MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES

RESEARCH REVIEWS 3: 307312 (1997)

LANGUAGE DEVELOPMENT IN CHILDREN AND

ADOLESCENTS WITH DOWN SYNDROME
Robin S. Chapman*
University of Wisconsin-Madison, Madison, Wisconsin

This review of recent work on language development in

children and adolescents with Down syndrome focuses on sentence
structure, grammatical words, and vocabulary. Evidence is summarized for a specific expressive language impairment, over and above
the cognitive delay associated with the syndrome. A profile of
strengths (lexical comprehension) and deficits (lexical and sentence
production) is identified. Acquisition of productive syntax is shown
to be ongoing in adolescence, without evidence of limits to learning
at the onset of adolescence or the advent of complex syntax.
Additional difficulties in verb and grammatical morpheme acquisition are identified. Predictors of individual variation in performance
and competing explanations of language deficit are discussed briefly.
Interventions shown to increase communicative effectiveness are
summarized.
r 1997 Wiley-Liss, Inc.

characteristic of the syndrome in the context of developmentally

changing behavior. They include [Chapman, 1995]: 1) Is there
evidence of a specific language deficit in children with Down
syndrome, relative to nonverbal cognitive achievements? 2) Is
there a particular pattern of strengths and weaknesses (a
profile) characteristic of language acquired by children with
Down syndrome? 3) What is the developmental course of
language? Is its course best characterized as delay or atypical
acquisition? 4) What degree of individual variation exists in
development, and what are its predictors? What are the
underlying causes of specific language impairment? (pp.
641642). Additionally, we might ask: 5) What interventions
effectively increase communicative skill?

Key Words: Down syndrome; language development; specific language impairment

EVIDENCE OF SPECIFIC LANGUAGE

IMPAIRMENT IN DOWN SYNDROME?
Language delay typically accompanies general cognitive
delay (Bellugi details an apparent exception in the work on
Williams syndrome, reviewed in this issue). To ask if there is a
specific language impairment is to ask if the delay is greater than
that observed in nonverbal aspects of cognitive development, or
if language learning or use is somehow different from what one
would expect based on the childs cognitive status. Such
dissociation of language and other cognitive skills can occur in
otherwise typically developing children, and it takes at least two
forms: specific language impairment of expressive language (only), and
specific language impairment of both receptive and expressive language.

MRDD Research Reviews 1997;3:307312.

ndividuals with Down syndrome typically have a third copy

of chromosome 21 (trisomy 21), arising in about 1 in 700
births. The syndrome is one of the most frequent known
genetic causes of mental retardation. Associated with trisomy 21,
and arising from the cascade of effects introduced by the patterns
of increased expression of chromosome 21 genes, are a variety of
physical and behavioral features, including mental retardation
and language delays, middle ear disease, immune and endocrine
system abnormalities, and skeletal, heart, and digestive system
defects [Epstein et al., 1991]. As the genes on chromosome 21
that are related to retardation and language development are
identified, our understanding of the biological-behavioral links
affecting childrens learning, problem solving, and language
development will increase dramatically. The multiple genes,
their interactions, and the causal chains involved will make this a
more complex account than that for syndromes involving single
genes [Epstein, 1990; Korenberg et al., 1994].
The behavioral side, in this equation, requires a detailed
understanding of the development of language and cognitive
skills in children with Down syndrome and their relation to one
another and typical patterns of development. The questions that
have driven research on language skills of children with Down
syndrome have persisted over the last two decades, although our
understanding of the answers has shifted substantially as our
assessment instruments and ability to collect and analyze free
speech samples have expanded. The questions focus on the
attempt to establish a phenotypic description of language skills

r 1997 Wiley-Liss, Inc.

Sensorimotor Period (Mental Age 02)

In children with Down syndrome, sensorimotor development (as indexed by Piagetian tasks of object permanence,
means-end, causality, and schemas in relation to objects) often
appears near normal in the first year, delayed in the second year,
and increasingly delayed at ages 2 to 4 [Dunst, 1990], despite
typical sequences of emergence. Significant weakness in
communication skills, relative to daily living and socialization
skills, are reported on Vineland parent interviews [Dykens et al.,
1994]. Development of speech sounds, for example, is more
delayed [see Stoel-Gammons review, this issue], as are aspects of
joint attention and prelinguistic communication. Children with
Grant sponsor: National Institutes of Health; Grant number: R01HD23353.
*Correspondence to: Robin Chapman, Waisman Center, 1500 Highland Avenue,
University of Wisconsin, Madison, WI 53705. E-mail: chapman@waisman.wisc.edu

Down syndrome more often attend to

the face of the social partner, and less
often to nonfocal toys, than mental-agematched controls [Kasari et al., 1990].
Higher verbal language skills are correlated with more positive affect displayed
toward people and shorter average looks
in the Down syndrome group. The use of
nonverbal requesting is reduced in children with Down syndrome, compared to
mental-age-matched controls [Mundy et
al., 1995]. Initial variance in this measure
was related to the development of
expressive language a year later. In
contrast, high levels of pointing and
reaching and visual checking of the
partners focus of attention appeared in
preverbal children with Down syndrome
[Franco and Wishart, 1995]. Caregivers
were equally responsive to their children
[Mundy et al., 1988].
Although the early emergence of
communicative intentions in Down syndrome shows the same early inventory of
looking, smiling, laughing, reaching,
touching, pointing, showing, giving, and
communicative routines as typically developing children, in similar sequence
[Fischer, 1987], these signals are less likely
to be spontaneous and more likely to be
effective (mothers elicit and respond
contingently more frequently than control mothers). Additionally, these gestures
are less likely to be accompanied by
vocalizations or words [Greenwald and
Leonard, 1979; Smith and von Tetzchner, 1986].
The emergence of early words,
although it varies widely with chronological age, occurs at roughly the same mental
ages in children with Down syndrome as
in typically developing children [CardosaMartins et al., 1985]. Cumulative expressive vocabulary is similar in content to
typically developing children [Gillham,
1990]. Parent report validly reflects observed increases in vocabulary [Miller et
al., 1995b]. Expressive vocabulary shows
a slower rate of progress than mental age
controls [Beeghly et al., 1990; Miller et
al., 1995a].
Early spoken words not only accumulate slowly but are also often less
intelligible [Kumin, 1994; Pueschel and
Hoppman, 1993]. Intervention in this
period of language learning often includes signing, making the children with
Down syndrome more effective communicators and increasing their expressive
lexicon [Miller et al., 1995a]. Use of
exclusively signed words decreases with
time and eventually spoken word use
takes over at preschool ages [Miller et al.,
1995a].
308

Preoperational Stage
(Mental Age 27)
Parent interviews using the Vineland show that expressive language is
significantly weaker than receptive language from 24-month levels on. Communication skill generally continues to lag
behind daily living and socialization skills
[Dykens et al., 1994].
Mervis and Bertrand [1995] examined the learning of novel words for
nameless objects by children with Down
syndrome, showing that ability to perform exhaustive categorization of objects
(a stage 6 sensorimotor achievement) is
linked to childrens ability to fast map
the names of novel objects, to generalize
them, and to make rapid lexical development.

Currently, language
assessment is
recommended for both
lexical and syntactic
development, but not for
both comprehension and
production, for
phenotypic description.
Children with Down syndrome
learn new vocabulary more successfully
when referents constitute good prototypes of the concept category [Mervis,
1990]. Fast mapping of a single novel
word after one or a few exposures in
children and adolescents with Down
syndrome is as good as mental-agematched childrens learning, including
memory for the event involving the
novel object, comprehension of its novel
name, and production of its name on
requestthough, for all children, success
in production is more limited [Chapman
et al., 1990]. However, learning to
produce new verbs for novel actions is
significantly harder than learning novel
nouns for objects [Chapman, 1995]. Use
of vocabulary in narrative tasks is more
restricted than mental-age-matched controls. Both the total number of words and
the number of different words, in 12minute samples, are significantly smaller
than those for control narratives [Chapman, 1997].
The onset of multiword combinations emerges in children with Down
syndrome at mental ages similar to
typically developing controls [Miller et

al., 1995a], but sentence length and

complexity are slower to develop afterward. Expressive syntax in free speech
samples is significantly simpler, as indexed by mean length of childrens
utterances, than mental-age-matched controls [Chapman, 1997; Fowler, 1990,
1995; Rosin et al., 1988]. When transcripts are compared to those of children
matched for mean utterance length, those
of children with Down syndrome show
more frequent omission of grammatical
function words and more variability in
omission of bound morphemes [Chapman, 1995; Fowler, 1995].
Implications for Theories of
Language Deficit
The existence of a specific language
impairment unaccounted for by general
cognitive delay leads researchers to examine more closely the claim that other
cognitive skills are intact. In studies of
children with SLI who are not retarded,
impaired auditory processing, visual imaging, and inferencing skills have all been
proposed as co-occurring with language
impairment in some children. In individuals with Down syndrome, auditory shortterm memory (e.g., as assessed by repeating strings of digits or sentences) is an area
of particular deficit [ Jarrold and Baddeley, in press; Marcel and Weeks, 1988]
that is not improved by reducing distractions [Marcell et al., 1988]. Additionally,
communicative outcomes in Down syndrome have been attributed to abnormal
patterns of cerebral glucose metabolic
rates in language areas [Azari et al., 1994],
slower motor response times [Lincoln et
al., 1985], and anomalous cerebral lateralization [Elliott et al., 1994; Miezejeski et
al., 1994].
Implications for Describing the
Phenotype
Currently [Epstein et al., 1991],
language assessment is recommended for
both lexical and syntactic development,
but not for both comprehension and
production, for phenotypic description.
Clearly, assessment should take place for
both performance domains as well. Limitations in our current standardized assessments of comprehension should also be
acknowledged. Unlike our assessment of
language production in conversational
and narrative samples, comprehension
assessment is not usually extended to
pragmatic factors (e.g., understanding of
speech acts), discourse levels (e.g., story
comprehension), or the timing demands
of ordinary interaction. Tests of word and
sentence comprehension typically provide pictured alternatives and unlimited

MRDD RESEARCH REVIEWS LANGUAGE DEVELOPMENT IN DOWN SYNDROME CHAPMAN

response time. Speed of orientation to

and categorization of auditory stimuli,
and organization of a motor response, are
known to be significantly impaired in
children with Down syndrome [Lincoln
et al., 1985], and not predictable from
their mental age. Comprehension assessments which incorporated conversational
or narrative timing demands might reveal
substantially greater comprehension processing deficits than our tests of word and
structure knowledge reveal.
CHARACTERIZING THE
PATTERN OF LANGUAGE
DEFICIT
Studies specifically testing for patterns of performance confirm that deficits
in expressive language, relative to comprehension, exist; and that within comprehension, lexical comprehension is better
than syntactic comprehension in adolescence [Rosin et al., 1988; Chapman et al.,
1990; Dykens et al., 1994]. On the
Vineland Adaptive Behavior Scales, parents of children age 1 to 11 years with
Down syndrome reported that communication skills were significantly weaker
than daily living and socialization skills.
Within the communication skills scale,
expressive language was significantly
weaker than receptive language [Dykens
et al., 1994]. Adolescents showed a
profile of vocabulary comprehension
better than syntax comprehension, with
both better than expressive syntax as
measured by mean utterance length
[Rosin et al., 1988; Chapman et al.,
1991]. In these two studies, nonverbal
mental age measures either corresponded
to vocabulary [Rosin et al., 1988] or
syntax comprehension [Chapman et al.,
1991], depending on the use of the
Columbia Mental Measurement Test or
subtests from the Stanford-Binet 4th
edition. (The difference in nonverbal
tests appears to arise from the inclusion of
a test of short-term visual memory from
the latter.) Divergence among language
skills and from nonverbal cognition
increases from schoolage to adolescence
[Chapman, 1995].
Implications for Use of Down
Syndrome as a Comparison Group
With Other Syndromes
Fifteen years ago [Rosenberg,
1982], language development in Down
syndrome was viewed as developmentally
lagging, with similar rates of acquisition in
comprehension and production, better
predicted by mental age than chronological age, with no aspect of this picture
except increased unintelligibility associated with the diagnosis of Down syn-

drome. As cognitive and social skills, too,

seemed to develop typically, if with
delay, this made the group seem an ideal
slow-motion comparison group for
other syndromes with mental retardation.
The revised picture of specific strengths
in lexical comprehension and deficit in
expressive language, with auditory shortterm memory deficits more severely
affected than other nonverbal cognitive
domains, substantially alters the interpretations to be drawn in comparing groups
with Down syndrome to other syndromes.

Studies specifically testing

for patterns of
performance confirm that
deficits in expressive
language, relative to
comprehension, exist; and
that within
comprehension, lexical
comprehension is better
than syntactic
comprehension in
adolescence.
Many mental age matches in the
literature were made on the basis of the
Peabody Picture Vocabulary Test, on
which adolescents with Down syndrome
score substantially higher than their nonverbal mental age performance [Chapman et al., 1991]thus leading to a
group of Down syndrome children with
more limited cognitive skills than, e.g., a
typically developing control group. When
matches are made on expressive language
characteristics such as mean length of
utterance, substantial mismatch in (higher)
comprehension and cognitive skills occurs (this is a difficulty in interpreting the
comparisons with children with autism).
When nonverbal mental age is matched,
apparently higher language skills in the
other syndrome may in part reflect the
reduced language skills of the Down
syndrome group (this is a difficulty in
interpreting the Williams syndrome data).
Dissociations with age among visual
spatial tasks with and without a shortterm memory component [Chapman et
al., 1991] mean that measured nonverbal
mental age in adolescence will depend on
test content.

We need to include withinsyndrome comparison of developmentally calibrated tasks to establish evidence

of dissociation; and, in the light of new
evidence, to choose the particular matching variable most crucial to the interpretation of the study, with additional measures to substantiate our beliefs of
equivalence on associated domains.
DEVELOPMENTAL COURSE OF
LANGUAGE ACQUISITION?
Fowler and colleagues [Fowler,
1990; Fowler et al., 1994], on the basis of
longitudinal observation, proposed that
children with Down syndrome encounter a plateau in productive language
development associated either with the
passing of a critical period of maturationthe onset of adolescence (or, on
some versions of the critical period
hypothesis, 7 years chronological age)or
the limitation of syntactic learning to
simple syntaxthat is, a syntactic ceiling. Other cross-sectional [Chapman,
1995] and longitudinal [Carr, 1988;
Chapman, in press] data, as well as
Fowlers subsequent work [Fowler, 1995],
refute these hypotheses. Significant increases can be found in narratives of
adolescents with Down syndrome age
1620 years, in comparison with younger
adolescents, and these narratives contain
instances of complex sentences at rates
similar to younger preschool controls
matched for mean utterance length
(MLU) levels. The appearance of plateaus
in syntax development may in part be
linked to the nature of the sample; past
MLUs of 1.13.0, associated with the
emergence of simple sentences, MLU is
less correlated with chronological age in
free play samples; narratives collected at
this point in time reveal more complex
language [Chapman, in press].
When children and adolescents
with Down syndrome are compared to
controls matched for mean utterance
length, some aspects of morphosyntax
appear more delayed than MLU and
sentence structure generally. Grammatical morphemes (for example, auxiliary
and modal verbs, prepositions, the articles
a and the) were omitted significantly
more often by speakers with Down
syndrome than by MLU-matched controls in narrative samples [Chapman,
1997]. Similarly, Bol and Kuiken [1990]
report delays in the language of Dutch
children with Down syndrome, particularly in the areas of use of subjectpredicate constructions, pronouns, and
verb agreement.

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309

Theories of Delay
The language delay associated with
general cognitive delay can be accounted
for by non-modular theories of language
development that view communicative
intent and the making of meaning as the
driving forces of acquisition in production and comprehension. When the
theory is process-based, development of
the two performances can become dissociated [e.g., Chapman et al., 1992].
Naigles et al. [1995] show that the
particular deficit in verb acquisition in
children with Down syndrome can be
linked to problems of syntactic bootstrappingthat is, being able to draw
information about the verb from the
syntactic frame in which it occurs.
Additionally, input frequency may affect
verb learning, although language input is
typically well adjusted to childrens language levels. Tingley et al. [1994], in
studying mealtime conversations, found
that mothers of children with Down
syndrome used fewer inner state words,
particularly cognitive state words; verbs
from these categories typically contribute
to complex sentence structure forms.
Theories of Grammatical
Morpheme Deficit
Explanations of the additional problems of grammatical morphology for
children with SLI are debated by information processing, connectionist, and linguistic accounts and could be extended to
children with Down syndrome.
A pervasive deficit in sequencing
skills of children with Down syndrome
was proposed by Rosin et al. [1988] to
account for deficits in auditory memory,
expressive language, and speech tasks.
However, examination of recall of visual
sequence of beads, spoken sequence of
digits, and sequence of propositions in
story retellings failed to reveal any
increased frequency of ordering errors
[Kay-Raining Bird and Chapman, 1994].
Leonard [1992] has proposed that
specific deficits in grammatical morphology in children with specific language
impairment (but not mental retardation)
might arise just for those elements of
limited phonetic substance, showing variation in the omitted elements across
languages as a function of phonological
form. A similar account might be attempted for individuals with Down
syndrome to account for the more
frequent omission of grammatical words.
Omission of bound morphemes, which is
much more variable in children with
Down syndrome than their MLUmatched controls [Chapman, 1997], may,
310

in this same line of reasoning, be related

to the presence of hearing problems.
Rosenberg and Abbeduto [1993, p.
91] reject information processing accounts of the delay in morphosyntax
development of children with Down
syndrome, arguing that they cannot
account for the delays in acquisition of
grammatical morphology greater than the
delay in basic sentence structure. They
propose that a Universal Grammar framework [Chomsky, 1986] might better
account for the pattern of exceptional
difficulty in acquisition of grammatical
morphology. In terms of such a framework, one or more principles may not
operate, or are delayed, or one or more of
the parameters of the local language are
not set properly, or are delayed in
activation. Clahsen [1989], for example,
has proposed that verb agreement errors
can be a particular locus of additional
omission and error in children with
specific language impairment. Children
with Down syndrome appear to omit
many additional grammatical morphemes,
however.

The revised picture of

specific strengths in
lexical comprehension and
deficit in expressive
language substantially
alters the interpretations
to be drawn in comparing
groups with Down
syndrome to other
syndromes.
The acquisition of grammatical
morphology has also been viewed as
requiring dual mechanisms: a paradigmbased acquisition of inflections, such as
regular past tense, and an associative
learning mechanism for irregular forms.
Connectionist theories such as those
Marchman (this issue) reviews, however,
have provided strong alternative accounts
of past tense verb learning by taking into
account the frequency with which regular and irregular verbs are encountered,
indicating that apparent dissociations between vocabulary and morphosyntax, or
between irregular and regular past tense
forms, need not be taken as evidence for
dual learning mechanisms at work.
Rather, acquisition reflects the combined

outcome of the history of input and a

learning mechanism that can accommodate nonlinear effects. An underlying
difference, such as a smaller network,
generates greater dissociation between
individual verb and past tense learning.
Extensions of such modeling might
account for the dissociation in lexical
production and grammatical morphemes
seen in Down syndrome.
INDIVIDUAL DIFFERENCES IN
COMMUNICATIVE SKILL?
Wide individual differences in communicative skill exist in individuals with
Down syndrome, but much of this
variation can be understood if the predictors of chronological age, nonverbal
mental age, and hearing status are taken
into account [Chapman, 1995]. Some
degree of mild to moderate hearing loss is
present for as much as 60% of the group
[Dahle and McCollister, 1986] and accounts for some variance in comprehension skill [Chapman et al., 1991]. Learning environment (see Warren, this issue)
and intelligibility (see Stoel-Gammon,
this issue) also play roles in developing
language skills.
The role of auditory short-term
memory, correlated with language deficits, is also of interest [Chapman, 1995].
Rondal [1995] has discussed the exceptional case of a young woman with Down
syndrome and exceptional skill in syntactic aspects of language learning, associated
with good performance on auditory
short-term memory tasks.
EFFECTIVE INTERVENTIONS?
Effective interventions clearly need
to begin in the prelinguistic stage with
support for hearing, initiation of communicative requesting, and sufficient amounts
of input tuned to the childs level. In
reviewing the roles of parent directives or
commands in language intervention, McCathren et al. [1995] conclude that
directives following the childs lead are
likely to support language learning, but
not those initiating new topics or attempting to engage the child. Prelinguistic skills
of requesting, commenting, and vocal
imitation have been successfully taught
and generalized within a milieu teaching
approach that emphasizes the naturalistic
creation of speaking opportunities and a
linguistically responsive environment
[Warren et al., 1993]. Joint attention in
both typically developing children and
those with Down syndrome is increased
when adult play behavior closely follows,
and is contingent on, the behavior of
children [Levy and Dawson, 1992].

MRDD RESEARCH REVIEWS LANGUAGE DEVELOPMENT IN DOWN SYNDROME CHAPMAN

The use of signing to increase

communicative success in early word use
has clearly facilitated effective communication within the family [Miller et al.,
1995a]. Signing appears to drop out as
intelligibility, number of communicative
partners, and vocabulary size increase.
The development of writing and
literacy skills has succeeded with children
with Down syndrome as young as 3 years
[Buckley, 1993, 1994] and offers another
route to augment communicative effectiveness and language development. The
auditory-short-term memory problems
associated with the syndrome are circumvented through the use of print. Full
reading skills in adolescents and young
adults with Down syndrome, just as in
typically developing readers, depend on
skills of phonological awareness for the
learning of lettersound correspondences
and successful decoding of novel words,
but the visual knowledge of words allows
those with Down syndrome to succeed in
early reading grades at levels above their
phonological skill [Fowler et al., 1995].
Work to increase speech intelligibility has
beneficial consequences for communicative effectiveness [Swift and Rosin, 1990].
CONCLUSIONS
The answers to the questions we
began with, then, as we currently understand them from research reviewed here
and elsewhere [Miller, 1988; Fowler,
1990, 1995; Chapman, 1995, 1997], are
as follows:
1. There is specific language impairment relative to nonverbal
cognition in children and adolescents with Down syndrome,
increasingly evident as children
move into preschool and schoolage ages. The general delay in
learning cannot account for the
additional, specific language impairment. The use of children
with Down syndrome as a
control for generally delayed
development is called into question.
2. The characteristic profile of
language skills in individuals
with Down syndrome is one of
major dissociation between
comprehension skills and production skills, with deficits in
production that are more severe
in syntax (average sentence
length and structure) than in
lexical development (vocabulary learning). Acquisition of
grammatical morphology is
more impaired and variable than
overall sentence structure in

production. Phenotype descriptions should include the full

array of processes and linguistic
domains.
3. Researchers continue to debate
whether the developmental
course of language acquisition is
typical or atypical [Chapman,
1995; Fowler, 1990, 1995; Rondal, 1995; Rosenberg and Abbeduto, 1993], although the
majority of the evidence suggests a developmentally typical
sequence of skill acquisition
within each language domain,
but different rates across domains (lexical vs. sentence structure vs. grammatical morphology) and processes (comprehension
vs. production).
4. Individual variation in rate of
language learning, which is great,
can be predicted from nonverbal cognitive level, hearing status, and chronological age
[Chapman, 1995].
5. Interventions that increase communicative effectiveness include early work on all aspects
of cognitive and language development, use of signing or augmentative communication aids
at unintelligible stages of development, management of middle
ear disease and hearing impairment through childhood and
adolescence, the early and continued teaching of literacy skills,
ongoing speech therapy for intelligibility, and language therapy
targeting practice of expressive
language use throughout childhood and adolescence [Spiker
and Hopmann, 1997]. j
ACKNOWLEDGMENT
This review was carried out in an
extension year of grant NIH
R01HD23353 to R. Chapman, while
she was on sabbatical leave at the Applied
Psychology Unit of the Medical Research Council in Cambridge, England,
and a by-Fellow of Churchill College,
Cambridge University.
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MRDD RESEARCH REVIEWS LANGUAGE DEVELOPMENT IN DOWN SYNDROME CHAPMAN