Maternal responsivity in mothers of young children with Down syndrome

Parental Responsivity and Child Communication During Mother-Child and Father-Child Interactions in Fragile X Syndrome

PURPOSE

Past research shows that parentally responsive behavior toward the child positively influences language development in both neurotypical children and children with intellectual and developmental disabilities, including those with fragile X syndrome (FXS); however, most studies have focused exclusively on the mother-child relationship. The current study examined relationships between parent behavior (i.e., responsivity and behavior management) and child language performance in both mother-child and father-child interactions, as well as relationships between child characteristics and both parent behavior and child language.

METHOD

Participants were 23 families of young boys with FXS between 3 and 7 years of age. Mothers and fathers independently completed questionnaires assessing child characteristics and separately engaged in 12-min play-based interactions with their child via telehealth. One parent also completed a comprehensive interview assessing child adaptive behavior. Video recordings of the parent-child interactions were transcribed and coded for parent and child behavior, and measures of parent and child language were obtained from the transcripts.

RESULTS

Mothers and fathers used similar rates of responsive behaviors during parent-child interactions, and parental responsivity was positively associated with some aspects of child language performance (i.e., talkativeness and lexical diversity). Parental behavior, however, was not associated with syntactic complexity. Older children and children with higher levels of adaptive behavior had parents who used higher rates of responsive behaviors. Fathers used higher rates of behavior management strategies compared to mothers, and this type of parent behavior was not associated with child language.

CONCLUSION

Overall, this study provides evidence that interventions focused on increasing parental responsiveness would be beneficial for families of children with FXS and that these interventions should be delivered early given the association between responsivity and child age.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25229939.

Permissive parenting mediates parental stress and child emotions in families of children with Down syndrome

BACKGROUND

Parenting styles mediate parental stress and child emotions in families of typically developing (TD) children. Our main aim was to study these relations in families of children with Down syndrome (DS), who in past research reported increased parental stress and permissive parenting.

METHOD

Our sample included 100 parents of children with DS and 72 parents of TD children age 4-12 years. Parents completed online surveys of parental adjustment and emotion regulation (ER), parenting styles, and child ER and mood.

RESULTS

Parents of children with DS reported more distress and permissive parenting than parents of TD children. Within parents of children with DS, there was an indirect effect of parental stress on child emotions through permissive parenting. This effect was partly conditional upon parental ER and positive adjustment.

CONCLUSIONS

Results have implications for distressed parents of children with DS whose families may benefit from improved coping strategies and increased support.

The FMR1 Premutation Phenotype and Mother-Youth Synchrony in Fragile X Syndrome

A subset of mothers who carry the FMR1 premutation may express a unique phenotype. The relationship between the FMR1 phenotype and mother-child interaction in families with fragile X-associated disorders has not been well characterized, despite the importance of high-quality mother-child interaction for child development. This study examined the association between the FMR1 phenotype and the quality of interactions between mothers and their adolescent/young adult sons with fragile X syndrome. Mother-youth synchrony was coded from a dyadic interaction. Maternal anxiety and depression symptoms, executive function deficits, and pragmatic language difficulties were evaluated. Results indicated that pragmatic language was associated with mother-youth synchrony. These findings highlight the importance of family-centered intervention practices for families with fragile X-associated disorders.

Responsive Parenting as a Target for Telehealth Language Interventions in Fragile X Syndrome: Implications for Scalability and Best Practices

This review highlights the ways in which telehealth procedures can be implemented to help bridge the research-to-practice gap in supporting developmental outcomes for youth with fragile X syndrome (FXS). We review how the literature to date has informed potential treatment targets in the areas of speech and language development with a focus on understanding and supporting the dyadic relationship between the child and their biological mother, who is also impacted biologically. Notably, parental responsivity is an area that is strongly related to child language outcomes, both early and into adolescence, and thus, it is an important treatment target for subsequent interventions. To date, several parent-implemented interventions have been done in FXS across a broad age range (2-17-year-olds) all showing support not only that parents are successful in learning responsive strategies but also that there are subsequent impacts to child language development. Moreover, these interventions were successfully implemented at a distance through telehealth procedures including video teleconferencing and shared recordings of parent-child interactions. This review also addresses potential moderators of treatment gains. Implications for scaling such interventions in the future as well as best practices for incorporating telehealth procedures into future research and intervention programs are also discussed.

Maternal Use of Decontextualized and Contextualized Talk: An In-Depth Investigation of Early Parent-Child Interactions in Down Syndrome

Purpose The goal of this study was to characterize and quantify maternal use of decontextualized and contextualized input during mother-child interactions including young children with Down syndrome (DS). Method Participants included 22 mother-child dyads with DS (M age = 42.8 months) and 22 mother-child dyads with typical development (M age = 44.0 months). Parent-child language samples were collected during free-play, book reading, and snack time, and coded for maternal decontextualized (i.e., pretend, explanatory, and narrative talk) and contextualized input (i.e., descriptions, conversation, praise, questions, and directives). Results Mothers of children with DS used a larger proportion of pretend talk compared to other types of decontextualized input and also used a larger proportion of questions, conversation, and descriptions compared to other types of contextualized language. Mothers of children with DS generally used a smaller proportion of decontextualized input compared to mothers of children with typical development, with the exception of pretend talk. Maternal decontextualized input was not related to children's age or language ability in DS. Conclusions Findings shed new light on the early language environments of children with DS, providing important insight into the ways that mothers of children with DS are incorporating decontextualized and contextualized talk into early mother-child conversations. Additional implications and future directions are discussed.

Maternal Input and Child Language Comprehension During Book Reading in Children With Down Syndrome

Purpose Communication interactions between parents and children during shared book reading impact a child's development of both language and literacy skills. This study examined maternal language input and child expressive communication during a shared book reading activity in children with Down syndrome (DS) and children with typical development (TD). Additionally, children's receptive language was examined to understand the relationship between maternal language input and child receptive language ability. Method Participants included 22 children with DS and 22 children with TD between 22 and 63 months of age and their mothers. Each mother-child dyad participated in a 7-min naturalistic shared book reading activity. Results Compared to mothers of children with TD, mothers of children with DS used significantly more utterances with less grammatical complexity, but a similar range of vocabulary diversity. Mothers of children with DS used more questions, descriptions, gestures, and labels, whereas mothers of children with TD used nearly half of their utterances to read directly from books. Children with DS communicated at a similar frequency compared to their peers with TD; however, they produced significantly fewer spoken words. Conclusions This study reveals important differences between early shared book reading interactions and provides implications for future research targeting parent-coached intervention strategies that may enhance children's learning during shared book reading by providing access to expressive language and print instruction.

Expressive language development in adolescents with Down syndrome and fragile X syndrome: change over time and the role of family-related factors

BACKGROUND

It is well known that individuals with Down syndrome (DS) or fragile X syndrome (FXS) demonstrate expressive language difficulties beginning early in childhood. It is less clear, however, whether expressive language skills change during the adolescent period in these individuals, and if any of these changes are syndrome specific. Studying this, as well as the role of maternal and family-related factors in expressive language development, may provide the foundation for efficacious interventions for adolescents with DS or FXS.

METHODS

In this study, we examined expressive language trajectories, assessed through conversation and narration, in 57 adolescent males with intellectual disability (ID) (20 DS and 37 FXS) in relation to the diagnostic group (DS vs. FXS) and family-related factors (maternal IQ, maternal psychological distress, closeness in the mother-child relationship, family income, and maternal and paternal education) after adjusting for chronological age (CA) and nonverbal cognition.

RESULTS

Changes over repeated annual assessments for males with DS or FXS were observed only during conversation, such as an increase in talkativeness, but a decrease in syntax complexity and lexical diversity. We found a diagnosis-related effect in the change over time in conversational talkativeness favoring those with FXS. Finally, a closer mother-child relationship predicted less decrease over time in lexical diversity during conversation, and participants of mothers who graduated college showed a greater increase in conversational talkativeness over time compared to those of mothers with a high school education.

CONCLUSIONS

Our results suggest that, during the adolescent period for males with DS or FXS, there is an increase in the amount of talk produced in conversational contexts, but also a decrease in the quality of the language produced. In addition, our results indicate syndrome-specificity for aspects of expressive language development and reinforce the protective role of family-related factors.

[The development of autonomy among adolescents with Down syndrome based on the pedagogy of Paulo Freire]

Autonomy is a process that enables us to understand and act on the environment and on ourselves. During adolescence, transformations result in the development of autonomy. Adolescents with Down syndrome (ADS) have perceptual-cognitive limitations and few opportunities to acquire autonomy. The development of autonomy in an occupational therapy group, with dyads of ADS and their main caregivers was analyzed. The evaluation of the materials produced in the therapeutic process pointed to four categories of analysis: self-perception, perception of the other, shared experience and change of attitude. The results show symbiotic relationships between the dyad, which hamper the individuation process and limit the opportunities to carry out activities independently. The therapeutic process based on Paulo Freire's pedagogy raised the level from an ingenuous to a critical awareness, resulting in changes in the attitudes of caregivers in relation to the identification of potential and acceptance of their own limitations and the ADS under care. This symbiosis complicates the individuation process and the access to experiences necessary for the development of autonomy. The therapeutic process can modify the attitudes of caregivers and foster continuity in development and autonomy.

Physiological arousal and observed behaviour in parent-child interactions involving young children with Down syndrome

BACKGROUND

Parents of children with Down syndrome (DS) play an important role in their child's development. Physiological measures, such as electrodermal activity (EDA), can shed light on parent-child relations beyond the behavioural level. The goals of the current study were to assess the feasibility of collecting EDA data in preschool age children with DS, examine the association between parent and child EDA during play-based interactions, and investigate the relation between parent and child EDA and observed parent behaviours.

METHOD

Two parents in 15 families participated in dyadic free play interactions with their child with DS (i.e., 15 mother-child and 15 father-child interactions). The children with DS (aged 24-61 months) and both of their parents wore multisensory wristbands measuring EDA. Parent behaviours were coded as requests for behavioural complies, requests for verbal complies, or comments.

RESULTS

Usable EDA data were collected for 13/15 children and 11/15 mothers during the mother-child interactions and 14/15 children and 12/15 fathers during the father-child interactions. Parent and child EDA variability was significantly positively related for father-child but not mother-child dyads. Maternal use of requests for behavioural complies was positively related to child EDA variability.

CONCLUSIONS

The collection of EDA data through wristbands worn by young children with DS during early parent-child interactions was feasible. Preliminary findings indicated that some aspects of parent and child physiology in DS may be related in different ways for mother-child and father-child dyads.

An investigation into maternal use of telegraphic input to children with Down syndrome

Maternal input influences language development in children with Down syndrome (DS) and typical development (TD). Telegraphic input, or simplified input violating English grammatical rules, is controversial in speech-language pathology, yet no research to date has investigated whether mothers of children with DS use telegraphic input. This study investigated the quality of linguistic input to children with DS compared to age-matched children with TD, and the relationship between maternal input and child language abilities. Mothers of children with DS simplified their input in multiple ways, by using a lower lexical diversity, shorter utterances, and more telegraphic input compared to mothers of children with TD. Telegraphic input was not significantly correlated with other aspects of maternal input or child language abilities. Since children with DS demonstrate specific deficits in grammatical compared to lexical abilities, future work should investigate the long-term influence of maternal telegraphic input on language development in children with DS.

Language nutrition for language health in children with disorders: a scoping review

The quantity and quality of child-directed speech-language nutrition-provided to typically-developing children is associated with language outcomes-language health. Limited information is available about child-directed speech to children at biological risk of language impairments. We conducted a scoping review on caregiver child-directed speech for children with three clinical conditions associated with language impairments-preterm birth, intellectual disability, and autism-addressing three questions: (1) How does child-directed speech to these children differ from speech to typically-developing children? (2) What are the associations between child-directed speech and child language outcomes? (3) How convincing are intervention studies that aim to improve child-directed speech and thereby facilitate children's language development? We identified 635 potential studies and reviewed 57 meeting study criteria. Child-directed speech to children with all conditions was comparable to speech to language-matched children; caregivers were more directive toward children with disorders. Most associations between child-directed speech and outcomes were positive. However, several interventions had minimal effects on child language. Trials with large samples, intensive interventions, and multiple data sources are needed to evaluate child-directed speech as a means to prevent language impairment. Clinicians should counsel caregivers to use high quality child-directed speech and responsive communication styles with children with these conditions.

Parenting behaviour and executive function in children with Down syndrome

BACKGROUND

Parenting behaviours influence many domains of child development, and recent work has demonstrated the specific effects of parenting on the development of executive function (EF) abilities. The relationship between parent-child interaction patterns and EF has been examined in typically developing (TD) children but has not yet been examined in dyads where the child has a diagnosis of Down syndrome (DS).

METHOD

The current study examines the differences in patterns of parenting behaviours between DS dyads and dyads with TD children equated on nonverbal mental age. DS dyads (n = 42), child ages 59 to 118 months, and TD dyads (n = 28), child ages 30 to 49 months, participated in a modified version of the Parent-Child Challenge Task. Parent directive and teaching behaviours were coded, along with child compliance and noncompliance. Child participants also completed a laboratory measure of inhibition and working memory, and parents completed the Behaviour Rating Inventory of Executive Function-Preschool.

RESULTS

There was a greater frequency of parenting directives and child compliance in the DS dyads, and parents of children with DS were more likely to follow child compliance with directives than parents of TD children. In both groups, parenting directive behaviour was a significant predictor of child EF laboratory performance.

CONCLUSIONS

Results characterise the relationship between specific parenting behaviours and child EF in DS and TD dyads. The implications for parent training and intervention are discussed.

How do maternal interaction style and joint attention relate to language development in infants with Down syndrome and typically developing infants?

Down syndrome (DS) is more detrimental to language acquisition compared to other forms of learning disability. It has been shown that early social communication skills are important for language acquisition in the typical population; however few studies have examined the relationship between early social communication and language in DS. The aim of the current study is to compare the relationship between joint attention and concurrent language skills, and maternal interactive style and concurrent language skills in infants with DS and in typically developing (TD) infants matched for mental age. We also investigated if these relationships differ between children with DS and TD children. Twenty-five infants with DS (17-23 months) and 30 TD infants (9-11 months) were assessed on measures of joint attention, maternal interactive style and language. The results indicated a significant positive relationship between responding to joint attention (RJA) and concurrent language for the DS group, and a significant positive relationship between maternal positive expressed emotion (PEEM) and concurrent language for the TD group. We hypothesise that different social-communication factors are associated with language skills in DS, at least between 17 and 23 months of age compared to TD infants of similar non-verbal and general language abilities.

Vocalization patterns in young children with Down syndrome: Utilizing the language environment analysis (LENA) to inform behavioral phenotypes

Children with Down syndrome (DS) are at higher risk for both delayed expressive language and poor speech intelligibility. The current study utilized the quantitative automated language environment analysis (LENA) to depict mother and child vocalizations and conversational patterns in the home of 43 children with DS, chronologically aged 24-64 months. Children with DS displayed fewer utterances than typically developing children; however, there was wide variability. Furthermore, children with DS did not show increased vocalization counts across their chronological ages. In contrast to previous findings, this study found that the mothers of children with DS had a reduced number of vocalizations. However, the vocalizations increased with age in comparison to mothers of typically developing children. Implications for targeted interventions that facilitate learning opportunities in bidirectional contexts for children with DS and their parents are discussed, with particular attention to quantify behavioral phenotypes utilizing a novel expressive language assessment tool.

Maternal Responsiveness to Gestures in Children With Down Syndrome

PURPOSE

This study compared gesture use in young children with Down syndrome (DS) and typical development (TD) as well as how mothers respond to child gestures based on child age and diagnosis.

METHOD

Twenty-two mother-child dyads with DS and 22 mother-child dyads with TD participated. The child participants were between 22 and 63 months and were matched on chronological age. We coded child gesture use and whether mothers recoded child gestures (i.e., provided a verbal translation) during naturalistic interactions.

RESULTS

The children with DS used more gestures than peers with TD. After controlling for expressive language ability, the two groups were not significantly different on child gesture use. Regardless of child diagnosis, mothers recoded approximately the same percentage of child gestures. There was a significant interaction between child diagnosis and child age when predicting the percentage of maternal gesture recodes; mothers of children with DS did not demonstrate differences in the percentage of maternal gesture recodes based on child age, but there was a negative relationship between the percentage of maternal gesture recodes and child age for the children with TD.

CONCLUSIONS

Young children with DS gesture more than chronological age-matched children with TD, therefore providing numerous opportunities for caregivers to recode child gestures and support language development. Early intervention should focus on increasing parent responsiveness to child gestures earlier in life in order to provide additional word-learning opportunities for children with DS.

Parenting of children with Down syndrome compared to fragile X syndrome

Children with Down syndrome (DS) and fragile X syndrome (FXS) struggle with language development. Parenting variables, such as responsiveness to children's communication attempts (Maternal Responsivity), and techniques used to support and teach appropriate behavior (Behavior Management) are known to have a significant impact on early child development. We examined these two aspects of parenting style via coded, videotaped parent-child interactions in two groups of participants matched on child age (2-5 years) and child expressive language level: mothers of children with DS and mothers of children with FXS. The mothers differed in their use of gestures and redirecting the child's attention. Overall, mothers in both groups of children appeared to adapt appropriately to their children's developmental needs.

Assessment of the feasibility and clinical value of further research to evaluate the management options for children with Down syndrome and otitis media with effusion: a feasibility study

BACKGROUND

There is clinical uncertainty of the benefits and costs of different treatment options for children with Down syndrome who have glue ear. This study was designed to assess the extent of this lack of knowledge and determine if pursuing further information would be practical, beneficial and cost-effective.

OBJECTIVES

To assess the level and practical effect of current uncertainty around treatment options for children with Down syndrome and glue ear. To assess the feasibility of studying the options for management of glue ear in children with Down syndrome via a randomised controlled trial (RCT) or multicentre prospective cohort study by evaluating the willingness of (1) parents to agree to randomisation for their children and (2) clinicians to recruit participants to a definitive study. To undertake value of information analyses to demonstrate the potential economic benefit from undertaking further research.

DESIGN

A feasibility study exploring the views of parents of children with Down syndrome and professionals who have responsibility for the health and education of children with Down syndrome, on the participation in, and value of, future research into interventions for glue ear. Data were collected from parents via self-completed questionnaires, face-to-face interviews and focus groups and from professionals via online questionnaires and a Delphi review exercise. Development of economic models to represent clinical pathways of care and a RCT informed a value of information (VOI) analysis.

SETTING

UK (professionals); East Midlands region of the UK (parents).

PARTICIPANTS

Parents of children aged 1-11 years with Down syndrome (n = 156). Professionals including audiologists, ear, nose and throat surgeons, audiological physicians, speech and language therapists, and teachers of the deaf (n = 128).

MAIN OUTCOME MEASURES

Quantitative and qualitative data on parental views and experiences of glue ear and its effects; interventions and treatment received; taking part in research and factors that would encourage or discourage participation; and the importance of various outcome domains to them and for their children. For professionals: information on caseloads; approaches to clinical management; opinions on frequency and significance of the consequences of glue ear for this population; importance of different outcome measures; opinions of interventions and their role in future research; views on health research; facilitators and barriers to recruitment, and participation in research involving RCTs.

RESULTS

The complexity of the experience and individual characteristics of children with Down syndrome poses challenges for the design of any future research but these challenges were not considered by professionals to raise sufficient barriers to prevent it being undertaken. Parents were generally supportive of the need for, and value of, research but identified practical and emotional issues that would need addressing. Glue ear was considered to impact more on speech, language and communication than on hearing. Outcome measures for future research would need to evaluate these elements but measures should be designed specifically for the population. Parents and professionals identified randomisation as a significant barrier to participation. The VOI analyses identified lack of data as problematic but concluded that a future trial involving surgical intervention would be feasible at costs of < £650,000.

CONCLUSIONS

Future research into the benefits of interventions for glue ear in children with Down syndrome would be feasible and could be cost-effective but should be carefully designed to facilitate and maximise participation from parents and professionals responsible for recruitment.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.