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Session 14 - Speech Interventions

Evaluating the BabblePlay app intervention to encourage vocalising in infants with Down Syndrome

Authors: Tamar Keren-Portnoy,1 Laura Boundy,1 Sue Buckley,2 Kelly Burgoyne,3 Helena Daffern,1 Mona Kanaan,1 Sab Arshad1

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

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

Background

For typically developing infants, gaining experience in speech sound production may facilitate early word production (McGillion et al., 2016). Infants with Down syndrome (DS) are not very vocal (Parikh & Mastergorge, 2018) and are at risk for language delay (Zampini & D'Odorico, 2013). Encouragingly, Yoder et al. (2014) found that encouraging vocalising in infants with DS may lead to earlier word production.

Building on this research, we are testing a novel parent-led intervention intended to encourage more vocalising in infants with DS, using the BabblePlay app (Daffern et al., 2020). If successful, it may fulfill a real need, as in the UK Speech and Language Therapy provision for infants with DS is rarely accessible, as reported by our pilot study participants (Keren-Portnoy et al., 2023 [in preparation]).

This presentation will report on an ongoing Feasibility Randomised Controlled Trial (RCT) of the intervention (Boundy et al., 2024.). We will report on the project’s performance on several success criteria, which were chosen to determine whether to proceed to a full RCT.

Success criteria:

  1. Recruitment of 40 families
  2. Retention of 30 families to completion
  3. Families adhere to the protocol

Methods

44 Families with babies with DS (aged 7-15 months) have been recruited. Families are randomly assigned to a group. Each group plays with a ‘tool’ (a mirror for the control group and BabblePlay for the experimental group) for 3 weeks twice daily for 5 minutes at a time. Both groups then play with BabblePlay for another 3 weeks. Infants are audio-recorded at baseline and after each 3 week period and parents fill in several questionnaires.

Results

  1. 44 families have signed consent.
  2. 23 families have completed their participation.
  3. We will report on several measures of adherence (still undergoing analysis).

Conclusions

The feasibility results are promising, making a definitive RCT our next step for this project.

References

Boundy, L., Keren-Portnoy, T., Kanaan, M., Burgoyne, K., Daffern, H., Buckley, S., & Arshad, S. (2024, August 10). Evaluating the BabblePlay app intervention to encourage vocalising in infants with Down Syndrome. https://doi.org/10.17605/OSF.IO/V2DNH

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.

Keren-Portnoy, T., Boundy, S., Buckley, S., Burgoyne, K., Daffern, H., Kanaan, M. & Arshad, S. (2025). A pilot study of the BabblePlay app as an intervention tool for babies with Down syndrome [Manuscript in preparation]. Department of Language and Linguistic Science, University of York.

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, Amanda Boutot1, Miriam Kornelis2, Lizbeth Finestack2, Susan Loveall3, Lauren Thompson4, Laurel Bruce1, Nancy Scherer1, Carol Stoel-Gammon5, Jennifer Davis1, Nancy Potter4, VanDam4, Linda Eng1, Varsha Samudrala1, Amy Armstrong-Heimsoth6, Kelsey Lucca1, Sue Buckley7,8

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

Contact: Beate.Peter@asu.edu

Progress and next steps at Babble Boot Camp for infants with Down syndrome

Children with Down syndrome typically experience delays and slow growth in motor, communication, and cognitive development from birth. Babble Boot Camp (BBC) was designed to support speech and language development with intensive early intervention for children with conditions known to be at risk for delays. BBC is a parent-led speech and language intervention delivered by a speech-language pathologist (SLP) via telehealth. The approach is detailed in an invited chapter by Buckley et al. (2024). Our initial pilot study with 10 children with Down syndrome age 4-16 months showed high acceptability and implementation fidelity. Children’s linguistic environments were comparable to those of typical controls in terms of child utterance rates, adult word counts, and conversational turns. Babble complexity, along with receptive and expressive vocabulary, increased over time, with first words emerging earlier than expected (Peter et al. in press). A small RCT, funded by the American Speech-Language Hearing Foundation, is now underway to examine group-level treatment effects for families randomized to either receive weekly individualized BBC sessions or monthly standardized parent group education sessions on pre-speech and speech production, language skills, and parent-child interactions. The progress of this study and preliminary findings will be presented.

A new development from this team is the development and trial of BBC Play. Joined by experts in motor development, play, and early cognitive development and with a grant from ASU Women and Philanthropy, we have designed intervention activities to encourage social, motor, communication, and cognitive development around play with specific toys. Five families with infants with Down syndrome are now receiving weekly sessions provided jointly by an SLP and a play expert. The effectiveness of this approach to stimulate growth across domains and the experience of families on the benefits of the approach are being evaluated. We will describe the toy-based activities and discuss the possible implications for the way early intervention is delivered in the future.

Buckley, S., Finestack, L. H., Keren-Portnoy, T., Loveall, S., Peter, B., Stojanovik, V., & Thompson, L. (2024). The Case for Early, Time-Sensitive Speech, Language, and Communication Interventions for Young Children with Down Syndrome or Other Intellectual and Developmental Disabilities. In IRRDD 67: International Review of Research in Developmental Disabilities (International Review Research in Developmental Disabilities). Elsevier. Advance online publication.

Peter, B., Finestack, L., Loveall, S., Thompson, L., Bruce, L., Scherer, N., Stoel-Gammon, C., Davis, J., Potter, N., VanDam, M., Eng, L., & Buckley, S. (In press). Babble Boot Camp for infants with Down syndrome: Piloting a proactive, caregiver-led intervention designed to boost earliest speech and language skills. American Journal of Speech-Language Pathology.

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