AJSLP
Research Article
Adaptation of the MacArthur-Bates
Communicative Development Inventories for
Spanish Children With Down Syndrome:
Validity and Reliability Data for Vocabulary
Miguel Galeote,a Elena Checa,a Concepción Sánchez-Palacios,a
Eugenia Sebastián,b and Pilar Sotob
Purpose: The MacArthur-Bates Communicative Development
Inventories are widely used to study early language and
communicative development. We recently developed a
Spanish version for children with Down syndrome (the
CDI-Down) adapted to their particular profile of linguistic
and communicative development. The principal aims of this
study are to assess the concurrent validity and test–retest
reliability of the vocabulary section of this adaptation.
Method: Validation for productive vocabulary (Study 1) was
achieved by correlating CDI-Down scores on expressive
vocabulary and measures on the basis of spontaneous
speech samples (n = 29). Validation for receptive vocabulary
(Study 2) was achieved by correlating CDI-Down scores on
receptive vocabulary and measures derived from language
T
he assessment of early communicative and language
development poses substantial methodological
challenges. As Mervis and Becerra (2003) pointed
out, language samples obtained through recordings of parent–
child interactions consistently underestimate children’s
language skills for at least two reasons: (a) Young children
talk less when they find themselves in unfamiliar settings
or around people they do not know well, and (b) it is im-
possible during a play session to simulate the wide variety
of situations in which a child produces language. Further-
more, this approach is expensive and time-consuming (i.e.,
transcription and analysis of naturalistic language samples
requires highly trained personnel and a substantial amount
a the examiner. CDIs therefore provide a rapid overall assess-
University of Málaga, Spain
b
Autonomous University of Madrid, Spain
Correspondence to Miguel Galeote: mgaleote@uma.es
Editor: Krista Wilkinson
Associate Editor: Deborah Fidler
Received January 22, 2015
Revision received June 30, 2015
Accepted December 8, 2015
DOI: 10.1044/2015_AJSLP-15-0007
American Journal of Speech-Language Pathology • Vol. 25 • 371–380 • August 2016 • Copyright © 2016 American Speech-Language-Hearing Association
items of the Brunet-Lézine Scale (Josse, 1997; n = 70).
Reliability (Study 3) was measured with a subset of parents
who completed the same inventory 4 months after the
original sampling (n = 26).
Results: CDI-Down expressive and receptive vocabulary
scores showed a significant positive relationship with their
comparison measures, thereby demonstrating convergent
validity. A significant positive relationship was also
found between test–retest measures for productive and
receptive vocabularies, thus supporting the reliability of the
adaptation.
Conclusion: The results demonstrate that the CDI-Down
is a valid and reliable tool that could be useful for parents,
teachers, clinicians, and researchers.
of time), and children’s performance is affected by factors
such as fatigue or lack of familiarity with the examiner.
Similar problems arise when using standardized measures.
As a result, most studies incorporating language samples
use small numbers of participants, and large-scale studies
are very scarce.
One viable alternative is to use parent reports, one of
the most popular being the MacArthur-Bates Communi-
cative Development Inventories (CDIs; Fenson et al., 1991,
1993, 2007). CDIs have several strengths when assessing
early communicative and language development (Fenson
et al., 1993): (a) They are cost-effective and time-efficient,
(b) they take advantage of parents’ extensive knowledge of
their child’s language abilities, and (c) the child’s perfor-
mance is not affected by fatigue and lack of familiarity with
ment that can serve both screening and research purposes.
There are two forms of CDIs: words and gestures
(CDI:WG) for children ages 8 to 16 months and words and
sentences (CDI:WS) for children ages 16 to 30 months. The
CDI:WG consists of a list of words and a list of gestures
Disclosure: The authors have declared that no competing interests existed at the time
of publication.
371
and actions. The list of words is divided into several se-
mantic categories that include nouns, verbs, and grammar
words (e.g., articles, prepositions). The list of gestures and
actions is also grouped into categories (i.e., deictic and rep-
resentational gestures, routines, pretend actions). The CDI:
WS form also consists of a list of words divided into several
categories in addition to a section on grammar production
that assesses first word combinations, emerging syntax, and
use of various morphological forms.
There is now a substantial body of literature demon-
strating the validity and reliability of CDIs for assessing
early language development of children learning English
(Dale, 1991; Dale, Bates, Reznick, & Morisset, 1989;
Fenson et al., 1994), Italian (Camaioni, Caselli, Longobardi,
& Volterra, 1991; Modena & Caselli, 1996), Mexican Span-
ish (Jackson-Maldonado et al., 2003; Jackson-Maldonado,
Thal, Marchman, Bates, & Gutiérrez-Clellen, 1993), Euro-
pean Spanish (López-Ornat, Gallego, Gallo, Karousou,
& Mariscal, 2005), and Galician (Pérez-Pereira & García-
Soto, 2003; Pérez-Pereira & Resches, 2011). Because of this
high validity and reliability, CDIs have been incorporated
into early language assessment batteries along with other
standardized tests and language samples.
It is important to note that CDIs have been used to
assess early language development not only in children with
typical development (TD) but also in those with particular
conditions (e.g., preterm, early and late talkers, language-
impaired children) or certain types of developmental disabil-
ities. However, very few studies have been done on the
validity and reliability of this instrument for children with
disorders. This is a relevant point because each develop-
mental disorder has its own particular characteristics (i.e.,
different behavioral and language profiles), which a CDI
may not take into account. As Bruckner, Yoder, Stone, and
Saylor (2007, p. 1636) noted, “Characteristics of clinical
populations may differ from those of typical populations in
important ways that affect item functioning and validity.”
Therefore, CDIs should not be considered as general tools
that can be used to assess children who are not developing
typically or who present developmental disabilities; for these
children, a specific adaptation is needed.
Children with Down syndrome (DS) represent one such
group. These children present a general delay in language
development in relation to other developmental areas (e.g.,
cognition, social), and this delay increases as they get older.
They also show specific dissociations among different linguis-
tic domains (e.g., comprehension vs. production) or subdo-
mains (e.g., lexicon vs. morphosyntax; Abbeduto, Warren,
& Conners, 2007; Berglund, Eriksson, & Johansson, 2001;
Caselli et al., 1998; Chapman, 1995; Chapman, Schwartz,
& Kay-Raining Bird, 1991; Chapman, Seung, Schwartz, &
Kay-Raining Bird, 1998; Fowler, 1990; Galeote, Sebastián,
Checa, Rey, & Soto, 2011; Galeote, Soto, Sebastián, Checa,
& Sánchez-Palacios, 2014; Miller, 1988, 1999; Roberts,
Price, & Malkin, 2007; Vicari, Caselli, & Tonucci, 2000).
However, children with DS often use more complex com-
municative gestures than do children with TD. In fact,
gesture production is considered a strength of children with
372 American Journal of Speech-Language Pathology • Vol. 25 • 371–380 • August 2016
DS relative to their receptive and expressive language skills
(Caselli et al., 1998; Chan & Iacono, 2001; Galeote et al.,
2011; Singer-Harris, Bellugi, Bates, Jones, & Rossen, 1997).
In light of the above, it is clearly important to adapt
CDIs to the developmental profile of children with DS.
To date, however, they have not been adapted to the profile
of language development shown by children with DS, nor
has the original version been validated for these children
with the exception of a single study of the productive vocab-
ulary section (Miller, Sedey, & Miolo, 1995). Therefore, the
first objective of the research project of which the present
study forms part was to adapt CDIs to the profile of language
and communicative development of children with DS.
An adaptation of this kind would also need to be vali-
dated for use by parents of children with developmental dis-
abilities. As highlighted by Miller et al. (1995), the validity
of parent report instruments cannot be taken for granted in
families of children with developmental disabilities because
parents of these children may not have the same reporting
styles as parents of children with TD. For example, several
studies have found that parents of disabled children overesti-
mate their child’s performance on cognitive tasks as compared
with their actual performance on standardized tests (Gradel,
Thompson, & Sheehan, 1981; Hunt & Paraskevopoulos,
1980). On the other hand, Miller (1988) suggested that parents
of children with developmental disabilities are often in-
formed at the child’s birth or shortly after that his or her
development may be significantly compromised. This knowl-
edge may limit parents’ expectations of their child’s devel-
opment and lead them to underestimate his or her abilities.
In the case of children with DS, the asynchronies within
different linguistic domains and subdomains, as well as in
other developmental areas, may make the accurate reporting
of language abilities even more challenging for parents. This
further underlines the importance of assessing the validity
of parent report measures for use with this population.
In previous work, Galeote, Soto, Lamela, et al. (2006)
and Galeote, Soto, Serrano, et al. (2006) developed an adapta-
tion of the CDI for use with children with DS (hereinafter,
the CDI-Down). The main aims of the present study were to
examine the concurrent validity and reliability of the vocab-
ulary checklist section of the new adaptation. In the next
section, we summarize the general structure of the CDI-
Down, focusing specifically on the vocabulary part and de-
scribing the modifications made in order to take into account
the profile of language development shown by children with
DS. We also refer to other sections or aspects of relevance
for this research (instructions, cultural and linguistic modi-
fications, etc.; for a detailed description of the adaptation,
see Galeote, Soto, Lamela, et al., 2006; Galeote, Soto,
Serrano, et al., 2006).
Adaptation of the CDI: General Structure
and Modifications
At present, there are two recognized adaptations
of the CDI in Spanish: one in Mexican Spanish and
the other in Iberian Spanish. The first was produced by
Jackson-Maldonado et al. (2003) and the second by López-
Ornat et al. (2005). The CDI-Down draws on both these
previous versions. Although the two adaptations present a
considerable overlap, the Iberian Spanish version is adapted
to the linguistic and sociocultural context of Spain (in terms
of vocabulary used and the routines of interactive games
most commonly played in Spain, etc.). Data from previous
work on the development of vocabulary in Spanish-speaking
children collected by our own research group (Lamela &
Soto, 2003) was also used as well as information provided by
parents of children with DS and clinicians working with
these children (see below). Last, the adaptation in Galician
by Pérez-Pereira and García-Soto (2003), one of the first
adaptations of CDIs produced in Spain, was also consulted.
Our adaptation applies the same shared standards
and procedures as the original CDI format and maintains
the major structural categories. As in the original version, the
CDI-Down consists of the same three parts: (a) vocabulary
(words), (b) actions and gestures, and (c) sentences and gram-
mar. The vocabulary part includes a vocabulary checklist
containing 651 words organized into 21 categories: animals,
vehicles, clothing, body parts, action words, and so forth.
A major difference of the CDI-Down is that the two
original forms of the CDI are combined into a single inven-
tory that assesses the whole age range (from 8 to 30 months).
The rationale for this was that the chronological age (CA)
of children with DS is often twice that of their mental age
(MA). Compared with children with TD, therefore, children
with DS have a broader experience of the world, which
may create opportunities for more diverse vocabulary expo-
sure and learning (Chapman, 1995; Galeote et al., 2011;
Grela, 2002, 2003). Indeed, Chapman et al. (1991) observed
superiority in comprehension in a group of adolescents and
young adults with DS, and Galeote et al. (2011) found a
similar result in children with DS with a MA of 8–29 months.
Regarding gestural communication, Franco and Wishart
(1995) and Singer-Harris et al. (1997) have demonstrated
that the greater ability shown by children with DS in using
communicative gestures results from their longer social
experience due to their older CA. Although we do not claim
that children with DS produce greater numbers of words
than do children with TD, one cannot rule out differences
in the content of their vocabulary. Bruckner et al. (2007)
made a similar argument for toddlers with autism spectrum
disorders, stating that differences in the experiences of chil-
dren in different groups at different CAs may affect the
content of the mental lexicon.
As a consequence, in the vocabulary checklist, we
assess both spontaneous production and comprehension of
words in children with mental ages of 8 to 30 months. We
assess word comprehension because one of the character-
istics of the developmental profile of children with DS is
the relative preservation of their lexical comprehension
versus lexical production abilities (Abbeduto et al., 2007;
Chapman, 1995; Chapman et al., 1991; Galeote et al., 2011;
Roberts et al., 2007).
Another significant modification in the CDI-Down
has to do with age. Given the wide variability in cognitive
performance among children with DS, CA may not be an
adequate measure for studying language development.
Hence, we take into account the child’s MA, which can be
determined using any test that measures a baby’s develop-
mental age. In the present study, we used the Brunet-Lézine
Psychomotor Development Scale (hereinafter, the BL Scale;
Josse, 1997).
Last, the CDI-Down also assesses symbolic or refer-
ential gestures. Here, we added a third column (“understands
and gestures”) after the standard comprehension and pro-
duction columns (“understands” and “understands and
says”), the aim being to assess spontaneously produced
gestures representing concrete lexical items (e.g., closing
the fingers tightly together and bringing them near the
mouth to simulate “eat”). Parents are encouraged to dis-
tinguish these gestures from more general deictic or pointing
gestures.
General Information
The section of the CDI compiling general informa-
tion about children and their families was modified and
extended in order to account for physical, social, and family
aspects of children with DS that might influence their lan-
guage and communicative development. Thus, in the
CDI-Down, this section includes information about hearing
and visual impairments, general health information (meta-
bolic diseases, hearing infections, etc.), schooling and early
intervention programs, and family information (sociocultural
level, pregnancy, previous knowledge of DS, birth difficul-
ties, etc.) that may affect language development.
Instructions
Special attention was also paid to the general and
specific instructions for completing the inventory. First, as
noted earlier, parents of children with developmental dis-
abilities may have different reporting styles (Miller et al.,
1995). Second, parents evaluate their children’s language level
according to their knowledge of the behavior to be observed
(Carrillo, Jackson-Maldonado, Flores, & Thal, 1997; Fenson
et al., 2000). Last, levels of education, socioeconomic status,
and ethnicity may be associated with different CDI scores.
As Stiles (1994) pointed out, the design of the CDI places
multiple demands on parents to observe and interpret
various aspects of communication. Feldman et al. (2000)
noted that each of the CDI scales is potentially susceptible
to effects and biases related to the parents’ educational level.
In developing the CDI-Down, therefore, we sought to
make the instructions clear and to provide examples so as to
ensure that parents really do understand their task.
Cultural and Linguistic Adaptation of the Inventory
Care was also taken to ensure that the CDI-Down
was well suited to the cultural and linguistic setting in which
it would be used. Thus, before deciding upon the final
version, we asked several professionals (clinicians working in
early intervention units or associations for children with
Galeote et al.: Validity and Reliability of CDI-Down 373
DS, teachers, caregivers, etc.) and a sample of 20 parents
about the content of the inventory. They were provided with
a preliminary version of the CDI-Down and received an ex-
planation of its objectives. They were then asked to check if
it reflected the language development of children with DS
(daily and frequent words, gestures, behavior, etc.). Both
clinicians and parents agreed that the inventory was fit for
purpose. They especially endorsed the instructions, and they
stated that the behaviors considered in the inventory were
consistent with those shown by their children in daily life.
In the next section, we present the results of three stud-
ies performed to attain our main objectives:
1. To establish the concurrent validity of the CDI-Down
for productive vocabulary, comparing the results
obtained in the inventory with spontaneous language
measures (Study 1).
2. To establish the concurrent validity of the CDI-Down
for receptive vocabulary comparing the results ob-
tained with those of an independent test (Study 2).
3. To study the reliability of the CDI-Down for produc-
tive and receptive vocabulary through a test–retest
procedure (Study 3).
Study 1. Concurrent Validity:
Productive Vocabulary
The purpose of this study was to examine concurrent
validity for productive vocabulary on the CDI-Down
vocabulary checklist. Concurrent validity is demonstrated
when a measure under evaluation correlates well with
another measure that has previously been validated for the
assessment of similar abilities. Here, this was achieved by
correlating parental reports of productive vocabulary from
the CDI-Down with the number of different words pro-
duced spontaneously during a 30-min language sampling.
This is the approach most commonly used in validation
studies of CDI productive vocabulary.
Method
Participants
Twenty-nine children (17 girls, 12 boys) with DS
and their parents participated in this study (see Table 1).
Twenty-four of these children had taken part in an earlier
normative study (Galeote, Soto, Sebastián, Rey, & Checa,
Table 1. Means and ranges for chronological age (CA) and mental age (MA) of the children with Down syndrome who participated in each of
the three studies.
Study Girls Boys
1. Concurrent validity: Productive vocabulary 17 12
2. Concurrent validity: Receptive vocabulary 37 33
3. Reliability 11 15
Note. Age is presented as months;days.
374 American Journal of Speech-Language Pathology • Vol. 25 • 371–380 • August 2016
2012). The children ranged in CA from 26;4 (months;days)
to 72;19 (M = 52;12, SD = 13;27) and in MA from 15;15 to
29;12 (M = 24;28, SD = 3;25). MAs were calculated using
normative data of the BL Scale. All children met the follow-
ing inclusion criteria: (a) cytogenetic documentation of
trisomy 21 and (b) absence of neurosensory deficits and
psychopathological disorders. All children had a monolin-
gual Spanish background.
Although this sample may seem small for a validity
study, it represents 12.61% of the total sample in the nor-
mative study (230 children with DS from 8 to 29 months of
MA; see Galeote et al., 2012). This proportion is higher
than those used in other studies of CDI validity involving
children with TD.
Vocabulary levels varied widely. Taking as a reference
the data from our normative study (Galeote et al., 2012),
19 children were between the 25th and 75th percentiles,
three were below the 25th percentile, and seven were above
the 75th percentile. This reflects the large interindividual
variability typical of people with DS.
With respect to the mother’s educational level, eight
(27.59%) had primary studies, nine (31.03%) had com-
pleted secondary education, and 12 (41.38%) held a uni-
versity degree. Eleven children (37.93%) were first born,
13 (44.83%) second born, and three (10.34%) later born.
Two girls were first-born twins.
Children were recruited from the cities of Malaga and
Madrid, Spain. Families were contacted through early in-
tervention units or associations for children with DS, from
which the children received their standard treatment. In-
formed consent was obtained from the families. The research
followed the ethical guidelines of the Spanish Psychological
Society. All parents willingly participated in the data col-
lection and showed interest in the instrument; in fact, they
often stated that the task of completing the CDI-Down made
them observe their child more carefully and made them
more aware of his or her real abilities.
Instruments
MA was measured by means of the BL Scale. This
scale assesses the development of children 1–30 months of
age in four domains: postural control and motor function;
oculomotor coordination or adaptation to objects; language;
and social and personal relationships.
For the assessment of vocabulary, a copy of the
CDI-Down was given to each family. Spontaneous speech
CA, mean MA, mean
Total (range) (range)
29 52;12 (26;4–72;19) 24;28 (15;15–29;12)
70 35;24 (11;12–71;1) 19;2 (8;3–29;12)
26 44;7 (11;12–67;23) 22;7 (10;18–29;12)
samples were also obtained using three sets of toys: (a) farm
toys with farmers, animals, and vehicles; (b) vegetables and
money as a shopping game; and (c) plastic mobile tele-
phones. In addition, we used a picture book especially de-
signed for the purpose of this research. Both the pictures
in the book and the other material already mentioned rep-
resented words featured in the vocabulary section of the
CDI-Down, such as animals, parts of the body, vehicles,
and clothes.
Procedure
An initial interview was held with the parents of each
child, in which the research objectives were carefully and
clearly explained. The instructions for completing the CDI-
Down were read aloud, and each section was shown and
explained so as to ensure that parents understood every
item. Parents were asked to begin by simply observing their
child during a week, thus giving them time to observe a
range of the child’s communicative behaviors. At the end of
the week, they completed the inventory, which was to be
returned within a maximum of 10 days.
Once the inventory was returned, parents attended
a new interview during which they discussed any difficul-
ties they had, and the inventory was reviewed in order to
detect any mistakes or misunderstandings. The aim was
to make sure that parents had filled them out correctly and
completely.
During this period, MAs were obtained and spon-
taneous language samples were collected. For the latter, the
children were filmed as they participated in approximately
30 min of free play: 15 min with the parent and 15 min with
the examiner (an expert in speech-language pathology).
Parents were asked to interact with their child as they
would usually do at home. All sessions included toy play
(especially with the farm), symbolic play (especially with the
shopping set and the mobile telephones), and book reading.
All intelligible and nonimitative utterances produced
by the children during the play interactions (30 min) were
transcribed orthographically and analyzed manually. Be-
cause the speech of children with DS is often unintelligible,
we chose a conservative method to transcribe the samples
of spontaneous language. First, the samples were ortho-
graphically transcribed by a trained transcriber. A second
transcriber then transcribed the samples independently,
and all disagreements were marked. Second, the two tran-
scribers reviewed together the items on which there was
disagreement until they reached a consensus. If the two
transcribers could not reach agreement, a third transcriber
(the third author) watched the videotapes. If she agreed
with one of the two coders, then the agreed-upon utterance
was retained. If she did not agree with either transcriber,
the word was deleted from the data. A total of 14 language
samples were analyzed to determine the reliability of the data
(words produced) transcribed. For orthographic transcrip-
tion of words, the average agreement before reviewing the
disagreements was 93.09% (range: 79.66%–100.00%). After
review, the reliability was 98.44% (range: 93.22%–100.00%).
The number of different words (lexical diversity) produced
spontaneously by the children was then calculated (imitated
words were excluded; formulas and routines were only
considered if they were produced spontaneously).
Results and Discussion
The mean scores, standard deviations, and ranges
for parent report vocabulary (CDI-Down) and observed
vocabulary are presented in Table 2. There was important
variability among children in the overall number of words
produced according to both measures.
Correlations were calculated between (a) number of
words reported in the vocabulary section of the inventory
and (b) the number of different words (types) produced
spontaneously by the children during the naturalistic inter-
actions. Because the second variable violated the Shapiro-
Wilks test of normality (S-W = .84, df = 29, p = .001),
Spearman’s rho coefficients were calculated in order to
obtain validity estimates. High and significant correlations
between the two measures were obtained (rs = .91; p = .000,
one-tailed).
Our correlations were very similar to those obtained
in previous studies using the same measures for validity:
r = .83 in the study by Bates, Bretherton, and Snyder (1988);
r = .79 in the report by Beeghly, Jernberg, and Burrows
(1989); and r = .84 in the study by Jackson-Maldonado
et al. (1993). Pérez-Pereira and Resches (2011) also found
strong and significant correlations between the number
of words in the CDI and the number of different words ob-
served in spontaneous language samples at ages 18 and
24 months (r = .86 and r = .80, respectively). Miller et al.
(1995) reported a correlation of .82 for parents of children
with DS and .75 for parents of children with TD. Thus, our
data provide strong evidence for the validity of CDI-Down
in relation to the assessment of the productive vocabulary
of children with DS.
Study 2. Concurrent Validity:
Receptive Vocabulary
The purpose of this study was to examine the concur-
rent validity for receptive vocabulary on the CDI-Down
vocabulary checklist. This was achieved by correlating pa-
rental reports of receptive vocabulary (number of words
understood by their children) using the CDI-Down with the
number of words understood by their children in some lan-
guage items from the BL Scale. A similar procedure was
followed by Dale et al. (1989), who used the receptive lan-
guage items on the Bayley Scales of Infant Development
(Bayley, 1969) as a criterion variable.
Analyzing the validity of parental reports by compar-
ing them with the child’s comprehension on another mea-
sure was regarded as important for two reasons. First, this
aspect is not usually assessed in CDI validation studies, and
second, the CDI:WS does not evaluate vocabulary com-
prehension. The reason for this is that “parents are less
likely to be able to keep track of both comprehension and
production as their child’s expressive language begins to
Galeote et al.: Validity and Reliability of CDI-Down 375
Table 2. Parent reports of vocabulary and the observed vocabulary measure (Study 1) and the number of words understood on the language
items of the Brunet-Lézine Psychomotor Development Scale–Revised (Study 2).
Study Measures
Study 1: Production CDI
Spontaneous speech
Study 2: Comprehension CDI
Number of items understood
Note. CDI = MacArthur-Bates Communicative Development Inventory.
grow rapidly toward the end of the second year of life”
(Jackson-Maldonado et al., 2003, p. 11). Because the CDI-
Down assesses comprehension up to 30 months of MA,
it was necessary to check that parents’ responses were valid.
Method
Participants
The participants were 70 children (37 girls, 33 boys)
with DS and their parents, 19 of whom had participated in
Study 1. All these children had been included in the nor-
mative study. This sample represented 30.43% of the total
sample in the normative study (see Galeote et al., 2012).
The children ranged in CA from 11;12 to 71;1 (M = 35;24,
SD = 16;04) and in MA from 8;03 to 29;12 (M = 19;02,
SD = 6;14). Mental ages were again measured by means of
the BL Scale. All children met the same inclusion criteria
as in Study 1, and all of them had a monolingual Spanish
background.
There was great variability in the level of vocabulary
comprehension. Taking as a reference the data from our
normative study (Galeote et al., 2012), 43 children were
between the 25th and 75th percentiles, 13 were below the
25th percentile, and 14 were above the 75th percentile. As
in Study 1, this distribution reflects the large interindividual
variability typical of people with DS.
With respect to the mother’s educational level, 20
(28.57%) had primary studies, 26 (37.14%) had completed
secondary education, and 24 (34.28%) held a university
degree. Thirty children (42.86%) were first born, 30 (42.86%)
second born, and 10 (14.28%) later born.
Children were recruited from a number of Spanish
cities, mostly in the region of Andalusia. Families were
contacted in the same way as in Study 1. Informed consent
was again obtained, and all parents willingly participated in
the data collection, showing a similar degree of interest.
Instruments and Procedure
Each family was given a copy of the CDI-Down. The
general procedure followed was the same as in Study 1:
Two interviews were held, and the children’s MAs were ob-
tained by means of the BL Scale. As already stated, com-
prehension was assessed using language items from the BL
Scale that serve to test children’s understanding of names of
objects. This test is presented at developmental levels corre-
sponding to 14, 17, 20, and 24 months (numbers of items:
109, 118, 127, and 137). Children are considered to have
376 American Journal of Speech-Language Pathology • Vol. 25 • 371–380 • August 2016
n Mean SD Range
29 275.59 181.92 18–640
29 75.59 55.22 3–278
70 291.40 197.62 8–654
70 4.23 3.32 0–8
reached these developmental levels if they understand at
least one word at 14 months, three at 17 months, four at
20 months, and eight words at 20 months.
The objects presented to the children in the BL Scale
are a ball, doll, car, spoon, glasses, button, horse, clock,
pencil, and a sheep. All these objects occur frequently in early
childhood, and their names all appear in the CDI-Down. The
objects were placed in front of the child (at the 14-month
level, only the first five objects were presented) while simul-
taneously asking him or her, “What is this?” If the child
had not named all the objects once they had been presented,
the examiner then held out a hand, palm upward, and
asked the child to give her an object (e.g., “Give me the
ball”). In this case, it was important not to ask the child for
the object that he or she was currently touching or looking at.
For the purpose of scoring, the total number of words
parents reported (using the CDI-Down) as understood by
their child was added. For the BL Scale language items,
each child was assigned a score on the basis of the number
of object names that he or she had understood. Children
who failed to respond to any of these language items were
given a score of zero.
Results and Discussion
The mean scores, standard deviations, and ranges for
parent reports of vocabulary and the number of words
understood on the BL Scale are presented in Table 2. There
were considerable differences among children in the overall
number of words understood according to both measures.
These interindividual variations are typical of children
with DS.
Correlations were calculated between (a) the number
of words understood according to parent reports using the
vocabulary section of the CDI-Down and (b) the number
of words understood when administering the language
items of the BL Scale. Because the two variables violated
assumptions of normality (S-W = .94, df = 70, p = .002
and S-W = .80, df = 70, p = .000), Spearman’s rho coefficients
were calculated in order to obtain validity estimates. High
and significant correlations between the two measures were
obtained (rs = .79; p = .000, one-tailed).
These results are important for two reasons. First,
they show the validity of CDI-Down in relation to the
assessment of the receptive vocabulary of children with DS.
Second, they justify one of the most important modifica-
tions made when developing the CDI-Down, namely the
decision to assess vocabulary up to 30 months of MA. Of
the 70 children who took part in this study, 55 had an MA
above 18 months (the CDI:WS begins at 16 months).
These results are similar to those obtained by Dale
et al. (1989) when using the receptive language items on the
Bayley Scales of Infant Development as a criterion variable.
In their study, the total vocabulary score was based on the
Early Language Inventory, a previous version of the CDI,
and their validity data were derived from samples of full-term
(n = 32), social risk full-term (n = 65), preterm (n = 21),
and precocious (n = 44) children. Correlations between total
vocabulary at age 20 months and the receptive language
subscore of the Bayley Scales of Infant Development at age
24 months (there was a 4-month interval between the two
measures) were statistically significant for full-term, social
risk, and precocious samples (r = .59, .41, and .50, respec-
tively). The correlation was not significant for the preterm
sample (r = .13). Our results cannot be compared with other
studies because, as already noted, vocabulary comprehension
is not usually examined in CDI validity studies. At all events,
this is the first time that this aspect has been evaluated in
children with DS.
Study 3. Reliability
Reliability refers to the consistency with which the
items on a test or scale produce similar results under consis-
tent conditions. In this study, the reliability of the CDI-
Down was evaluated by means of the test–retest procedure
(i.e., the extent to which test scores are consistent across
two or more assessment sessions). To this end, we asked a
group of parents to fill out the inventory a second time.
Method
Participants
Participants in this study were the parents of 26 chil-
dren (11 girls, 15 boys), 19 of whom had participated in
Study 1, 18 in Study 2, and 17 in both. All these children
had been included in the normative study (Galeote et al.,
2012), and they represented 11.30% of the total sample in
that study. At Time 1 the children ranged in CA from 11;12
to 67;23 (M = 44;07, SD = 17;26) and in MA from 8;15
to 28;24 (M = 21;03, SD = 6;15). At Time 2, the children
ranged in CA from 15;7 to 70;18 (M = 48;4, SD = 17;11)
and in MA from 10;18 to 29;12 (M = 22;07, SD = 5;24;
four children were not assessed). The mean interval between
the two assessments was 3.26 months (SD = 3.06, range =
1.24–5.15). MAs were again measured by means of the
BL Scale. All the children recruited for this study met the
same inclusion criteria as in Studies 1 and 2, and they all
had a monolingual Spanish background.
Levels of receptive and productive vocabulary varied
considerably. Taking as a reference the data from our nor-
mative study (Galeote et al., 2012), the results for com-
prehension showed that 22 children were between the 25th
and 75th percentiles, two were below the 25th percentile,
and two were above the 75th percentile. With respect to
production, 16 children were between the 25th and 75th per-
centiles, seven were below the 25th percentile, and three were
above the 75th percentile.
In terms of the mother’s educational level, four (15.38%)
had primary studies, 12 (46.15%) had completed second-
ary education, and 10 (38.46%) held a university degree.
Eight children (30.77%) were first born, 14 (53.84%) second
born, and four (15.38%) later born.
Children were recruited from a number of Spanish
cities, mostly in the region of Andalusia. Criteria for inclu-
sion and the general recruitment procedure were the same
as in the previous study.
Instruments and Procedure
The same inventory (CDI-Down) was given to par-
ents approximately 3 months after the original sampling,
thus allowing us to examine test–retest reliability. Care was
taken to remind parents that they should begin by observing
their children during a week.
This time interval between the two data collection
points was chosen for several reasons. First, and as noted
earlier, children with DS are identified as such right from
birth, and their parents generally monitor their development
very closely. Second, language development is very slow in
these children. As a consequence, parents often have a very
clear memory of their child’s previous language and com-
municative behaviors, and this could affect the results of re-
liability studies. Last, other studies have also used long
intervals. For example, Fenson et al. (1994) and Pérez-
Pereira and García-Soto (2003) used, respectively, intervals
of 6 and 9 months between the first and second assessment
points.
Results and Discussion
The mean scores, standard deviations, and ranges for
parent reports of comprehension and productive vocabu-
lary at Times 1 and 2 are presented in Table 3. There were
considerable differences among children in the overall num-
ber of words produced and understood at Times 1 and 2.
Correlations were calculated between the number of
words reported by parents in the first and second samples
(using the vocabulary section of the CDI-Down) as being
understood and produced by their children (see Table 3).
For comprehension, Pearson product–moment correlation
coefficients were calculated in order to obtain reliability
measures (the variables did not violate assumptions of
normality). High and significant correlations were obtained
between the two measures (r = .90; p = .000, one-tailed).
Table 3. Parent reports of vocabulary (production and
comprehension) at Times 1 and 2 (Study 3).
Vocabulary Measures n Mean SD Range
Production Time 1 26 131.08 144.65 0–409
Time 2 26 195.42 188.73 4–512
Comprehension Time 1 26 339.00 175.88 44–602
Time 2 26 401.08 164.76 90–465
Galeote et al.: Validity and Reliability of CDI-Down 377
 For vocabulary production, Spearman’s rho coeffi-
cients were calculated in order to obtain validity estimates
because both variables violated assumptions of normality
(S-W = .82, df = 26, p = .000 and S-W = .83, df = 26,
p = .001 for Measures 1 and 2, respectively). High and sig-
nificant correlations were obtained between the two measures
(rs = .93; p = .000, one-tailed).
These data provide evidence of strong reliability for
the CDI-Down as a measure of vocabulary comprehension
and production. The correlations obtained are also sim-
ilar to those reported previously. For example, Jackson-
Maldonado et al. (1993) obtained statistically significant
correlations between their two assessment points of .97 for
word comprehension and .81 for word production, on the
basis of administration of the CDI:WG to a sample of
16 children. The same authors also report a significant corre-
lation of .70 for the CDI:WS in a sample of 20 children.
López-Ornat et al. (2005) obtained even higher correlations
for the former inventory (.98 and .99 for vocabulary com-
prehension and production, respectively); for the second
inventory, these authors report a correlation of .99 for pro-
ductive vocabulary. For their part, Pérez-Pereira and García-
Soto (2003) obtained a correlation of .62 for productive
vocabulary in a sample comprising 41 sets of parents.
General Discussion
The primary aims of this research were to examine
the validity and reliability of the vocabulary part of the
CDI-Down. Correlations were high and statistically signifi-
cant between CDI-Down scores on expressive vocabulary
and measures from spontaneous speech samples (Study 1),
CDI-Down scores on receptive vocabulary and measures
made on the basis of language items from the BL Scale
(Study 2), and parent reports at Times 1 and 2 for the num-
ber of words understood and produced by their children
(Study 3). These results provide strong evidence for the
validity and reliability of this adaptation of the CDI and
support its use as a tool for assessing productive and re-
ceptive vocabulary development in Spanish-speaking chil-
dren with DS.
Although our findings in general add to the literature
on the validity and reliability of CDI, particular mention
should be made of the results for receptive vocabulary. This
is because hardly any data have been published on this
measure (although see Dale et al., 1989), and to the best of
our knowledge, this is the first time that this aspect has
been assessed in children with DS. Our data are also rele-
vant because the CDI-Down examines receptive vocabulary
from 8 to 30 months (as opposed to the CDI:WG, e.g.,
which stops at 16 months). The inventory covers this wider
age range because children with DS often show a dissociation
between productive and receptive language, and normative
data regarding both aspects are required.
As we noted in the introduction, several authors have
suggested that the validity of parent report instruments
cannot be taken for granted for families of children with de-
velopmental disabilities because these parents may not have
378 American Journal of Speech-Language Pathology • Vol. 25 • 371–380 • August 2016
the same reporting styles as parents of children with TD
(Gradel et al., 1981; Miller, 1988; Miller et al., 1995).
Nevertheless, our data indicate that parents of children with
DS can provide a valid report of their child’s language and
communicative ability. Several factors could explain our
results. One is that we conducted an initial interview to
make sure that parents clearly understood not only the aims
of our research but also each part of the inventory and the
task they were being asked to perform. In other words,
steps were taken to ensure that the inventory was completed
properly. Parents were also requested to observe their chil-
dren for a week prior to filling in the CDI-Down (see also
Caselli et al., 1998). Although this procedure is more time-
consuming and demanding for parents, it may help to
reduce the overestimations and underestimations that are
often associated with parental reports. Another possible
explanation for our results has to do with the particular char-
acteristics of parents of children with DS. Because these
children are identified as such at birth, their parents tend to
monitor their general development, and particularly their
language development, from the earliest stages. In fact, the
interviews held after the CDI-Down had been returned
revealed that parents carefully observed their children’s de-
velopmental progress. A third explanation might be that
language development in children with DS is delayed, and
so parents may find it relatively easy to monitor their prog-
ress; however, this possibility needs to be assessed in an
experimental situation.
To sum up, our data suggest that the modifications
introduced in the development of the CDI-Down have pro-
duced an instrument whose vocabulary part is a reliable
and valid tool for assessing children with DS. The other
parts of the inventory (gestures and morphosyntax) are cur-
rently under validation, and the preliminary results are sim-
ilar to the ones presented here.
As with other CDIs (Fenson et al., 1993), the CDI-
Down constitutes a tool for documenting the full range of
communicative abilities of children with DS on the basis of
their parents’ knowledge of the child’s language use across
a wide range of contexts and conversational partners. This
is important, because direct observation is an expensive and
less reliable method for this population, especially in the
case of very young children in whom more extensive lan-
guage sampling is required to detect their limited language
and communicative repertories. Parental reports therefore
represent a complementary alternative that provides a more
complete and representative idea of the language and com-
municative abilities of these children.
A key modification introduced into the CDI-Down is
the use of MA rather than CA due to the wide variability
in IQ among children with DS. In our view, the use of MA
may help researchers to study language development in
these children and to compare the results with those obtained
in other populations. From the clinical point of view, the
use of MA enables psychologists and educational profes-
sionals to assess the development of a particular child and
compare his or her performance with standardized norms
and thus guide the choice of intervention.
 Last, it should be noted that the CDI-Down has made
it possible to conduct large-scale studies to analyze develop-
mental trends and individual variations in the language
and communicative development of Spanish children with
DS (Galeote, Rey, Checa, & Sebastián, 2010; Galeote
et al., 2011, 2014, 2012). This is important because, as
Pueschel and Hopmann (1993) pointed out, the results derived
from good normative studies of the communication and
language skills associated with DS could provide useful
guidelines for both parents and professionals. As Berglund
et al. (2001) indicated, however, there are few studies of this
kind with children with DS. In this respect, the informa-
tion derived from the CDI-Down may begin to address this
need and assist clinicians in developing intervention goals
and monitoring the progress of these children over time.
Acknowledgments
This research was supported by Grant PSI2008-02748 from
the Spanish Ministry for Science and Innovation (Ministerio de
Ciencia e Innovación) and by the European Regional Development
Fund (Fondo Europeo de Desarrollo Regional, FEDER). The
grant was awarded to Miguel Galeote. We would like to express our
thanks to the children and their families and to the many therapists
of the Down syndrome associations and early intervention units.
We are also grateful to those members of the research team who
helped to collect, transcribe, and analyze the data.
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