Conflict of Interest
The authors of this article declare no conflict of interest.
It is known that alterations in Down syndrome (DS) occur at cognitive and language levels that affect the acquisition of reading and academic skills. The aim of this study is to know which neuropsychological variables predict the potential efficacy of early intervention in reading in this population with a program traditionally used with this population. Thirty-eight children of around 5 years of age with DS who were immersed in an early childhood care program participated in the study, 20 of them were immersed in a reading program. Significant differences were found at neurocognitive and linguistic level, especially in the experimental group at neurocognitive level, with achievements in reading and writing at early ages. In addition to this, two variables were found to predict reading acquisition. As conclusion, the effectiveness of the reading program and its benefits at neuropsychological and psycholinguistic levels in the development of this group of children with DS at an early age was revealed.
Se sabe que en el síndrome de Down (SD) se producen alteraciones a nivel cognitivo y del lenguaje que afectan la adquisición de habilidades académicas y de lectura. El objetivo de este trabajo ha sido conocer qué variables neuropsicológicas predicen la eficacia potencial de la intervención temprana en la lectura en esta población con un programa que se usa tradicionalmente con la misma. En el estudio participaron 38 niños con SD de alrededor de 5 años que estaban inmersos en un programa de cuidado de la primera infancia, de los cuales 20 estaban inmersos en un programa de lectura. Como resultados, se observan diferencias significativas a nivel neurocognitivo y lingüístico, especialmente en el primero en el grupo experimental, con logros en lectura y escritura a edades tempranas. Además, hay dos variables que predicen la adquisición de la lectura. En conclusión, se comprueba la efectividad del programa de lectura y sus beneficios a nivel neuropsicológico y psicolingüístico en el desarrollo de este grupo de niños con SD a una edad temprana.
Many children with DS have great potential to learn to read, although there is great variability in the reading levels that are finally reached (
It is now accepted that the majority of children with DS achieve an adequate level of reading (
It can be said that most individuals with DS have cognitive impairments, ranging from mild to moderate (
In addition, performance on short-term verbal auditory memory tasks is often significantly affected. An individual’s lexical capacities are typically higher than those in the morphosyntactic domain, with better general performance in comprehension than in production and lexical comprehension that is higher than syntactical decoding. Poor phonological awareness is often present in this population, that is, their ability to identify/recognize/produce explicit speech sounds (
On the other hand, providing visual representations of verbal information seems to benefit children with DS (
Therefore, we want to verify which factors, of those included in a neuropsychological assessment of preschool children with DS, can predict their early acquisition in reading. This objective can be operationalized into a series of specific aims, such as (a) checking the potential efficacy of early intervention in reading in DS children and (b) establishing which assessment variables predict their reading acquisition.
The sample of the present study consists of 38 children with DS (specifically, with trisomy 21), of whom 22 were boys and 16 were girls (
Therefore, the criterion for assigning each method was that no reading method was initiated, so in the experimental group a reading method was initiated and in the control group it was initiated 9 months later.
The children in the experimental group (EG) came from Down syndrome association centers and ECDC in Jaén, Ciudad Real, Córdoba, and Andújar. Children in the control group (CG) were from two centers in Linares and one in Úbeda.
Early child care programs are drawn up at all the centers. Centers were then asked for permission to conduct this study, permission that was also sought from families. In all the centers, except for two in Linares and one in Úbeda, the pretest situation is evaluated first and immediately afterwards the interventions which are carried out for between four to five years. The training program application (
However, although the centers in Linares and Úbeda are evaluated at the pretest level, intervention is not carried out there because these centers usually start this method a little later, around the age of five. The situation regarding age is used to create a control or waiting group, as they will eventually receive treatment nine months later. Finally, all the children are reassessed in a posttest situation. The control group will be evaluated first in order not to delay the start of their own reading training program.
This work was approved by the bioethics committee of the University of Jaén (code: DIC.18/0.PRY).
The use of
The number of evaluation sessions was between 3 and 4 sessions for each participant (pre- and post-evaluation) with a variable duration depending on the test administered, ranging from 15 to 90 minutes. It was administered individually and in different sessions in a balanced way: first WPPSI, followed by CUMANIN, and finally PLON-R.
The evaluation sessions in both groups were conducted by the first two researchers of this study, with biweekly follow-up sessions, for the intervention program, with the psychologists who administered the training program in each center on a regular basis, and monthly with the families by video call.
The intervention phase is applied only to the experimental group. Initially a pre-workout evaluation is performed. Alongside these evaluation sessions it is noted, with interviews with the teaching psychologists who attend to these children, that the methodology of this intervention program is being followed. Two aspects are checked with them. On the one hand, that it is important to work the motivation of the child as well, since it is much easier to get their attention on a simple word and rich in content than on a sign in principle unintelligible. On the other hand, all children, who are cared for in ECDC centers, are undergoing an educational process and training their perceptual and discriminatory abilities. Before starting reading, they have been training attention, perception, and discrimination (skills to associate, select, classify, name, and generalize) and manual dexterity, as directed by the method. This whole process takes about three months from the end of 2017.
In January 2018 the intervention began, continuing throughout the year, with the exception of August. The reading method comprises three different stages with specific objectives and provides its own materials for each of them. At the same time, the three stages are interrelated and sometimes objectives must be reached simultaneously. This is mainly because the conditions of understanding, fluency, and motivation must be kept and consolidated at any time in the process. It is not necessary to complete all the goals of one stage before starting to work on the next.
The first stage is global perception, recognition of written words, and understanding their meaning. The important thing at this stage is for the student to understand what reading is, that is, how you access meanings and messages through graphic symbols. This stage starts with isolated words and soon phrases are presented. This recognition must occur whether the words are presented in isolation one at a time or presented in a phrase. There are specific goals for the student, including recognizing his or her written name and that of four or five members of their family and recognizing and understanding the meaning of 15 to 20 written words consisting of two direct syllables. Words should include two or three verbs of action known to the child, written in the third person singular in the present tense. A further goal is that the child recognizes 50 to 60 words including the above. Most words will consist of two direct syllables and some of them with three syllables. Words must include five verbs in the first and third person singular of the present tense and some adjectives. The number of words in indicative should not be taken as a hard and fast rule, and the amount of words is gradually increasing.
In order to choose the words the child must learn and add some new ones, we take into account the idea that each word must have a clear meaning known to the child. This usually happens with the names of next of kin and those of commonly used objects, which they know and use on a daily basis in real life. The child has often heard the words used to name them. They do not have to know how to say them. Words are selected that can be clearly represented graphically. Short words will be chosen, and when 30 to 40 words are recognized it is advisable to choose those words that start with letters of the alphabet that have not yet been seen in the initial position of the words. In order to coordinate and consolidate learning, words can be chosen that include concepts (size, shape, and colors), adjectives, and others that can be classified by categories (food, toys, animals, etc.). Finally, another criterion used is the choice of new words that increase a child’s vocabulary.
In the second stage, we work on learning syllables. The fundamental objective is for the student to understand that there is a code that allows us to access any written word not previously learned. When we master the code we can read all the texts written in our language, even if we do not know the meaning of some words. The general objective is for the student to read fluently and flexibly words formed by any syllable, and immediately understand their meaning. To achieve this, the specific objectives are that the student observes that the words are formed of syllables, in order to compose with a model words known of 2 direct syllables; in order to compose without a model, words known with 2 direct syllables that are presented to him recognize and read the 2 syllables used to form a word; in order to compose with 2 known syllables, unrecognized words of meaning, quickly recognize and read all direct 2-letter syllables, form words that are dictated to them or that they think have been dictated, choosing the direct syllables needed, read without syllables, understanding previously unrecognized words, which are made up of direct syllables; in order to compose with model, words that have a locked syllable, recognize and read locked syllables, compose words of 2 syllables without a model, one of them locked, fluently read words of 2 syllables, one of them locked; in other to compose with model, words containing 1 reverse syllable, recognize and read reverse syllables; in order to compose, without a model, words containing reverse syllables, model compose words with 1 consonant group and 1 direct syllable, recognize and read the consonant groups, and finally read words containing consonant groups fluently.
Once the student has understood what reading is and gets to know the reading mechanics, the third stage is carried out, that of progress in reading.
In the third stage, the ultimate goal is to get students to read progressively more complex texts and to allow them to make practical and functional use of their reading skills, to see reading as a pleasurable activity, which provides information and allows them to spend their time enjoyably and finally that reading is a tool with which to learn other academic content.
In December of the same year it is reassessed, ending in January 2019.
An intersubjetct design of the quasi-experimental type (
Both groups were equivalent in sex and age; participants were assigned in nonrandom fashion. Due to the size of the sample, nonparametric measures were used; specifically, the Wilcoxon test was applied to contrast differences in the CUMANIN, WPPSI, and PLON-R scores in the pre- and post-phases. The effect size was measured using the criterion of Cohen’s index (see
The results suggest analyzing independence of the errors to assess the suitability of the multiple regression model. We did so by using the Durwin-Watson test (DW = 1.96); results indicated that this assumption is fulfilled in the IVs (psychomotricity, articulatory language, comprehensive language, expressive language, spatial structuring, visuoperception, iconic memory, rhythm, attention, verbal fluency, and laterality). The assumption of non-multicollinearity was also fulfilled for the IVs, since their value was below 10 (
According to the results observed in
In this study, the findings from the neuropsychological evaluation underscore the need for treatment. Specifically, there were significant differences in the EG in all the variables evaluated compared to the CG (in which there were no differences between both points of measurement for most of the variables). However, CG children (without the reading program intervention) in ECDC improved significantly in psychomotricity, comprehensive language, spatial structuring, and iconic memory. This is in agreement with what is known in the scientific literature, i.e., that all these variables are strengths in DS, with the exception of spatial structuring (
When we related these findings to the evaluation of reading, we found that a program has been implemented that works to promote success in early childhood education and that prepares children for access to the educational curriculum through activities such as perceiving relationships, comparing and judging similarities and differences, codifying information in progressively more abstract forms, classifying and categorizing, performing memory searches, and retrieving information (
Moreover, the finding that two variables of the study (rhythm and attention) predicted reading in this sample helps us understand what aspects are important to train from a very early age. From a very young age, work should be done to implement specific reading methodologies that take advantage of the strengths of this syndrome in terms of the visual route (
These findings add to the growing literature that supports the use of phonological awareness approaches to improve reading instruction in children with DS (
This work provides support for incorporating phonological awareness and phonics-based instruction in reading in DS children, since there seems to be no specific learning phenotype (
A possible explanation for this important development of reading skills in DS children may be the effect of the interaction between improvement in language skills and the intervention program in the development of literacy skills. The relationship between the development of reading skills and that of language has been identified in different studies.
Despite our findings, there is a limitation in that we cannot make an exhaustive evaluation of the reading in a personalized way (as was done by
We conclude that the CG children significantly improved in psychomotricity, comprehensive language, spatial structuring, and iconic memory. According to the results obtained, this program can work to promote success in early childhood education and prepare children for access to the educational curriculum. The EG, in contrast to the CG, significantly improved in all the variables when being evaluated neuropsychologically and they also improved specifically in reading and writing (especially in reading). Two variables in the study (rhythm and attention) predicted reading in this sample and helps us understand what aspects are important to develop from a very early age. Our findings provide support for the incorporation of phonological awareness and phonics-based instruction in reading for children with DS.
We thank all the children, their parents, and teachers for their participation.
Para citar este artículo: Robles-Bello, M. A., Sánchez-Teruel, D., & Camacho-Conde, J. A. (2020). Variables that predict the potential efficacy of early intervention in reading in Down syndrome.