Down Syndrome Research and Practice


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liter acy

Reading interventions for children with Down


Kelly Burgoyne

Though many individuals with Down syndrome are now able to achieve useful levels of literacy skills, it is still not

clear how best to support the development of reading skills with this group. Research with typically developing

children has identified successful methods of teaching reading, and recent work has begun to evaluate these

methods for individuals with Down syndrome. The aim of this paper is to review this work, and to highlight areas in

need of further research.

Many children with Down syndrome are

now educated in mainstream classrooms

and have access to the same levels of literacy

teaching as typically-developing children.

As a consequence many individuals

with Down syndrome are now able to

achieve useful levels of literacy skills. A

recent overview of the literature suggests

that children with Down syndrome aged

between 7-14 years typically attain reading

ages of between 5 years, 5 months and 10


[1]. There is, however, wide variability

in the level of reading skills that children

with Down syndrome can achieve, with

some children able to develop reading

skills that are in line with, or in advance

of, their chronological age (e.g.

refs 2,3).

Explaining this variability is not straightforward,

as a wide range of factors impact

on reading progress

[1]; nonetheless, effective

literacy instruction is imperative

to enable all children to reach their full

potential and many believe that more can

be done to promote reading development

in children with Down syndrome (e.g.



). Given the potential benefits of reading

for the development of speech, language

and memory skills of children with Down

syndrome (see

ref 1) there is a clear need

to explore potential methods of supporting

reading with this group of children.

Research with typically developing children

has identified effective methods of

supporting reading development, and this

work has informed the development of

reading intervention research with children

with Down syndrome. The aim of

this paper is to review some of this work,

and to highlight areas that are in need of

further research.

Learning to read is a complex and challenging

task which requires explicit teaching

and considerable practise to acquire.

To appreciate what is involved in learning

to read, and therefore what needs to be

taught, it is useful to simplify the process.

A useful framework for this is provided

by the Simple View of Reading

[5]. In this

framework, which underlies the National

Strategy Primary Curriculum, effective

reading (reading with meaning) involves

two interacting, but separate, components:

word recognition and language

comprehension. To become effective readers,

children need to develop the skills

involved in both word recognition and

language comprehension; both are necessary

for reading, but neither is sufficient

on its own. Thus, reading cannot occur

unless the child can recognise the printed

word. However, the child must not only

identify the words, but must also understand

the text, for reading to be effective.

Research supports the independence of

word recognition and linguistic comprehension

components (e.g.

refs 6-9), and

clear evidence of the dissociation between

the two abilities is seen in populations

with dyslexia (who have good comprehension

but impaired word reading) and

‘poor comprehenders’ (a group who have

significant difficulties understanding text

despite good word reading skills). The

Simple View of Reading suggests that, to

become effective readers, children need to

be taught both components: how to identify

the words on the page, and how to

understand the texts that they read. This

update will first consider interventions

which target the processes involved in the

development of word recognition skills,

before considering work which has a more

specific focus on comprehension.

Much of the reading research has focused

on the word recognition component.

Work with typically-developing children

has identified phonological awareness

and letter knowledge to be essential for

the development of alphabetic reading.

Phonological awareness is the ability to

reflect on the sound structure of speech

and is assessed by tasks which require

children to separate words into syllables,

identify and produce rhymes, match

words that begin with the same sound,

and to manipulate individual sounds (or

‘phonemes’) in words, for example, by

blending, segmenting and deleting them.

This skill is a strong predictor of reading

in typically-developing children (e.g.

refs 10,11,12

), and a large body of research

evidence points to the efficacy of phonics

teaching in supporting the reading development

of typically-developing children

who have reading difficulties. An early


[11] compared four groups of 7-yearold

poor readers: a control group and three

experimental groups who received training

in reading, phonology, or reading and

phonology combined. The results showed

that following the intervention, the group

who received training in both reading

and phonology made the most progress.

Thus, the teaching of phonology is most

effective when it is combined with reading

instruction, and when the links between

sounds and letters are made clear. The



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success of this approach (reading with

phonology) in helping struggling readers

has since been supported by a large body

of research evidence (e.g.

refs 13-17). In line

with this accumulating knowledge base

a recent review of the teaching of early


[18] recommends an integral role

for the teaching of phonics within the

national literacy framework.

Though early research with children

with Down syndrome suggested no relationship

between phonological awareness

and reading ability for this group

[19] later

studies showed that phonological skills

were not absent in this group, though they

are delayed relative to typically-developing

groups and to word reading skills (e.g.

refs 20-23

). A comparison of 12 individuals

with Down syndrome (aged 10-26 years)

with 14 typically-developing children

aged 6-7-years, who were matched for

word reading skills, demonstrated measurable

levels of phonological awareness

skills (initial sound detection, phoneme

deletion and rhyme detection) for the

group with Down syndrome, though they

scored significantly lower on these measures

than the typically-developing group


. Nonetheless, phonological awareness

skills are correlated with reading for individuals

with Down syndrome (e.g.



). Thus, though research has yet to

clarify whether phonological awareness

skills are an essential precursor to reading

for children with Down syndrome, or

whether they develop as a consequence of


[22], the evidence does suggest that

phonological awareness skills play a role

in the reading development of this group

of children.

This evidence has led a number of

researchers to investigate the efficacy of

phonological awareness training for supporting

reading development in children

with Down syndrome. In a small-scale

intervention study

[25], three children with

Down syndrome (aged 6 years, 11 months;

8 years, 4 months; and 8 years, 10 months)

received training in phonological awareness

delivered in eight one-hour sessions

over four weeks. Improvements in targeted

phonological awareness skills (alliteration

detection, initial phoneme isolation) were

observed following the intervention, as

were gains in spelling, though it should be

noted that it is difficult to evaluate the size

of the gains as no statistics are reported.

These skills did not, however, generalise

to untrained phonological awareness

tasks (i.e. segmentation), suggesting that

specific skills need to be taught explicitly.

This study also assessed the effects of the

training on speech production: though

some improvements were recorded, these

were minimal and were not apparent in

all participants. It must be noted that this

intervention was over a very short period

and did not explicitly target speech production;

effects of phonological awareness

on speech production may be seen from

longer training studies that include a specific

speech element. There is some support

for this argument from research with

children with speech impairment, which

found improvements in speech production

following 20 hours of phonological

awareness training


A larger study

[27] evaluated a phonological

intervention programme based on

Jolly Phonics (

[28]; a programme which is

widely used in UK schools to teach lettersounds)

and the reading with phonology

programme developed by Peter Hatcher

and colleagues

[11]. The intervention incorporated

training in phoneme awareness

and letter knowledge, and was adapted

to include a component which worked

on speech production, though the impact

of training on this skill is not reported.

Learning support assistants were trained

to deliver the intervention to individual

children in daily 40-minute sessions. In

this study, 15 children with Down syndrome

(aged 8-14 years) were split into

two groups: Group 1 received the intervention

over eight weeks whilst Group

2 acted as a waiting control group; both

groups then received the intervention for

the following eight weeks. Group 1 showed

larger gains in phoneme awareness, letterknowledge,

word and non-word reading

than the waiting control group, who

began to make progress once they started

the intervention; effect sizes were large

to moderate (Cohen’s

d = 1.27 for letter

knowledge to 0.40 for non-word reading).

Gains were maintained five months after

the intervention had ended. In sum, the

intervention was effective in accelerating

development: Children made more

progress in reading during the intervention

than they did during the year before

the intervention started. Furthermore,

this study suggests that learning support

assistants can be trained to deliver effective

intervention which is tailored to the

needs of individual children.

Other work

[29] suggests that parents can

also deliver effective phonics-based training.

In this study, parents of 7 young children

(aged 4-years) were trained to deliver

an intervention which combined phonological

awareness and letter-knowledge

training, delivered through parent-child

shared reading activities in four 10-minute

sessions each week, for six weeks. When

reading books with their children, parents

were encouraged to bring the child’s attention

to targeted letters and corresponding

sounds within words by stating the letter

name (‘this is the letter S’), describing the

sound it makes (‘it makes the ssss sound’)

and bringing the child’s attention to the

letter visually and orally (‘sss is the first

sound in the word Spot’). Statistically significant

gains in letter knowledge, print

concepts and initial phoneme identity

were reported following the intervention.

Cologon, Cupples and Wyver

[30] compared

two training programmes: a phonological

awareness programme, and a silent

reading or comprehension programme.

Fifteen children with Down syndrome,

aged 2-10-years were allocated to one of

the two training programmes which were

delivered over 10-weeks. The phonological

awareness training emphasised oral

reading, using word reading and blending

tasks. The comprehension or silent

reading tasks included selecting pictures

to match action words and sentences.

There was also some overlap between

the programmes, as both included sentence

completion and oral reading components.

In addition, taking advantage

of the visual strengths of children with

Down syndrome

[1], both programmes

made use of visual aids, such as pictures

and plastic letters, to promote learning.

Both programmes led to significant gains

on measures of phonological awareness,

letter-sound knowledge and word and

passage comprehension. This research

suggests that children with Down syndrome

may make considerable improvements

in phonological awareness and

letter-sound knowledge following periods

of instruction, even when teaching does

not explicitly target those skills. However,

other work which has compared phonological

awareness intervention with other

types of training (i.e. narrative training)

in children with Down syndrome report

greater gains following explicit teaching




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of phonological awareness (e.g., Cleave,

Kay-Raining Bird, Bourassa, Armstrong

& MacIsaac, 2006, cited in


The evidence outlined above suggests

that reading instruction, and more specifically,

training phonological awareness

in the context of learning letter-sound

knowledge, is effective for supporting the

development of reading in groups of typically-

developing children, and in children

with Down syndrome. Thus, many

children show strong and lasting gains

on reading measures following phonological

awareness intervention even where

interventions are of short duration. It is

important to note, however, that a minority

of children who receive phonological

awareness intervention fail to respond;

many studies of typically-developing

children and of children with Down syndrome

report wide variation in response

to phonological awareness intervention,

with some children failing to make any

progress, or even showing in a decline

in reading (e.g.

refs 15,27,29,32). Goetz et


[27] report no progress for 2 of the 15

children with Down syndrome who participated

in their intervention, whilst a

further 4 children showed small declines

in reading age over the course of the intervention

period. Similarly, van Bysterveldt

et al.

[29] report significant variability

within the group of children with Down

syndrome, both in terms of initial level of

skill, and in progress made over the course

of the intervention, with some children

making very little or no progress.

Research with typically-developing

children has begun to explore why some

children fail to respond to phonological

awareness intervention. This research

suggests that these children have a similar

profile of more severe deficits in phonological

awareness and letter-sound knowledge

and relatively poor vocabulary skills


It has been argued that oral language, particularly

vocabulary knowledge, supports

the development of phonological awareness



as increasing vocabulary knowledge

forces a restructuring of the mental

lexicon at a sub-lexical phonological level.

In this way, developing vocabulary knowledge

is likely to have a facilitative effect on

developing phonological awareness. This

would predict that intervention which

targets oral language skills alongside phonological

awareness skills would be particularly

effective for supporting reading

development for this group of children.

Evidence with typically-developing children

appears to support this prediction.

A recent study

[34] evaluated a programme

of intervention which combined training

in reading and phoneme awareness


with a programme of rich vocabulary


[35] with 12 8-year-old children

who had previously failed to respond to a

period of reading intervention. This programme

included work on book-reading,

vocabulary instruction and narrative

skills, combined with phoneme awareness,

letter-knowledge and sight-word

reading. Teaching assistants were trained

to deliver the intervention to individual

children in two daily 15-minute sessions

over a period of nine weeks. The findings

showed that, for this group, a combined

reading and vocabulary training programme

was more effective than a programme

which solely targeted reading.

Significant progress was made in word

reading, letter-sound knowledge, phoneme

segmentation and expressive grammar

over the course of the intervention

(effect sizes ranging from Cohen’s

d = 0.44

to 1.23), with children showing gains in

reading that were three times greater than

gains made before and subsequent to the


Research with typically-developing children

therefore suggests that children who

have low levels of vocabulary may be less

able to benefit from phonics training and

that intervention which combines robust

vocabulary teaching with reading instruction

could be more effective for this group

than traditional reading intervention

programmes. Potentially, children with

Down syndrome may also be more likely

to benefit from a combined approach.

Language impairments are common in

children with Down syndrome (see e.g.

ref 4

) and evidence suggests that oral language

skills play a significant role in the

development of reading for this group


This suggests that instruction which combines

highly-structured phonics training

with oral language skills training might

be highly beneficial to the reading and

language skills of children with Down


The work reviewed above has focused

on developing reading skills through the

word recognition component, mainly by

targeting phonological awareness skills

and letter knowledge. It is clear though

that the most recent developments in

reading intervention work, which include

oral language training as a component to

reading intervention, take a more holistic

view of reading that incorporates processes

involved in supporting language

comprehension, i.e. vocabulary. By including

vocabulary and narrative skills in the

teaching programme, this training has the

potential to impact directly on the development

of comprehension, though this

needs to be evaluated in future studies.

Returning to the

Simple View of Reading[5]

discussed earlier, this framework identifies

language comprehension as the second

essential component involved in reading.

In contrast to research on word reading

and phonological awareness, there is considerably

less research on comprehension

and we know much less about how best to

support the development of this skill. This

paper will first provide a brief summary of

the processes involved in comprehension

and review what we know about the comprehension

skills of children with Down

syndrome, before considering methods by

which comprehension may be supported.

Reading comprehension clearly relies to

some extent on word recognition: children

cannot begin to understand text

unless they can first accurately identify

the printed word. Indeed, poor reading

skills are the cause of some children’s

difficulties with reading comprehension.

However, recognising the word is no

guarantee of comprehension; many more

processes beyond those involved in word

recognition are required to make sense

of text. In line with this, research has

identified a group of children who have

particular difficulties with comprehension,

despite demonstrating good decoding

skills. These children are referred to

in the literature as ‘poor comprehenders’,

and they are typically identified as having

reading comprehension skills that are

at least one year below age-appropriate

reading accuracy skills. The discrepancy

between reading accuracy and comprehension

means that they understand text

at a level significantly below that which

could be expected from their reading

accuracy, signalling a problem with comprehension

that is not caused by reading

accuracy difficulties. Research suggests

that approximately 10% of children of

primary-school age fit the profile of poor





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Reading comprehension is a multidimensional

skill that involves a number

of processes at several different levels,

any of which may impair comprehension;

components identified as important for

comprehension include language skills

(grammar, semantics and pragmatics),

working memory, background knowledge,

and processes including inferential

processing, and comprehension monitoring



. Given that many children with

Down syndrome experience difficulties

with at least two of these components,

namely language

[37] and memory[38], it may

be expected that this group would demonstrate

difficulties with comprehension.

Few studies of reading skill in individuals

with Down syndrome report comprehension

data; consequently the evidence base

is limited. However, the evidence that is

available suggests that reading comprehension

is typically below reading accuracy

for this group (e.g.

refs 2,24,39-43). In

a preliminary report

[39] 10 individuals

with Down syndrome (aged 11-19 years)

were compared with 10 typically developing

children (aged 8-10 years) who were

matched for single-word reading. Though

the groups did not differ in reading ability,

the group with Down syndrome

scored significantly more poorly on a

test of reading comprehension. Reading

comprehension scores in this group were

found to be on average 18 months below

reading accuracy. Similarly, the case study

of an ‘exceptional’ reader with Down syndrome



showed that K.S. achieved scores

on a reading comprehension test that were

significantly below the level which would

be expected from her reading accuracy

ability; specifically comprehension was

13 months below reading accuracy. Thus,

many children with Down syndrome

comprehend text at a level which is poorer

than could be expected given their reading

accuracy skills. Discrepancies between

accuracy and comprehension are comparable

to that recorded for poor comprehenders,

suggesting a similar profile


As noted above, many children with

Down syndrome have weaknesses with

language and memory, both of which are

likely to constrain their ability to understand

text. Indeed, the reading comprehension

difficulties of children with Down

syndrome are associated with difficulties

with language comprehension and wider

language skills including verbal cognitive

ability, receptive vocabulary and

receptive semantic knowledge

[2,39]. This

would suggest that interventions which

target vocabulary knowledge or memory

skills may also support the development

of comprehension. Though research has

explored ways of supporting these skills

in children with Down syndrome (see e.g.

refs 4,44

) there is little research evidence

concerning the impact of this on comprehension;

clearly, this is an area in need

of further research. There is insufficient

space here to discuss research which has

developed and evaluated language and

memory interventions with children with

Down syndrome; this will be addressed in

future research updates.

There is some suggestion that children

with Down syndrome have particular difficulties

with inferential comprehension


Inferencing is the process whereby readers

fill in the gaps left by explicit text information,

and the ability to do this is significantly

related to comprehension


Work with typically-developing children

suggests that less-skilled comprehenders

experience impaired inference making

relative to skilled comprehenders


Nash et al.

[39] suggest that children with

Down syndrome also experience particular

difficulties with inference generation:

though both typically-developing children

and children with Down syndrome

scored lower on questions that required an

inference than on questions that required

a literal understanding of the text, the difference

between the scores on the two question

types was greater for the group with

Down syndrome. Groen et al.

[2] also argue

that children with Down syndrome may

find inferential comprehension particularly

difficult. In their study, K.S. scored

more highly on a test of comprehension

which was argued to test mainly literal

understanding, than on a comprehension

test which also included inferential questions.

Research with typically-developing

children suggests intervention which

targets inferencing skills can be effective

for supporting comprehension

[48-49]. For

example, McGee and Johnson

[49] found

that 3 weeks of inference training led to

comprehension gains of 20-months in

6- to 10-year-old less-skilled comprehenders.

Training in this skill may also

then be effective for children with Down

syndrome. However, further work which

clarifies the nature of comprehension difficulties

in children with Down syndrome

is needed before exploring this kind of


Work with typically-developing children

suggests that teaching comprehension

strategies is also effective for supporting

comprehension. Strategies that have

been identified as particularly important

for successful comprehension include

prediction, questioning, clarifying and


[50]. Readers can be taught

to use comprehension strategies with the

result that understanding and memory

of the text is improved

[51]. Palincsar and


[52] developed an instructional programme

to teach comprehension strategies

called “Reciprocal Teaching”. This

method makes use of modelling and

scaffolding techniques to teach appropriate

use of strategies and children learn to

apply strategies during group activities

which encourage discussion and dialogue

between participants. This programme

of instruction has been shown to lead to

significant increases in comprehension

for different populations of students


Recent work with adults with mild intellectual


[56] suggests that direct

teaching of strategies to individual children

is as effective as the traditional

reciprocal teaching format (working with

groups) for supporting comprehension.

The impact of comprehension strategy

instruction for enhancing reading

comprehension has been evaluated for 6

young adults with Down syndrome (aged


[58]. The intervention was

delivered over 15 weeks in weekly sessions

of 15-30 minutes duration. Participants

attended in pairs for the first 12 weeks at

which point training was tailored to individual

student’s needs. This study focused

on three key strategies: accessing prior

knowledge and past experiences, prediction

and retelling. Findings are reported

for a single case study: a young man with

Down syndrome named Lewis, aged 19

years and 6 months. Following the intervention,

Lewis demonstrated increased

use of the trained strategies: he was more

able to access relevant prior knowledge

and past experiences and to use this to

understand the text, was better able to

predict the context of text and discuss the

text following reading, and better able to

recall details and retell a text. These types

of strategic processing facilitate comprehension

by enabling the reader to actively




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process the text and to develop a more

detailed and coherent representation of

the text that is supported by personal

experience and background knowledge.

Increases in strategy use were coupled

with significant increases in reading ability:

at the end of the intervention period,

Lewis’s comprehension had increased by

12 months, and accuracy by 10 months.

Thus, teaching comprehension strategies

may be an effective method of supporting

comprehension for individuals with

Down syndrome, though clearly further

work is needed to support this.

A different type of strategy training that

has been investigated is the use of mental

imagery techniques. Imagery may

facilitate comprehension by providing an

alternative (visual) way of representing

information: visual mental images can

help to organise information for retrieval

and support integration of ideas, which

would complement and may reduce the

verbal processing load. Research suggests

that mental imagery training is as effective

as verbally-based reciprocal teaching

methods for improving the reading,

language and memory skills of typicallydeveloping

groups with poor comprehension



. Oakhill and Patel[59] carried

out a training study with 9-10-year-old

typically-developing children who were

identified as good and poor comprehenders,

by teaching them to picture stories in

their minds which they were then to use

to answer comprehension questions. The

training led to increased comprehension,

having a greater effect for poor comprehenders

than for the more skilled group,

who presumably are already using this

strategy to aid comprehension. A recent


[60] evaluated visual imagery training

as a method of supporting comprehension

in children with specific language impairment

(SLI). In this study, nine children

with SLI aged 9 years, 6 months participated

in five 30-minute training sessions

each week for three weeks. Using picture

cues, children were encouraged to visualise

sentences; as children progressed in the

intervention they gradually shifted from

visualising segmented sentences, through

to individual sentences, before graduating

to 5-sentence stories. The use of picture

cues was gradually reduced over time

so that children were required to create

their own mental images by the end of the

intervention. The intervention was delivered

to children in small groups, in which

they were encouraged to share and discuss

their mental imagery. Significant gains in

comprehension were reported following

the intervention (effect size = 0.608).

Research has yet to evaluate mental

imagery training as a method of supporting

comprehension in children with

Down syndrome; however, evidence that

this group benefit from visual learning



suggests that visual imagery training

may play to their strengths. Furthermore,

there is evidence that this group benefit

from mental image strategies to improve


[61]. In this study, 52 individuals with

Down syndrome (aged 7-57 years) were

asked to listen to stories and recall words

and ideas. Recall was best when the stories

were presented along with pictures

representing the main points of the story.

Recall was also significantly better when

participants were given a short training

period in ‘the formation of mental images

in order to learn a story’ than when they

only listened to the stories. This suggests

that this type of strategy is suitable for

individuals with Down syndrome and

may support learning. However further

research is needed to evaluate whether

mental imagery training can be used to

support comprehension specifically in

children with Down syndrome, rather

than simply recall.

In summary, reading intervention work

with typically-developing children has

identified methods of supporting reading

development by targeting the processes

involved in word recognition and

in comprehension. This evidence has

started to inform research with children

with Down syndrome, and there is clear

evidence that some of these methods

are effective for supporting the reading

skills of this group. It must be noted that

there are difficulties interpreting many of

these training studies as they often fail to

include an untreated control group with

which to compare the intervention group,

and are often small scale or report data

from single case studies. There is clearly

a need for further research to evaluate

those methods which appear promising

for supporting reading in children with

Down syndrome, using well-designed and

controlled research methods. In addition,

despite recent advances in knowledge,

there remain significant areas in which

our understanding is lacking, and this is

particularly true of comprehension. More

research is needed to explore the comprehension

skills of children with Down

syndrome, and to evaluate methods of

instruction which may support the development

of this skill. Clearly, there is still a

long way to go.

Kelly Burgoyne is at Down Syndrome Education

International, Portsmouth, Hampshire, UK. email:


doi: 10.3104/reviews.2128

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