneficial. Overall, the best gains were made by children with the least severe medical complexities. As in other studies, the physical and psychosocial health of many caregivers was problematic, and many showed evidence of under-reporting their own stress levels. The insights into feasibility, acceptability, and suggestive progress motivate a fully powered BBC clinical trial for infants with DS including those with severe medical complexities, toward a paradigm shift in how children with DS receive support in verbal communication. The poor physical and psychosocial health and under-reported stress levels in many caregivers motivate developing proactive interventions that build resilience against these risks as well.