The influence of reading instruction on language and memory development in children with Down syndrome
Glynis Laws, Sue Buckley, John MacDonald and Irene Broadley
This paper reports evidence for the importance of reading instruction for memory and language development in children with Down syndrome. Language and memory measures for 14 children were obtained over nearly four years as part of our research investigating the effect of teaching memory strategies. Half of the children were readers or became readers in the course of the study. At the start of the study, there were no significant differences between readers and non-readers in vocabulary and grammar understanding, or in auditory and visual memory performance. By the end of the study, a significant advantage for the readers was noted for all language and memory measures. Possible reasons for these findings are discussed, as well as the implications for educational intervention.
Laws G, Buckley SJ, MacDonald J, Broadley I. The influence of reading instruction on language and memory development in children with Down syndrome. Down Syndrome Research and Practice. 1995;3(2);59-64.
Since 1966 there have been reports in the literature suggesting that children
with Down syndrome can achieve functional levels of literacy and that reading
might accelerate speech and language acquisition (Duffen,
Orme, Fisher & Griggs, 1966;
Rhodes, Gooch, Siegelman, Behrns & Metzger, 1969;
& Collins, 1972). All these authors used case study evidence to argue
for the effect of reading on spoken language. For example, Duffen (1976),
when describing the progress of his daughter Sarah, observed: "Sarah's reading
ability has considerably helped the development of her speech. The critical
discovery was that Sarah read, remembered and later used, in the correct
context, sentences that she was incapable of remembering when she just heard
Saunders and Collins (1972) also claimed that reading benefited spoken language:
"It would be true to say that through our work we have taught some children
to speak through teaching reading".
More recently, Buckley (1995a) has argued that reading should also lead
to an improvement in short term memory span. This influence of reading progress
on speech, language and memory skills would be predicted from the study
of typically developing children. Being able to read opens up access to
knowledge and leads to the biggest vocabulary explosion for children between
the ages of 7 and 16, when children are typically learning around 3,000
words each year (Nagy
& Herman, 1987).
Garton and Pratt (1989) stress the close inter-relationship between spoken
and written language, pointing out that experience with both these forms
will contribute to further language development. Buckley's studies with
adolescents with Down syndrome (Buckley,
showed how teaching which used printed sentences provided more effective
support in improving grammar production and comprehension than teaching
which used speech and pictures.
Studies of reading development in typically developing children suggest
reciprocal interactions between reading progress, language and memory skills
& Large 1988;
Gathercole & Baddeley, 1993). Longitudinal studies have demonstrated
that beginning readers' language knowledge, phonological awareness and working
memory skills influence reading progress during the first year of reading
instruction. In turn, the better readers at the start of the second year
show the biggest gains in working memory and phonological awareness by the
end of the year (Ellis
& Large, 1988).
Gathercole and Baddeley (1993) reviewed many studies
of the links between phonological processing and reading. They found the
evidence suggested "...that reading and phonological awareness, and reading
and phonological memory, develop in mutually facilitative fashions."
Until very recently, it would have been difficult to establish a longitudinal
study to look at the effect of reading progress on other cognitive skills
in children with Down syndrome, as the majority were not being taught to
read. With the recent shift in education provision toward mainstreaming
the children, longitudinal studies are becoming possible; another paper
in this issue describes the early data from one such study (Byrne,
Buckley, MacDonald and Bird, 1995). In Byrne et al's study, all the
children are being taught to read. The shift to mainstream placement of
the primary aged children with Down syndrome has been so rapid in this part
of the UK that the majority are in mainstream schools. Since they are all
taught reading, this means it is no longer feasible to set up a local study
to compare the cognitive development of children with Down syndrome being
taught to read with those who are not receiving literacy instruction.
However, during this transition in our local education provision from 1990
to 1995, we have collected data which has made such a comparison possible.
Reading, memory and language data have been collected over nearly four years
from 14 children with Down syndrome, 7 of whom are now reading. These children
are part of a larger group which participated in research on developing
memory strategies. The data provide the opportunity to observe differences
in language and memory progress over this period which could be attributed
to reading status. Since all but one of the readers in this group attend
mainstream school, reading is confounded with educational experience. However,
we also present data from initial pre-training assessments for the larger
group which allow us to look at these differences for children who all attend
The subjects had been assessed originally as part of a project to train
children with Down syndrome to use memory strategies (Broadley,
Broadley and MacDonald, 1993;
Broadley, MacDonald and Buckley, 1994;
Broadley, MacDonald and Buckley, 1995). They formed part of a group
of 51 children who received pre-training assessments in October 1991. After
assessment, half were assigned to be trained while the other children became
an untrained control group. All these children were assessed a number of
times to measure the effect of the training and to compare the performance
of the trained children with the performance of the control children. The
final investigation of this project followed up 14 of the trained children
to investigate long term maintenance of the trained memory skills in July
MacDonald, Buckley and Broadley, in press). As a result we have longitudinal
data for these children plotting their memory and language development over
more than three and a half years.
Full details of the testing and training procedures are reported elsewhere
Broadley and MacDonald, 1993). This paper is concerned with results
obtained from a subset of the tests presented: British Picture Vocabulary
Scale (BPVS); Test for the Reception of Grammar (TROG); Raven's Coloured
Progressive Matrices (Matrices); British Ability Scales reading test; and
auditory and visual word span measures. The word span measures were obtained
from serial recall tasks where the child was asked to repeat sequences of
one-, two- and three-syllable words. The sequences were presented under
two conditions: the words were spoken by the experimenter and the child
was required to repeat them; or they were presented to the child as pictures.
For the visual presentation, each picture in a sequence was laid before
the child one at a time and its name spoken by the experimenter. The pictures
were then turned over and the child was asked to recall the sequence verbally.
The 14 children were categorised as readers or non-readers on the basis
of whether or not they had scored anything on the BAS reading test at the
follow-up assessment. 7 of the children were classed as readers. Their scores
ranged from 3 to 39 with a mean score of 21 (SD=12.62). We were also interested
in the type of school the children attended. The majority of the original
sample attended special schools but six of the fourteen children in the
follow-up group were at mainstream schools.
The ages of the children ranged from 8 years 8 months to 14 years 10 months.
The average age of the readers was 10 years 2 months; and the average age
of the non-readers was 11 years 5 months. There was no significant difference
between the mean ages of the groups.
Raw scores for each of the standardised tests used were recorded and means
across subjects for readers and non-readers were calculated separately and
used in the analyses reported below. For the memory tests, word spans under
each condition were calculated as means across the three syllable lengths
to give an auditory memory score and a visual memory score. Table 1 shows
the mean scores achieved on these assessment measures in 1991 and 1995 by
Table 1: Mean matrices, language and memory scores for readers
and non-readers in 1991 and 1995.
Our main question is whether learning to read enhances vocabulary and grammar
understanding and memory performance. If it does, we would expect readers'
performance on tests of vocabulary, grammar and memory to be superior to
the performance of non-readers. Furthermore, if the difference in performance
is to be attributed to the reading rather than to some underlying difference
in language abilities between the children (in other words if the reading
produced better language skills rather than those with better language abilities
going on to become readers), we should find a difference between the groups
for the most recent assessment scores but less difference in the abilities
of the two groups at the beginning of the study when only three of the children
had started reading.
We examined this question, using a series of mixed two-way analyses of variance
(ANOVA's) to investigate the differences between means for each of the measures
of interest with reading as a between-groups factor (readers versus non-readers)
and time of measurement as a within-subjects factor (1991 versus 1995).
First, we will deal with the analysis of Matrices scores. As a measure of
non-verbal intelligence, we would not expect the teaching of reading to
have a direct impact on scores achieved on this test. The means reported
in Table 1 suggest this to be the case as we see little difference between
the groups while both readers and non-readers show an increase in scores
over time. The ANOVA confirms this impression: there is a highly significant
main effect of time (F=25.61; df=1,10; p=.000) but no main effect for reading
(F=.48; df=1,10; p=.503) and no interaction (F=.02; df=1,10; p=.899). Thus
there are no differences between the groups on this measure of non-verbal
intelligence and both show the same developmental progress over time.
The analysis of mean scores on the BPVS showed a different pattern of results.
Again, we see a main effect for time (F=13.19; df=1,12; p=.003), but reading
also has a significant effect on means (F=10.49; df=1,12; p=.007). An interaction
between time of measurement and reading approached significance (F=3.82;
df=1,12; p=.074). Vocabulary scores for the readers are tending to diverge
from those of the non-readers. Whereas there was a difference of less than
two items between the groups in 1991, the difference in 1995 was nearly
This pattern of results is even more marked for scores on the TROG test;
over time the non-readers have progressed by an average of less than one
block on the TROG, whereas the difference in the readers' scores was nearly
three blocks. Analysis of variance confirms the significant main effect
for time (F=12.10; df=1,12; p=.005) and for reading (F=6.61; df=1,12; p=.024).
Again the interaction between reading status and time of assessment approaches
significance (F=4.35; df=1,12; p=.059).
As we can see in Table 1, auditory memory measures were almost identical
for the two groups at the start of the study but the final assessment reveals
an advantage for the readers. Analysis of variance shows a significant effect
for time (F=10.27; df=1,12; p=.008) and also for reading (F=11.43; df=1,12;
p=.005). There is a significant interaction between time of assessment and
reading (F=5.24; df=1,12; p= .041) reflecting the increased performance
of the readers compared with that of the non-readers at the 1995 assessment.
A similar pattern of results was found for the visual memory scores - a
much greater difference between the groups at the end of the period than
existed at the beginning. The ANOVA confirms the main effect for time (F=29.69;
df=1,11; p=.000) and also for reading (F=9.14; df=1,11; p= .012). Once again
we found a significant interaction between these two main effects (F=5.75;
df=1,11; p=.035) reflecting the much wider difference between the 1991 and
1995 scores of the readers compared with the difference found for the non-readers.
To investigate the interactions, we looked at the difference between the
1991 and 1995 scores for each group separately using paired-sample t-tests.
For the non-reading group, there was no significant increase over time in
their performance on any of the measures except Matrices. In contrast, the
readers showed statistically significant gains over time on all the measures.
Table 1 suggests that the readers were already slightly more advanced in
1991. We compared their performance at that time with that of the non-readers
using independent groups t-tests to examine the differences in mean scores
for all the measures. In 1991, no significant differences were found between
readers and non-readers on any of our measures. In contrast, independent
groups t-tests used to examine the difference between the groups' mean scores
in 1995 showed that the readers scored statistically significantly higher
than non-readers on all the measures of interest, except the Matrices. (BPVS:
p=.002; TROG: p=.017; auditory memory: p=.003; visual memory: p=.006). Thus
groups of children who started out in 1991 with much the same average scores
on our assessment measures had become quite different from each other by
Time of effect
We were interested in seeing at what point the memory scores of the readers
had begun to diverge from those of the non-readers. Since these data were
collected primarily to evaluate the effects of training a rehearsal strategy,
we have assessments carried out immediately post-training in summer 1992,
and then some eight months later in spring 1993. Table 2 shows the full
picture of memory scores over time. Across all the subjects included in
the follow-up study, we found that the significant gains in memory performance
produced by the training had been much reduced. Since the children had not
continued with the memory training procedures this was probably to be expected.
However, if we look separately at readers and non-readers we see that post-training
memory performance was much the same for both groups but, whereas the memory
measures for the non-readers had returned almost to pre-training levels
by 1995, the readers had sustained much of the training gain.
Table 2. Mean auditory and visual memory scores for readers
and non-readers (s.d.'s in brackets)
|Eight months later
|Three years later
Size of gains
Of course, apart from the statistical significance so far discussed, we
are interested in the real significance of these effects; what do such differences
on these tests signify in terms of developmental progress? Perhaps one way
to consider this is to convert the raw scores on the standardised tests
to the age-equivalent scores shown in Table 3. This shows that the real
difference between the groups is that the readers are on average 1 year
9 months ahead on vocabulary understanding, and an average of at least 1
year and 4 months ahead on their level of grammar understanding.
Table 3. Age equivalent scores for 1995 BPVS and TROG measures
for readers and non-readers.
||4 yrs 11 mnths
||3 yrs 2 mnths
||4 yrs 4 mnths
No comparable age norms are available for the memory measures but we can
compare the word spans achieved with those reported by earlier researchers
for normally developing children.
Hitch and Halliday (1983) report word
spans averaged across three syllable lengths of 2.4 for spoken sequences
and 2.2 for picture sequences for 6 year old subjects.
Henry (1994) found
an average word span of just over 3 single syllable words for a group of
5 year olds.
Cowan, Saults, Winterowd and
Sherk's (1991) 4 year olds had
mean word spans of 3.41 for single syllable spoken word lists, whereas the
four year old subjects in
Hulme, Thomson, Muir and Lawrence's (1984) experiment
had mean spans of about 2 at this word length, and less for longer words.
No doubt the variations in word spans reported in the literature reflect
differences in stimuli used and procedures. However, in the general context
of the available data, the memory spans of our reading group seem to be
in line with their functional language level.
Reading or school?
So far, we have identified our two groups of children as either readers
or non-readers. In fact, the reading status of the children was almost completely
confounded by the type of school attended. All but one of the readers were
at mainstream schools, whereas all of the non-readers attended special schools.
This is a problem for our hypothesis that it is the reading itself which
has produced these differences in the language and memory measures. The
children at mainstream schools have a different educational experience which
goes beyond the opportunity to learn to read. It could be that our results
are explained by the fact that the mainstream children are developing in
a normal language environment and that growing up with peers following normal
patterns of language acquisition is what really boosts the language performance
of children with Down syndrome.
This is an important question which, fortuitously, we are able to examine,
albeit in a limited way. Although just one of the special school children
in our follow-up study scored on the BAS reading test, there were many children
in the initial large sample who were attending a special school and who
were also readers. This gives us the opportunity to compare readers with
non-readers under conditions where the two groups enjoy similar educational
Special school readers
For our analysis we selected all the children attending special school in
1991 who were within approximately the same age range as those in the longitudinal
sample reported above. Their ages ranged from 8 years 4 months to 14 years
9 months with a mean age of 11 years 6 months. The average age of the readers
was 12 years 1 month, and of the non-readers 10 years 11 months. As before,
the criterion for being placed in the reading group was that the child scored
something on the BAS reading test; 17 of the children were classified as
readers and 17 as non-readers. The range of reading scores achieved was
from 1 to 75 with a mean of 26.56 (SD=24.95). Table 4 shows the scores for
readers and non-readers on the language and memory measures. Comparing these
means with the 1995 results reported in Table 1, there is a close similarity
in the average scores both for readers and non-readers.
Table 4: Language and memory measures for special school readers
The differences between the mean scores for readers and non-readers were
investigated using simple factorial ANOVAs with reading as a between groups
factor and age treated as a covariate since at least some of the variance
in these scores seemed likely to be attributed to age. For each measure,
reading was shown to be a significant factor (BPVS: F=8.2; p=.007; TROG:
F=23.62; p=.000; Auditory memory: F=29.79; p=.000; Visual memory: F=14.10;
p=.001). Age was also shown to contribute to the variance for all measures
except the BPVS.
These analyses confirm that when readers and non-readers from similar educational
environments are compared, readers score significantly higher on tests of
language ability and memory capacity.
Our results suggest that learning to read has a significant impact on language
progress and on the development of auditory and visual memory skills. The
longitudinal data show that, nearly four years after starting out with similar
levels of vocabulary and grammar understanding, the readers have made considerably
more progress in their language development. This new evidence supports
the case study records which suggest that reading encourages improved grammar
Given the opportunity to increase language knowledge that reading provides
it is not surprising to find these advances. Most of the readers in the
longitudinal study started reading using an approach recommended by the
Sarah Duffen Centre. This differs from other approaches by deliberately
using reading to teach new words and concepts. The children begin by learning
a small sight vocabulary of words with which they are familiar, but then
move on to learning new words which are not yet in their speech repertoire.
Thus spoken and reading vocabularies advance together. A further important
feature of this approach is the early introduction of short sentences for
reading which can then be practised and used in everyday speech, and which
add to the children's knowledge of grammar. This is the area of language
learning which gives children with Down syndrome the greatest difficulty
For children with Down syndrome, the visual representation of language offers
a way to overcome their auditory processing and memory difficulties. In
contrast to spoken language, printed text provides a permanent rather than
a transitory signal. This allows more processing time, and gives the child
a better chance of learning.
Our cross-sectional data comparing the memory measures for children at special
schools reflects the evidence from typically developing children in studies
comparing good and poor readers (e.g.
Mann, Liberman and Shankweiler, 1980). These show that better readers
also perform better on tests of memory involving verbal material and that
poor readers may show memory deficits. In our study, we compared those who
can read anything at all with non-readers with similar results - significantly
higher mean memory scores for the readers. This evidence alone would be
difficult to interpret since it could be just as easily argued that only
those children with better memory capacity were able to read. Indeed, Fowler
(1994) has suggested that a digit span of 4 may be needed for the successful
development of reading skills.
However, the longitudinal data overcome the problems of interpretation,
and show that rather than some minimum memory capacity be required for reading
as Fowler suggests, that reading itself will promote the development of
memory skills. Children in our study groups began with very similar, extremely
low, scores on our memory measures. Nearly four years later, those who have
received reading instruction are clearly diverging from the non-readers.
Despite improvements in memory scores, none of the readers had a word span
average more than 3 (this measure was the average word span across three
syllable lengths) and, at the start of the study, only one of them had an
average span as much as 2. It would therefore be a great mistake to withhold
reading instruction from children from Down syndrome while waiting for them
to attain some minimum level of memory capacity.
The ways in which speech, language and memory development are mutually facilitated
could not be addressed in this limited study, but it is a research priority
to find out more about these relationships. Our own speculation, based on
reading research with typically developing children, would be that increased
memory capacity comes about as a result of the development of alphabetic
reading strategies which the mainstreamed children will be taught at school.
Sounding out a word letter by letter requires working memory capacity to
hold the early sounds in the word long enough to decode the whole word.
If this does account for the readers' memory performance, we might further
speculate that alphabetic reading could have provided working memory practice
and helped maintain the trained memory performance. In addition, if members
of the reading group have developed alphabetic strategies, there is the
possibility that the memory training may have actually contributed to this
ability. Angela Byrne's research programme, the early results of which are
published elsewhere in this issue, will hopefully provide further insights
into how these complex relationships between reading, language and memory
Although these results are based on data from a relatively small number
of children, we believe they clearly support the arguments for the importance
of teaching children with Down syndrome to read. Furthermore, despite the
apparent failure to maintain the effects of rehearsal training in the long
term for the group as a whole, it may also be important to include continued
memory training for this group. Memory is clearly intimately tied to language
and literacy development and interventions designed to improve any one of
these abilities could benefit the others.
The authors would like to thank the parents, teachers, and children who
took part in this study. The collection of data from the early part of the
study was funded by a bursary from The Portsmouth Down Syndrome Trust to
Irene Broadley. The follow up study was funded by a grant from the University
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