Journal of Speech and Hearing Research, Volume 34, 1106-1120, October 1991

Language Skills of Children and

Adolescents With Down Syndrome:
I. Comprehension
Robin S. Chapman
Scott E. Schwartz
Elizabeth Kay-Kaining Bird
University of Wisconsin-Madison

This study investigates the development of vocabulary and syntax comprehension skills
cross-sectionally in 48 children and adolescents with Down syndrome (Trisomy 21), aged 5 20
years, in comparison to 48 control children aged 2-6 years matched statistically for nonverbal
mental age and mother's years of education. Age-equivalent scores on vocabulary (PPVT-R)
and syntax (TACL-R) comprehension tests differed in the Down syndrome group but not the
control group; vocabulary comprehension was relatively more advanced than syntax Ageequivalent scores on nonverbal cognitive subtests of pattern analysis and short-term memory for
bead arrangements (Stanford-Binet, 4th ed.) also differed for the Down syndrome group but not
the control group, indicating an unusual pattern of nonverbal cognitive function in the Down
syndrome group. Stepwise multiple regression analyses showed that chronological age and
mean mental age, collectively, accounted for 78% of the variability in vocabulary comprehension
and 80% of the variability in syntax comprehension in the Down syndrome group, with total
passes on a hearing screening accounting for an additional 4% in each case Implications for
research are discussed
KEY WORDS: Down syndrome, language disorders, comprehension, mental retardation,
language development

Studies of children and adolescents with Down syndrome (DS) have frequently
indicated problems in expressive language development greater than one might
expect on the basis of cognitive delay in nonverbal domains or comprehension skill
(Andrews & Andrews, 1977; Bray & Woolnough, 1988; Cardoso-Martins, Mervis, &
Mervis, 1985; Cornwell, 1974; Dodd, 1975; Gibson, 1978; Greenwald & Leonard,
1979; Harris, 1983; Hartley, 1986; Hill & McCune-Nicolich, 1981; Holdgrafer, 1981;
Mahoney, Glover, & Finger, 1981; Miller, 1987, 1988; Mundy, Sigman, Kasari, &
Yirmiya, 1988; Rogers, 1975; Rohr & Burr, 1978; Rosin, Swift, Bless, & Vetter, 1988;
Smith & Tetzchner, 1986; Wiegel-Crump, 1981).
Much less consistent is any report of problems in language comprehension,
although the frequent middle ear infections and hearing loss experienced by many of
the children (Brooks, Wooley, & Kanjilal, 1972; Dahle & McCollister, 1986) might lead
one to expect consequent delays in language comprehension. Among mentally
retarded children In general, specific deficits in comprehension, over and above
cognitive delay in nonverbal problem-solving domains, are encountered frequently-in 25% (Miller, Chapman, & Bedrosian, 1978) to 60% (Abbeduto, Furman, &
Davies, 1989) of the sample.
For children with Down syndrome, few studies of language comprehension relative
to nonverbal cognitive level exist, and the findings are inconsistent. Hartley (1982)
finds poorer performance on syntactic comprehension tasks in children with Down
syndrome than in children with mental retardation of other origin, matched on
vocabulary comprehension. Within the Down syndrome group, poorer performance is
1991, American Speech-Language-Hearing Association

1106

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Chapman et al.: Language Comprehension inDown Syndrome

associated with a left ear advantage (and presumably right
hemisphere processing) (Hartley, 1985).
In contrast, Bridges and Smith (1984) report similar sentence interpretation strategies in children with Down syndrome matched for verbal comprehension on the Reynell
Developmental Language Scale (Reynell, 1969) to controls.
Carr (1988) reports no differences on verbal vs. expressive
portions of the Reynell Test of Language Comprehension.
Rosin, Swift, Bless, and Vetter (1988) have demonstrated
both strengths and weaknesses in the comprehension skills
of adolescent boys with Down syndrome. Communication
profiles showed single-word vocabulary comprehension, as
indexed by the revised Peabody Picture Vocabulary Test
(Dunn & Dunn, 1981), to be as good as that of controls
matched for mental age on the Columbia Test of Mental
Maturities. Syntactic comprehension in children with Down
syndrome, in contrast, was significantly worse than mental
age matched controls or a group who were retarded for
reasons other than Down syndrome. Normal hearing was a
requirement for participation in the Rosen et al. study; the
authors propose that the syntactic deficit is part of a general
deficit in sequential processing.
Other explanations for comprehension deficits could include hearing loss (Wilson, Folsom, & Widen, 1983); early
otitis media (Whiteman, Simpson, & Compton, 1986); lack of
early spoken language intervention programs or less than
optimal mother-child interaction, sometimes mediated by
medical problems or periods of hospitalization; or failure to
match samples on socioeconomic status, a variable known to
be associated with language skill in the normal population.
Researchers finding accelerated vocabulary comprehension in DS children, as opposed to controls, have cited as
sources of stimulation vocabulary enrichment or early language intervention programs or the access to a wider variety
of language learning environments that is afforded the chronologically older DS children in vocational education.
Variations in subject selection and control group matching
procedures complicate the interpretation of these studies.
Some researchers have excluded the very subjects who
others argue should be the ones to have comprehension
deficits. For example, those with hearing loss have been
excluded; or those with histories of hospitalization have been
excluded, although such periods may contribute to impoverished input or disruptions in mother-child attachment and
interaction (Miller, 1988). Ages of children studied have
varied; and there is some suggestion that both language and
cognitive impairments may increase with age. (Or, alternatively, that measurement instruments are more sensitive at
the higher levels of functioning.) Some studies have excluded children with low intelligibility.
The choice of comparison groups also offers problems.
Matches on expressive language are clearly inappropriate
given the evidence that some DS children are expressively
delayed. Matches on nonverbal cognitive level are complicated by tests that call themselves nonverbal (in response
requirements) but place demands on language comprehension. Further, children with Down syndrome have been
described as having short-term memory deficits in cognitive
processing (although control groups in these studies, described as matched on mental age, have actually been

1107

matched on comprehension vocabulary). Many of the nonverbal tests used in nonverbal mental age matching (e.g., the
Leiter, the Columbia) do not make many short-term memory
demands. As syntactic comprehension tasks make such
demands, it would seem appropriate to choose a control
group on the basis of nonverbal cognitive tests that included
some short-term memory tasks.
This study investigates the variation in receptive vocabulary and syntactic comprehension in a sample of children and
adolescents with Down syndrome aged 5-20 years, for
whom the only exclusionary criteria were moderate hearing
loss or use of signing as the primary means of communicaiton. Thus the sample should include individuals with mild
hearing loss, histories of medical complications, or intelligibility problems that have been argued as possible correlates
of comprehension deficit.
A group of normally developing children was selected as
control subjects on the basis of combined performance on
one nonverbal cognitive test that included short-term memory demands and another that did not, from the same test
battery (Stanford-Binet, 4th ed., Bead Memory and Pattern
Analysis subtests, Thorndike, Hagen, & Sattler, 1986); both
tests involved abstracted pattern matching rather than depending on school-taught content (another problem in choosing cognitive matching procedures when individuals have
different educational histories). The control group was also
matched for socioeconomic status; the statewide recruitment
of DS children (and possibly the demographics of the older
cohort that their parents are drawn from) yielded a sample
lower in years of education than the city alone would be likely
to yield, so recruitment of control children was extended to
rural areas.
We asked two questions: (a) whether children with Down
syndrome differed from a control group matched for mean
nonverbal cognitive level in their language comprehension
skills; and (b) how well variation in comprehension skill within
each group could be predicted on the basis of multiple
regression analyses of the best predictors from each of six
areas: chronological age, sex, cognitive level, socioeconomic
status, hearing status and history, and educational history.

Method
Subjects
Participating inthe study were 48 children and adolescents
with Down syndrome, ages 5:6 (years:months) to 20:6, and
48 children ages 2:0 to 6:0 who were developing normally
(these are the same children described in Chapman, KayRaining Bird, and Schwartz, 1990). The control group mean
was matched to the Down syndrome group on nonverbal
mental age, as determined by mean age-equivalent score on
the Bead Memory and Pattern Analysis subtests of the
Stanford-Binet, 4th ed. The groups were also matched on
mothers' years of education. Table 1 summarizes the groups'
mean chronological age, nonverbal mental age, mothers'
years of education, and sex.
The children with Down syndrome were recruited from
Wisconsin and northern Illinois through parent groups, per-

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1108 Journal of Speech and Heanng Research

34

1106-1120

Octoer

1991

TABLE 1. Children participating in study: Characteristics by group.

Group
Down syndrome
(N = 48)

Characteristic

No.

Controls (N = 48)

SD

Boys
30
Chronological age (years)
12.54
Nonverbal mental age (years)a
4.58
Mothers' education (years)
13.33
aBased on mean of Bead Memory and Pattern Analysis
*p < .05, t test of group difference
sonal referrals, and the Down Syndrome Developmental
Monitoring Program at the Waisman Center. All children who
used speech as their primary means of communication and
whose hearing showed no more than a mild loss were
included in the study, up to a limit of 13 subjects in each of
the 4-year age ranges between 5 1/2 and 20 1/2 years.
Children were excluded if sign language was the primary
means of communication or if they had a pure tone average for
the frequencies 500, 1000, and 2000 Hz greater than 45 dB in
the better ear. Five of the 53 Down syndrome children originally
meeting the criteria were excluded for reasons of meningitis,
visual impairment due to nystagmus and cataracts, a genetic
record indicating mosaicism, or a genetic record indicating
Down syndrome due to translocation (2).
Two of the older subjects did not have genetic records of
chromosomal analysis, although translocation in the parents'
chromosomes had been ruled out. One of the subjects
included in the oldest group had an incomplete chromosome
5 in addition to Trisomy 21 but fell within 1 standard deviation
of the mean of his age group in this study in mental age
measures.
The control subjects were recruited from children between
the chronological ages of 2 and 6 from Madison, WI, and
surrounding small communities. These ages corresponded
to the main range of mental age scores in the children with
Down syndrome.

Procedures
All children participated in a 3-hr protocol that included, in
order, a hearing screening, picture descriptions, story retelling, Form L of the Peabody Picture Vocabulary Test, Revised
(PPVT-R), conversation and narration with the examiner, an
object hiding task (Chapman, Kay-Raining Bird, & Schwartz,
1990), the Expressive Vocabulary, Bead Memory, and Pattern Analysis subtests of the Stanford-Binet, 4th ed., conversation and snack with a parent, a speech motor evaluation,
delayed story recall, event narration, the Test for Auditory
Comprehension of Language, Revised (TACL-R) (CarrowWoolfolk, 1985), and the delay condition of the object hiding
task. Breaks were incorporated at frequent intervals. Parent
interviews elicited background data on hearing history, educational and intervention history, and parent education and
occupation.

No.

23
4.50
4.16
1.45
4.71
1.87
13.88
subtests of Stanford-Binet, 4th

SD

p*

1 16 <.05*
1.43
NS
2.27
NS
ed.

Hearing was screened using a portable Beltone audiometer in the experimental room. Pass/fail data were collected for
each ear at 25 and 45 dB HL (ANSI, 1969) for the frequencies 500, 1000, and 2000 Hz. Background data were collected through questionnaire, parent interview, and follow-up
telephone conversations.

Scoring
Comprehension. PPVT-R raw scores were converted to
age-equivalent scores, in years. TACL-R subtest and total
test raw scores were converted to age-equivalent ranges and
the midpoint of the range, in years, used as the ageequivalent score. The age-equivalent scores provided were
extrapolated to 27-29 months, for zero scores, from data
normed on children beginning at age 3; no child tested in
either group failed to pass some items on at least subtest 1
and the total test.
Cognition. Raw scores on the Stanford-Binet 4th ed.
Pattern Analysis and Bead Memory subtests were converted
to age-equivalent scores for each subject. A mean mental
age score was computed by averaging the two age-equivalent scores. In the case of two children in each group who
passed no item on the Bead Memory (below age 2:5 on the
scale) but scored at least 2 years on the Pattern Analysis, a
score of 2 years was estimated for the Bead Memory
performance to compute the mean mental age score. A
difference score was also computed by subtracting the Bead
Memory age-equivalent score from the Pattern Analysis
age-equivalent score.
A composite standard age score (SAS) was computed by
converting an individual's raw scores for Pattern Analysis
and Bead Memory to standard age scores appropriate for
abstract visual reasoning and short-term memory areas,
respectively, using the tables appropriate to the individual's
chronological age. These two scores were then added and
their sum converted to a composite SAS score using the
conversion table appropriate for the individual's chronological age. The composite SAS is designed to have a mean of
100 and a standard deviation of 16.
Potential predictors of language comprehension were
quantified from these data in three domains: socioeconomic
status, hearing status, and educational history. These are
described in the following paragraphs.

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1114

Journalof Speech and Heanng Research

314 1106-1120

TABLE 8. Intercorrelatlons among predictor variables for children with Down syndrome (n = 48).
Independent variable

CA

Chronological age
Mean mental age
Occupational prestige index
Total passes, hearing screen
Note. CA = chronological age; MA
tional prestige index.

MA

OPI

.59**
.16
.08
.07
.07
-. 01
= mental age; OPI = occupa-

.*p < .01.

regression was used with SPSS default settings for criteria in

building the regression equation: A variable was removed at
a step if the probability of Fwas greater than or equal to .10
and added at a step if the probability of F was the smallest
and less than .05. Tolerance limits (the proportion of a
variable's variance not accounted for by other independent
variables in the equation) and minimum tolerance (the smallest tolerance other variables had when an additional variable
was included) were less than or equal to .0001.
Vocabulary comprehension. Three variables accounted
for 82% of the variability in vocabulary comprehension in the
group with Down syndrome: chronological age, mean mental
age, and total passes on the hearing screening test, with a
multiple R of .91 and beta weights of .55, .44, and .21
respectively. Age entered first, accounting for 64% of the
variance. Mental age entered second, accounting for an
additional 14%. Total passes entered third for an additional
4%. A summary of the stepwise multiple regression analysis
is given in Table 9.
Syntax comprehension. Three variables accounted for
84% of the variability in syntactic comprehension as indexed
by TACL-R total score: mean mental age, chronological age,
and total passes on the hearing screening test, with a
multiple R of .92 and beta weights of .56, .43, and .20
respectively. Mental age entered first, accounting for 69% of
the variance. Chronological age entered second, accounting
for an additional 11%. Total passes entered third, for an
additional 4%. A summary of the stepwise multiple regression analysis is given in Table 10.
Syntactic subtests. The same four predictors--chronological age, mean mental age, total hearing passes, and the
occupational prestige index-were entered in stepwise multiple regression analyses with each of the three TACL-R
subtests as dependent variables. Results are shown in Table
11.

taken together, accounted for 69% of the variance. Hearing

screening contributed 4% more. Beta weights for the three
variables were .48, .44, and .19. This result is similar to the
pattern found for vocabulary comprehension, in which chronological age is a better predictor than mental age, and is
consistent with the emphasis on lexical comprehension of
Subtest I.
In the analyses of Subtests II and III, the pattern of results
is similar to that for the TACL-R total score: Mean mental age
enters the prediction equation before chronological age, and
the two together account for 62% and 67% of the variance
respectively, for Subtests II and IlI. Total passes on hearing
screening do not enter the equation for Subtest II scores,
suggesting that mild hearing loss does not differentially affect
the comprehension of grammatical inflections. The beta
weights for mean mental age and chronological age are .50
and .38 respectively. Hearing passes account for an additional 4% of the variance on Subtest III. Beta weights for the
three variables are .50, .40, and .21, respectively.
Cognitive subtest predictors. The effects of substituting
the two cognitive subtests, Bead Memory and Pattern Analysis, for mean mental age in the multiple regression analyses
were also examined for PPVT-R, TACL-R Total, and TACL-R
Subtest scores, with the expectation that, to the extent that
modality-independent short-term memory factors played a
role in TACL-R total and TACL-R Subtest III performance,
Bead Memory might contribute additionally to explained
variance for those dependent variables. This was the case
for TACL-R total score but not Subtest III; Bead Memory
entered fourth in the equation, accounting for an additional
1%of the variance (Pattern Analysis entered first, accounting
for 68% of the variance). In the other analyses, Pattern
Analysis, the stronger predictor of the two in every case, was
the only index of mental age to enter any of the equations,
and in the same order as mean mental age in the original
analyses.
Nor did multiple regression analyses of PPVT-R and
TACL-R total scores carried out within each of the four age
groups, with the entry of age, Bead Memory and Pattern
Analysis forced, show beta weights for Bead Memory's
contribution to increase with age, as might be expected if the
gaps between cognitive subtests and comprehension tests
both arose from an increasing deficit in general short-term
memory. Beta weights are shown in Table 12.

Selecting predictor variables. Table 7 summarized the

correlations of predictor with comprehension variables for the
children who served as controls. Mean mental age was the

TABLE 9. Predicting vocabulary comprehension In children with Down syndrome: Stepwise

multiple regression analysis.

1
2

Predictor
Chronological age
Mean mental age

Total passes, hearing screen

1991

Mental Age Controls

For Subtest I, chronological age, mean mental age, and

total passes on the hearing screening all entered the equation, in that order, accounting for 73% of the variance in
comprehension score. Chronological age and mental age,

Step

Octoer

Beta
in

Multiple
R

R2

F(eqn)

Sig F

.80
46

.80
.88

.64
.78

<.01
<.01

.91

82.51
80.68

.82

.20

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68.60

<.01

1110

34

Journal of Speech and Hearing Research

110611201

October 1991

TABLE 3. Mean difference, vocabulary (PPVT-R) - syntax (TACL-R total) age-equivalent score,
by age groups.
Controls (n = 48)

Down syndrome (n = 48)

Age range
(years)

SD

Age range
(years)

SD

5.5-8.4
8.5-12.4
12.5-16.4
16.5-20.4

13
11
11
13

.04
.48
.86
2.23

.68
.58
.91
1.01

2.1-3.0
3.1-4.0
4.1-5.0
5.1-6.1

11
11
13
13

-. 48
.22
-.07
.49

.32
.79
.63
.90

Overall, then, there appears to be evidence for an increasing advantage in vocabulary comprehension, compared to
syntactic comprehension, in adolescents with Down syndrome, but little evidence for a difference in syntactic comprehension compared to a group matched in nonverbal
mental age and socioeconomic status.
The three TACL-R subtest scores are based on three
different kinds of content: TACL-R I, Word Classes & Relations, taps vocabulary comprehension and semantic relational comprehension conveyed by probable event knowledge. TACL-R II, Grammatical Morphemes, assesses
comprehension of prepositions, noun inflections, verb inflections, and derivational suffixes. TACL-R Ill, Elaborated Sentences, assesses comprehension of sentence modality
(questions, negation), semantically reversible sentence constructions (active and passive voice, direct/indirect object
constructions), and complex sentence constructions in which
comprehension may depend on a single word (e.g., the
meaning of a conjunction) or extended constructional as-

individuals in each age range showed differences scores

(PPVT-TACL) more than one standard deviation above or
below the mean, using the control group's standard deviation
(SD = .77) and mean (M = .06) as the reference. For the
control group, the percent of individuals falling below the
mean was 18%, 9%, 23%, and 15% for 2-, 3-, 4-, and 5-yearolds, respectively, or 16.7% overall. Control group individuals
fell more than one standard deviation above their mean 0%,
27%, 0%, and 38%, respectively, by age group, or 16.7%
overall.
In contrast, individuals with Down syndrome never scored
more than one (control group) standard deviation below the
(control) mean difference score. Scoring more than one
standard deviation above the mean were 8%, 36%, 45%, and
92% of the Down syndrome individuals in the 5-8, 8-12,
12-16, and 16-20-year age ranges, respectively. Thus the
proportion of individuals with Down syndrome who show a
vocabulary advantage relative to controls increases, with
age, from almost none to almost all.

DIFFERENCE OF PPVT - TACL SCORES

3.500 T
3.000
2.500
2.000
U
1.500
L)
.D
1.000
0.500
0.000
_,
._
-0.500
.000
- 1.500 +
-2.000

7771TWnnWM hrVNTlPPF'

AGE GROUP
FIGURE 1. Mean difference between vocabulary (Peabody Picture Vocabulary Test-Revised)
and syntax (Test of Auditory Comprehension of Language-Revised) age-equivalent scores as
a function of age group in Down syndrome children (5-8, 8-12, 12-16, and 16-20 years) and
controls (2, 3, 4, and 5 years). The vertical lines represent one standard deviation.

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Chapman et al.: Language Comprehension in Down Syndrome

pects. Thus Subtest I can be said to require substantive

vocabulary comprehension to a greater degree than II or III,
and the latter two to require syntactic comprehension. In the
case of II, the listener must often process morphemes of
limited phonetic substance; in the case of III, the listener
must often remember and use word order as a cue to
comprehension. Thus the TACL-R subtests may be differentially sensitive to advanced or restricted vocabulary development (I), hearing impairment (II), and auditory short-term
memory or sequential processing deficits (III).
The three subtest scores were analyzed in a one-way
repeated measures analysis of variance for each subject
group. For the Down syndrome group, a significant effect
[F(2, 94) = 8.11, p < .01] of subtest was found, with Subtest
I significantly different from II and III according to post hoc
Scheffe test. Children and adolescents with Down syndrome
performed significantly better on the subtest tapping lexical,
rather than syntactic, aspects of comprehension. For the
control group, a similar pattern of results emerged. A significant effect [F(2, 94) = 8.98, p < .01] of subtest was found,
with Subtest I significantly better than II or III in post hoc
Scheffe test.
Predictors of Comprehension Performance
Predictor variables for language performance were constructed in six domains for each group: chronological age,
sex, nonverbal cognition, socioeconomic status, hearing
status, and educational history. Means and standard deviations for the variables are listed in Table 4. The predictors are
defined and discussed in the following paragraphs.

Cognition. Cognitive predictors included mean mental

age, upon which the groups had been statistically matched;
age-equivalent scores for the two Stanford-Binet subtests
upon which the mean had been based, Pattern Analysis and
Bead Memory; the difference between these; and the IQ
score derived from these. Ttests of all but the last revealed
significant group differences (p < .05) in Bead Memory, a test
requiring short-term memory for visually presented sequences of differently shaped beads, with the group with
Down syndrome performing more poorly. There was a corresponding, but not significant, difference in the opposite
direction in Pattern Analysis scores. The mean difference of
these two scores (Pattern Analysis - Bead Memory) was
also significantly (p < .05) different between the two groups.
The mean difference was larger for the Down syndrome
group than for the controls, for whom it was approximately
zero, as standardization criteria would dictate.
For the Down syndrome group, the difference in cognitive
subtest scores increased significantly with age (r = .36, p <
.01). Within age groups (see Table 5), paired ttests indicated
significant differences in magnitude of Pattern Analysis and
Bead Memory in every age range. The control group, in
contrast, showed no significant correlation of the cognitive
difference score with age (r = -. 05, NS) and no significant
differences between Pattern Analysis and Bead Memory
score according to paired t test. Mean differences are illustrated for the two groups, by age, in Figure 2.
The composite Standard Age Score (SAS) based on Bead
Memory and Pattern Analysis is a deviation index with
expected mean of 100 and SD of 16. SAS decreased
significantly with age (r = -. 34, p < .05, n = 46) in the

TABLE 4. Means and standard deviations of predictor variables for children with Down
syndrome and controls (n = 48, each group).
Control

Down syndrome
Variable
Chronological age (years)

SD

SD

JD

12.54

4.50

4.16

1.16

Mean mental age

Pattern Analysis
Bead Memory
Difference, Pattern - Bead
Composite SASb

4.58
5.26
4.04
1.22
51.04

1.45
1.98
1.21
1.37
9.23

4.71
4.69
4.72
-0.03
108.70

1.43
1.53
1.52
1.03
12.14

NS
NS
<.05'
<.01*

Mother's education (years)

Father's education (years)
Occupational prestige indexc

13.33
13.29
41.38

1.87
2.38
21.91

13.87
14.00
39.75

2.26
2.47
20.55

NS
NS
NS

Tubes (1 = yes, 0 = no)

Better ear (failures)
Total passes, screening

.35
1.83
9.29

.48
1.02
2.53

.19
1.04
11.69

.39
.20
.80

Program (years before 5)

3.76

1.06

(proportion of life)
Age of out-of-home day care
Years of home day care

.64
-

.21
-

Cognition

Socioeconomic status

Hearing status

Educational history

1111

<.05**
<.01*
<.01

Speech-language therapy
1.96
1.17

1.70 d
1.34 d
.94 b

.72
Years of preschool
aBased on means of mental age-equivalent scores on Bead Memory and Pattern Analysis, nonverbal
subtests of Stanford-Binet (Bead Memory estimated at 2.0 for two untestable subjects in each group).
bn = 46. cComputed according to Stevens and Cho (1985). dn = 47. en = 44.

*Two-tailed t test. **One-tailed t test.

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1112 Journal of Speech and Hearing Research

34

1106-11207 Octoer 1991

TABLE 5. Mean difference, Pattern Analysis - Bead Memory age-equivalent scores, by age
range.
Down syndrome (n = 48)

Controls (n = 48)

Age range

Age range

(years)

SD

(years)

SD

5.5-8.4
8.5-12.4
12.5-16.4
16.5-20.4

13
11
11
13

.64
.89
1.53
1.80

1.24
1.24
1.38
1.41

2.1-3.0
3.1-4.0
4.1-5.0
5.1-6.1

11
11
13
13

-. 13
.35
.03
-.33

.69
.67
1.12
1.38

children with Down syndrome. These findings would be

consistent with a cumulative deficit in nonverbal cognitive
functioning-one increasing with age-in Down syndrome.
However, a negative correlation of SAS and age approaches significance inthe control group as well (r = -. 24,
p < .06). Mean SAS values by age ranges are displayed in
Table 6.
Thus, in the children with Down syndrome, there is evidence for an unusual pattern of nonverbal cognitive performance that increases in magnitude with age. The children
with Down syndrome performed relatively more poorly with
increasing age on a visual test that required short-term
memory for, and sequential production of, design sequences
than on a test requiring analysis and re-creation of geometric
visual patterns.
Socioeconomic status. Three predictors of comprehension status were constructed from socioeconomic indices:
mother's years of education, a measure that correlates with
language development in young normally developing chil-

dren; father's years of education; and an occupational prestige index (Stevens & Cho, 1985) for the head of household.
There were no significant (p > .05) differences between the
Down syndrome and control groups on these measures.
Hearing status. One index of hearing status was whether
tubes had ever been inserted in the ears. Two additional
indices were based on hearing screening at the time of test,
which afforded 12 opportunities to pass (3 frequencies x 2
sound levels x 2 ears): the number of failures in the better
ear, and the total number of passes. All of these measures
differed significantly between groups (p < .05, one-tailed t
test).
Educational history. Measures of educational history
were constructed separately for the Down syndrome and the
control group because of the dissimilarity of their experience.
For children and adolescents with Down syndrome, two
predictors were constructed: (a) the number of years, before
age 5, that individuals had received intervention programming of some sort; and (b) the proportion of years of life that

DIFFERENCE OF
PATTERN ANALYSIS - BEAD MEMORY

c-<

m
I

3.500
3.000
2.500
2.000
1.500
1.000

DOWN SYNDROME
I CONTROL

0.500
0. 000

< -0500
- 1.)00

-1. 500
-- v

411 I[

A
j3

AGE GROUP
FIGURE 2. Mean deference between Pattern Analysis and Bead Memory age-equivalent scores
as afunction of age group In Down syndrome children (5-8, 8-12, 12-16, and 16-20 years) and
controls (2, 3, 4, and 5 years). The vertical lines represent one standard deviation.

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Chapman et al.: Language Comprehension m Down Syndrome

1113

TABLE 6. Composite Standard Age Scores based on Bead

Memory and Pattern Analysis subtests, by age range, for
children with Down syndrome (n = 46).

Children with Down Syndrome

Age range
(years)

SD

Range

5.5-8.4

12

57.17

5.56

49-68

8.5-12.4
12.5-16.4
16.5-20.4

11
10
13

49.54
46.70
50.00

5.99
9.87
11.47

37-61
36-65
36-74

selected as the best cognitive predictor for each comprehension analysis; the occupation prestige index was the best
socioeconomic status indicator. Sex was never significantly
related to comprehension performance and was excluded
from subsequent regression analyses.
The hearing history report of insertion of tubes varied
negatively with chronological age (r = --.24, p < .06) as well
as comprehension, indicating a cohort or recency effect.
Shifts in medical practice or strains of antibiotic-resistant
bacteria may have contributed to this pattern. Total passes of
the screening test was used instead as the hearing status
predictor.
Among the educational history indices, only the number of
years before age 5 that intervention programming had been
received was significantly (p < .05) related to either comprehension measure, but the direction was negative rather than
positive, indicating a cohort effect associated with changing
public law and service program delivery. These variables
were excluded from further regression analyses.
Thus the four independent variables selected for entry into
the stepwise multiple regression equations were (a) chronological age, (b) mean mental age, (c) occupational prestige
index, and (d) total passes on hearing screening test.
Correlations among the four predictor variables selected
for stepwise multiple regression analysis are shown, for
children with Down syndrome, in Table 8. Stepwise multiple

individuals had received speech-language therapy specifically.

For control children, measures were constructed reflecting
the child's age when out-of-home day care began, the years
of home day care, and the years of preschool attendance.
Regression Analyses
Correlations of predictor variables in each of the six
domains with the dependent variables of vocabulary comprehension (PPVT-R age-equivalent score) and with syntax
comprehension (TACL-R total score, mean of age-equivalent
range) are summarized in Table 7 for each group. Within
each domain, the best predictor (largest correlation, p < .10)
was selected for entry into multiple regression equations
evaluating the predictor variables in a stepwise analysis.
Children with Down syndrome and control children were
analyzed separately.

Selecting predictor variables. Mean mental age was

TABLE 7. Correlations of predictor variables with vocabulary (PPVT-R) and syntactic comprehension (TACL-R total) age-equivalent scores for children with Down syndrome and controls (n
= 48, each group).

Down syndrome

Control

Variable

PPVT-R

TACL-R

PPVT-R

TACL-R

Chronological age
Sex
Cognition
Mean mental agea
Pattern Analysis
Bead Memory
Difference, Pattern - Bead
Composite SASb
Socioeconomic status
Mother's education (years)
Father's education (years)
Occupational prestige index
Hearing status
Tubes (1 = yes, 0 = no)

.80**
-. 02

.76**
-.04

.88**
-.01

.83**
.12

.77**
.75**
.69**
.48**
.00

.83'*
.82**
.72**
.56**
.13

.87**
.84**
.80**
.06
.01

.88*
.7!)**
.87**
-.12
.14

.06
.09
.25*

.01
.02
.13

.51*
.27
.29*

Better ear (failures)

Total passes, screening

Educational history
Program (years before 5)
Speech-language therapy
(proportion of life)
Age of out-of-home day care
Years of home day care
Years of preschool

-.11

-.16

.25*

-.15 t

-.09

.23

-.12t

-.59*

-. 57*

.04
-

.06

-.
-

.24

.3:3*
.21t
.21t

'

.33**

-.16

-.01

.03

--

.28*b
04
.70**d

--

.27b
-.04
.59**d

aBased on means of mental age-equivalent scores on Bead Memory and Pattern Analysis, nonverbal
subtests of Stanford-Binet (Bead Memory estimated at 2.0 for two untestable subjects in each group).
bn = 46. cComputed according to Stevens and Cho (1985). dn = 47. en = 44.
*p < .01, one-tailed. **p < .05, one-tailed. tp < .10, one-tailed.

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1114

Journalof Speech and Heanng Research

314 1106-1120

TABLE 8. Intercorrelatlons among predictor variables for children with Down syndrome (n = 48).
Independent variable

CA

Chronological age
Mean mental age
Occupational prestige index
Total passes, hearing screen
Note. CA = chronological age; MA
tional prestige index.

MA

OPI

.59**
.16
.08
.07
.07
-. 01
= mental age; OPI = occupa-

.*p < .01.

regression was used with SPSS default settings for criteria in

building the regression equation: A variable was removed at
a step if the probability of Fwas greater than or equal to .10
and added at a step if the probability of F was the smallest
and less than .05. Tolerance limits (the proportion of a
variable's variance not accounted for by other independent
variables in the equation) and minimum tolerance (the smallest tolerance other variables had when an additional variable
was included) were less than or equal to .0001.
Vocabulary comprehension. Three variables accounted
for 82% of the variability in vocabulary comprehension in the
group with Down syndrome: chronological age, mean mental
age, and total passes on the hearing screening test, with a
multiple R of .91 and beta weights of .55, .44, and .21
respectively. Age entered first, accounting for 64% of the
variance. Mental age entered second, accounting for an
additional 14%. Total passes entered third for an additional
4%. A summary of the stepwise multiple regression analysis
is given in Table 9.
Syntax comprehension. Three variables accounted for
84% of the variability in syntactic comprehension as indexed
by TACL-R total score: mean mental age, chronological age,
and total passes on the hearing screening test, with a
multiple R of .92 and beta weights of .56, .43, and .20
respectively. Mental age entered first, accounting for 69% of
the variance. Chronological age entered second, accounting
for an additional 11%. Total passes entered third, for an
additional 4%. A summary of the stepwise multiple regression analysis is given in Table 10.
Syntactic subtests. The same four predictors--chronological age, mean mental age, total hearing passes, and the
occupational prestige index-were entered in stepwise multiple regression analyses with each of the three TACL-R
subtests as dependent variables. Results are shown in Table
11.

taken together, accounted for 69% of the variance. Hearing

screening contributed 4% more. Beta weights for the three
variables were .48, .44, and .19. This result is similar to the
pattern found for vocabulary comprehension, in which chronological age is a better predictor than mental age, and is
consistent with the emphasis on lexical comprehension of
Subtest I.
In the analyses of Subtests II and III, the pattern of results
is similar to that for the TACL-R total score: Mean mental age
enters the prediction equation before chronological age, and
the two together account for 62% and 67% of the variance
respectively, for Subtests II and IlI. Total passes on hearing
screening do not enter the equation for Subtest II scores,
suggesting that mild hearing loss does not differentially affect
the comprehension of grammatical inflections. The beta
weights for mean mental age and chronological age are .50
and .38 respectively. Hearing passes account for an additional 4% of the variance on Subtest III. Beta weights for the
three variables are .50, .40, and .21, respectively.
Cognitive subtest predictors. The effects of substituting
the two cognitive subtests, Bead Memory and Pattern Analysis, for mean mental age in the multiple regression analyses
were also examined for PPVT-R, TACL-R Total, and TACL-R
Subtest scores, with the expectation that, to the extent that
modality-independent short-term memory factors played a
role in TACL-R total and TACL-R Subtest III performance,
Bead Memory might contribute additionally to explained
variance for those dependent variables. This was the case
for TACL-R total score but not Subtest III; Bead Memory
entered fourth in the equation, accounting for an additional
1%of the variance (Pattern Analysis entered first, accounting
for 68% of the variance). In the other analyses, Pattern
Analysis, the stronger predictor of the two in every case, was
the only index of mental age to enter any of the equations,
and in the same order as mean mental age in the original
analyses.
Nor did multiple regression analyses of PPVT-R and
TACL-R total scores carried out within each of the four age
groups, with the entry of age, Bead Memory and Pattern
Analysis forced, show beta weights for Bead Memory's
contribution to increase with age, as might be expected if the
gaps between cognitive subtests and comprehension tests
both arose from an increasing deficit in general short-term
memory. Beta weights are shown in Table 12.

Selecting predictor variables. Table 7 summarized the

correlations of predictor with comprehension variables for the
children who served as controls. Mean mental age was the

TABLE 9. Predicting vocabulary comprehension In children with Down syndrome: Stepwise

multiple regression analysis.

1
2

Predictor
Chronological age
Mean mental age

Total passes, hearing screen

1991

Mental Age Controls

For Subtest I, chronological age, mean mental age, and

total passes on the hearing screening all entered the equation, in that order, accounting for 73% of the variance in
comprehension score. Chronological age and mental age,

Step

Octoer

Beta
in

Multiple
R

R2

F(eqn)

Sig F

.80
46

.80
.88

.64
.78

<.01
<.01

.91

82.51
80.68

.82

.20

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68.60

<.01

Chapman et al.: Language Comprehension in D)own Syndrome

1115

TABLE 10. Predicting syntax comprehension (TACL-R total, age-equivalent score) In children
with Down syndrome: Stepwise multiple regression analysis.
Step

Predictor

Beta
In

Multiple
R

R2

F(eqn)

Sig F

1
2
3

Mean mental age

Chronological age
Total passes, hearing screen

.83
.42
.20

.83
.89
.92

.69
.80
.84

100.85
89.90
77.27

<.01
<.01
<.01

best of the cognitive predictors for both vocabulary and

syntax comprehension, just as it was in the group with Down
syndrome. Of the socioeconomic variables, mother's years of
education was the best predictor of comprehension, unlike
the group with Down syndrome but consistent with other
studies of SES effects in normally developing children. The
presence of tubes was the strongest correlate among the
hearing status indicators. Of the educational history predictors, the number of years of preschool was the best predictor.
Sex was not related to comprehension performance and was
excluded from subsequent analysis.
Thus, the five predictor variables selected for entry into the
multiple regression equations for controls were (a) chronological age, (b) mean mental age, (c) mother's years of
education, (d) tubes, and (e) number of years of preschool.
Their intercorrelations are summarized in Table 13 for the
control group.
Vocabulary comprehension. Results of the stepwise
multiple regression analysis of predictors of vocabulary comprehension are shown inTable 14. Three of the five variables
entered the equation: chronological age, mother's education,
and mean mental age, accounting for 90% of the variance in
PPVT-R score. Beta weights for the three variables in the
equation were .44, .24, and .43, respectively. Age entered
first, accounting for 78% of the variance. Mother's education
entered second, accounting for an additional 6%. Mean
mental age entered third, accounting for an additional 6%.
Syntax comprehension. Results of the stepwise multiple
regression analysis of predictors of syntax comprehension,
as indexed by TACL-R total mean age-equivalent score, are
shown in Table 15. Two of the five variables entered the
equation: mean mental age and presence of tubes, accounting for 81% of the variance in TACL-R total score. Beta
weights for the two variables were .83 and .18, respectively.

Mean mental age entered first, accounting for 78% of the

variance. Presence of tubes accounted for an additional 3%.
Syntactic subtests. The same five predictors, chronological age, mean mental age, mother's years of education,
tubes, and years of preschool, were evaluated in stepwise
multiple regression analysis with each of the three TACL-R
subtests as dependent variables. Results are shown in Table
16.

Discussion
Comprehension Skills in Children with Down
Syndrome
In this study we found that children with Down syndrome
showed differences, increasing with age, between lexical and
syntactic comprehension skill. They also showed differences,
increasing with age, between nonverbal cognitive subtests of
pattern analysis and short-term memory for bead arrangements. The magnitude of these differences was significantly
greater than those in a control group of children aged 2-6
matched for mean mental age and socioeconomic status.
Taken separately, the variations in lexical and syntactic
comprehension skill are well predicted by the three variables
of chronological age, mean mental age, and total passes on
the hearing screening exam in multiple regression analyses.
In each case, chronological and mental age together account
for about 78-80% of the variance; hearing status predicts an
additional 4%.
Among the mental age-matched controls, vocabulary
comprehension is well predicted by chronological age, mother's years of education, and mean mental age, accounting
together for 90% of the variance. These results underscore

TABLE 11. Predicting syntax comprehension in children with Down syndrome: Stepwise
multiple regression analyses for age-equivalent scores on TACL-R subtests.
Step

Predictor

Subtest I: Word Classes and Relations

1
Chronological age
2
Mean mental age
3
Total passes, hearing screen
Subtest II: Grammatical Morphemes
1
Mean mental age
2
Chronological age
Subtest lii: Elaborated Sentences
1
Mean mental age
2
Chronological age
3
Total passes, hearing screen

Beta
In

Multiple
R

R2

Feqn)

Sig F

.74
.46
.19

.74
.83
.85

.55
.69
.73

55.83
50.04
38.81

<.01
<.01
<.01

.73
.38

.73
.79

.53
.62

51.31
36.84

<.01
<.01

.76
.39
.21

.76
.82
.84

.57
.67
.71

61.42
45.70
36.54

<.01
<.01
<.01

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1116 Journal of Speech and Heanng Research

34

1106-1120

October 1991

TABLE 12. Beta weights by age group for children and adolescents with Down syndrome:
Multiple regression analysis predicting vocabulary and syntax comprehension with age, Bead
Memory, and Pattern Analysis.
Age group (years)
Variable

PPVT-R
Age
Bead Memory
Pattern Analysis
TACL-R
Age
Bead Memory
Pattern Analysis

5.5-8.4

8.5-12.4

12.5-16.4

16.5-20.4

(n = 13)

(n = 11)

(n = 11)

(n = 13)

.09
.38
.74

.02
-. 35
.44

.11
.37
.53

-.13
-.05
.79

.03
.40
.64

.25
-.22
.39

.11
.68
-. 06

-.10
-. 06
.76

the importance of matching the control group in mean mental

age and mother's years of education to the Down syndrome
group. Syntactic comprehension is accounted for by mean
mental age (78% of variance) and tubes, accounting for an
additional 3%.

Vocabulary Advantage or Syntactic Deficit for

Adolescents with Down Syndrome?
How is the discrepancy between vocabulary and syntax
comprehension, for adolescents with Down syndrome, to be
understood? One possibility can be ruled out. The degree of
discrepancy is not related to nonverbal IQ (Standard Age
Score).
Are we seeing a deficit in syntactic comprehension, or a
burst of new vocabulary learning, or both? Given the basis for
mental age matching used in this study, adolescents with
Down syndrome can be described as having advanced
vocabulary comprehension. That matching was based on the
average of Pattern Analysis and Bead Memory age-equivalent scores, because language requires both simultaneous
and sequential processing. If matching had been done on the
basis of nonverbal cognitive tasks that contained few requirements for short-term memory or sequential processing, such
as Pattern Analysis alone, the subjects in this study might
also have appeared to have mild deficits in syntax comprehension. Had matching been done on the basis of PPVT
scores, the subjects would have appeared to have deficits in
syntactic comprehension and cognitive performances.
A vocabulary comprehension advantage could arise (a) if
intervention programs were heavily targeted toward vocabulary enrichment, compared to usual educational experience;
or (b) if shifts in the learning environments of children with
Down syndrome brought opportunities to learn vocabulary

usually not available to children of similar mental age levels-for example, vocational work settings; or (c) the increased opportunities for vocabulary learning, relative to
mental age controls, make mental age-equivalent scores
overestimations. In any case, the advantage ought to appear
for other children with mental retardation in similar intervention vocational programs, in contrast to mental age controls.
No other control group of children with mental retardation
was included in this study, but Rosin et al. (1988) included
one and compared PPVT-R performance on standard scores
based on mental age performance on the Columbia Mental
Maturities Test; they found no evidence of vocabulary acceleration in children with Down syndrome, children with mental
retardation, or mental age-matched children. Their results
support the interpretation that the difference in operationalizing mental age is the source of discrepant findings.
If the discrepancy is to be understood as a specific deficit
in syntactic comprehension, one might argue that such a
deficit could arise from (a) mild hearing loss, particularly in
the case of items testing morphological inflections of limited
phonetic substance, such as the nonsyllabic allomorphs of
plural, possessive, and present tense singular markings in
TABLE 13. Intercorrelations among predictor variables for control group (n = 47).
Independent variable

CA

MA

MEd

Tubes

Chronological age
Mean mental age
Mother's education (years)
Tubes (1 = yes, 0 = no)
Years of preschool

.84*
.35*'
.42**
.68**

.29*
.31*
.64**

.09
58**

.36**

Note: CA = chronological age, MA = mental age, MEd = mother's

years of education.
*p < .05, one-tailed. **p < .01, one-tailed

TABLE 14. Predicting vocabulary comprehension (PPVT-R age-equivalent score) In control

children aged 2-6: Stepwise multiple regression analysis (n = 47).
Step

Predictor

Beta
in

Multiple
R

R2

F(eqn)

Sig F

1
2
3

Chronological age
Mother's education
Mean mental age

.88
.26
.43

.88
.92
.95

.78
.84
.90

162.24
117.56
126.18

<.01
<.01
<.01

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Chapman et al.: Language Comprehension in )own Syndrome

1117

TABLE 15. Predicting syntax comprehension (TACL-R total mean age-equivalent score) in
control children aged 2-6: Stepwise multiple regression analysis (n = 47).
Step

Predictor

Beta
In

Multiple
R

R2

F/eqn)

Sig F

1
2

Mean mental age

Tubes

.88
.18

.88
.90

.78
.81

159.14
92.86

<.01
<.01

English; or (b) general deficits in short-term memory peculiar

to Down syndrome, such as might be tapped by the Bead
Memory test of visual short-term memory; or (c) specific
deficits in auditory short-term memory, the kind of cognitive
deficit most frequently reported as typical of Down syndrome;
or (d) deficiencies in short-term memory mediated by the
articulatory loop (Baddeley, 1986).
Although the regression analyses demonstrate that mild
hearing loss accounts for some of the variance in both
vocabulary and syntactic comprehension score, the amount
of variance (4%) is relatively small. Further, both these
results and the failure of passes on hearing screening to
predict variance on the TACL-R Subtest II of grammatical
morphology suggest that the variance is not a factor that
contributes differentially to perception of brief stretches of the
acoustic input, with consequent, specifically syntactic, effects.
If mild hearing loss were the principle explanation for a
syntactic comprehension deficit, then we would expect it to
account for more variance in syntax comprehension scores
than in vocabulary comprehension scores, particularly for
items testing morphological inflections (Subtest II of the
TACL-R); and we would expect Subtest II performance to be
depressed relative to the other subtests. None of these
predictions is borne out in our data.
If short-term memory generally, including memory for
visual patterns, is implicated in a syntactic comprehension
deficit, then TACL-R Subtest III, Elaborated Sentences,
should show poorer performance than the other subtests for
children with Down syndrome, but not controls. This is not the
case. In addition, the Bead Memory subtest should be a
better predictor than the Pattern Analysis of syntactic comprehension, particularly of Subtest III. This was not the case
either for total TACL-R score or Subtest III. Nor was it the
case that Bead Memory was a better predictor than Pattern
Analysis when multiple regression analyses were undertaken

within each of the four age groups. Essentially, mean mental

age was always the best predictor, Pattern Analysis the best
inits absence. Thus the visual short-term memory or sequential processing deficit noted in the performance of older Down
syndrome children on the Bead Memory subtest did not
predict variability in syntactic comprehension, although the
magnitude and age course were similar.
If auditory short-term memory were implicated in the
syntactic comprehension deficit, we would also predict performance on the TACL-R Subtest III of elaborated sentence
construction to be worse than that on Subtest II.This was not
the case. The patterns of TACL-R subtest performance were
similar to, and no different from, the patterns of performance
in the control group. Further, the use of the picture pointing
format to test comprehension minimizes the contribution of
auditory memory factors in the assessment of syntactic
comprehension. However, it is still clear that matching sentence to picture may require relatively more short-term memory for the sentence than does a single-word vocabulary test.
No measures of auditory short-term memory were included in
the present protocol, so the relationship cannot be evaluated
directly, although individuals with Down syndrome typically
show deficits on auditory-vocal tasks (Gibson, 1978;
Pueschel, 1988).
A similar set of arguments can be made if a deficit in
articulatory rehearsal loop (Baddeley, 1986) is proposed as
the problem underlying poorer performance on syntactic
comprehension by children with Down syndrome. This proposal has the additional attraction that the use of the articulatory loop may increase with age or developmental level,
thus creating a deficit in older children's performance not
found in younger children. Presumably such a deficit should
be correlated with expressive language deficits.
The gradual emergence of an apparent syntactic comprehension deficit, with age, could also be due in part to test
characteristics. Prior to a developmental level of about 3

TABLE 16. Predicting syntax comprehension in children aged 2-6: Stepwise multiple regression analyses for age-equivalent scores on TACL-R subtests.
Step

Predictor

Subtest I
Mean mental age
1
2
Chronological age
3
Mother's education (years)
Subtest I
1
Chronological age
Subtest III
1
Mean mental age

Beta
in

Multiple
R

R2

RFeqn)

Sig F

.82
.40
.19

.82
.85
.86

.67
.72
.74

88.45
54.06
41.02

<.01
<.01
<.01

.74

.74

.55

52.98

<.01

.83

.83

.69

99.72

<.01

Note. Subtest I: Word Classes and Relations (n = 46); Subtest I: Grammatical Morphemes (n = 47);

Subtest IIl: Elaborated Sentences (n = 46).

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1118

34

Journal of Speech and Heanng Research

years, syntactic content of tests typically manipulates the

number of lexical items that the child must process, or simply
vocabulary content itself (e.g., Miller, Chapman, Branston, &
Reichle, 1980), rather than word order or grammatical morpheme cues. Thus the degree to which syntactic comprehension can be tested varies with developmental age in the
range studied; the TACL-R itself is more heavily weighted by
vocabulary content at the younger ages and on Subtest I,
Word Classes and Relations. In addition, age-equivalent
scores below 3 on the TACL are extrapolated linearly from
older children's trends in performance, rather than from test
data. Finally, an increasing discrepancy in age-equivalent
scores is expected, if acquisition rates are different for the
two domains but constant.
Sources of Discrepant Nonverbal Cognitive
Abilities in Down Syndrome
The search for a characteristic pattern of cognitive abilities
in Down syndrome has produced conflicting accounts (Gibson, 1978). Our finding that the subjects with Down syndrome show increasingly discrepant performance with age
on the nonverbal Bead Memory and Pattern Analysis
subtests of the Stanford Binet, 4th ed., is inconsistent with
reports of their relative strengths on visuomotor tasks (Gibson, 1978, ch. 7 & 8; Silverstein, Leguki, Friedman, &
Takayama, 1982) but consistent with findings of sequential
processing deficits (Das, Kirby, & Jarman, 1979; Rosin et al.,
1988; Snart, O'Grady, & Das, 1982) or visual storage deficits
(McDade & Adler, 1980). However, sequential processing or
short-term memory deficits are more typically reported for
auditory than visual memory in individuals with Down syndrome (Ellis, Deacon, & Wooldridge, 1985, one third of
whose subjects had Down syndrome; Marcell & Armstrong,
1982; Marcell & Weeks, 1988; Pueschel, 1988; Varnhagen,
Das, & Varnhagen, 1987). The deficits in auditory short-term
memory are not accounted for by requirements for verbal
responding (Marcell & Weeks, 1988) or by effects of attentional distractors (Marcell, Harvey, & Cothran, 1988).
It is also possible that relatively poorer performance on the
Bead Memory task arises from failures of verbal mediationeither a strategic failure to use rehearsal strategies, or
deficits inthe articulatory loop working memory that has been
postulated (Baddeley, 1986). If the last view is a correct one,
we might expect that Bead Memory performance, in older
individuals, was associated with degree of expressive syntax
deficit; Chapman, Schwartz, and Kay-Raining Bird (in preparation) evaluate these predictions for language production.
Limitations of Study
Our own exclusion criteria constitute one limitation of the
study: Children who depended on signing as their primary
means of communication, and children who had more than a
mild hearing loss, were excluded from this study. Thus,
comprehension deficits potentially present for signers, and
probably present for children with more than a mild hearing
loss, are not included here. Our findings may overestimate
the level of comprehension skill in the population of children

1106-1120

ctober

991

and adolescents with Down syndrome (Trisomy 21) as a

whole, then.
Relatively few children were excluded, however, by the
requirement that speech be the primary means of communication; fewer than might be excluded in younger cohorts of
children with Down syndrome, who frequently receive signing
instruction. Of the children and adolescents aged 5-20 inthis
study, 65% had received signing instruction at one time, but
only 35% were currently using sign to support spoken
communication, and these were predominately younger children.
Our subject-finding methods worked through parent networks; none of the children with Down syndrome recruited
were living in institutions. A home-reared sample, however,
may lead to cohort differences in a cross-sectional study,
such as this one, that covers a 15-year time span. Institutionalization was a more common practice 15 years ago than
now. The fact that the older individuals participating in the
study were also not institutionalized may mean that their
families are unusual in other ways that are reflected in
apparent correlations with age. Longitudinal follow-up of the
sample will permit us to confirm age-related findings within
individuals.
Secondly, the use of age-equivalent scores to determine
language delay relative to cognitive levels of functions has a
number of limitations [see, e.g., Lahey's (1990) recent discussion], including the fact that difference scores do not have
the same significance at different ages. In particular, the
apparent age gap in two abilities developing at different
constant rates should increase with increasing age. The use
of a control group design is thus an important adjunct to any
conclusions drawn from within-subject differences in scores.
Finally, the educational history measures reflected only
quantity, rather than quality, of interactions (intervention,
speech-language therapy, preschool experience) thought to
facilitate language development. Thus the failure of these
measures to contribute to the multiple regression analyses
may reflect our failure to measure qualitative aspects of
these events.

Implications for Research

These findings help explain the disparate reports in the
research literature. The age of children with Down syndrome
studied, in particular, will affect the probability of finding a
significant difference from mental age-matched controls. The
way in which mental age matching is accomplished, in
addition, will increasingly affect the outcome as older children
are tested. Matching on the basis of nonverbal tests with
minimal short-term memory requirements, such as the Leiter
or the Columbia, may put older children with Down syndrome
at an effective disadvantage, relative to controls, on shortterm memory tasks.
Similarly, the evidence for short-term memory deficits in
Down syndrome is less clear than it appears to be because
the "cognitive" matching in most of the memory studies has
been done on the basis of PPVT scores (e.g., Marcell,
Harvey, & Cothran, 1988; Marcell & Weeks, 1988)-that is,
on vocabulary comprehension, a procedure likely to put older

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Chapman et al.: Language Comprehension in Down Syndrome

groups of Down syndrome at a disadvantage with respect to

nonverbal mental age if vocabulary age is actually accelerated, relative to other developmental dimensions, by access
to more varied life events.
Finally, the matching achieved on a comprehension measure will depend on the relative amount of vocabulary and
syntactic comprehension tapped by the test. Bridges and
Smith (1984), for example, found a slight delay (6-12
months) inthe interpretation strategies for active and passive
sentences that children with Down syndrome aged 4-17
years used, compared to children without retardation
matched on the basis of verbal comprehension scores on the
Reynell Developmental Language Scale. The Reynell has
both vocabulary comprehension and syntactic comprehension items. If it had been entirely a vocabulary test, Bridges
and Smith might have found larger delays; if items had been
chiefly syntactic, performance might have been comparable.
Hearing status was significantly related to comprehension
performance in this study, confirming that the inclusion-or
exclusion--of children with mild hearing loss would affect
results. However, the magnitude of comprehension effects
associated with this index of current hearing level is much
smaller than those related to chronological or mental age.

Acknowledgments
This research was supported by NIH Grant R01 HD23353 to the
author Chapman and by Core Support Grant No. 5 P30 HD03352 to
the Waisman Center on Mental Retardation and Human Development. The help of the children and parents who participated is
gratefully acknowledged, as is the assistance of the Down Syndrome
Developmental Monitoring Program, directed by Joan Burns and Jon
Miller, in finding children, and that of Hye-Kyeung Seung in the
literature review. We thank Len Abbeduto for helpful comments. A
preliminary version of this paper was presented at the Annual
Convention of the American Speech-Language-Hearing Association,
Boston, MA, November 18, 1988.

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Received August 13, 1990

Accepted December 12, 1990
Requests for reprints should be sent to Robin S. Chapman, PhD,
Department of Communicative Disorders, University of WisconsinMadison, 1975 Willow Drive, Madison, WI 53706.

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