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Background: Spatial knowledge about an environment is an important determinant of ability to move effectively within it and of personal autonomy. Individuals with Down's syndrome (DS) have difficulty managing configural visuospatial information. Method: Twenty-nine individuals with DS and 29 typically developing (TD) children, matched for mental age, learned about environments through virtual exploration using a route or survey view. A sketch map of the environment was or was not presented before exploration. Then the acquisition of configural knowledge (landmark locations) and route retracing were tested. Results: Individuals with DS were able to acquire configural knowledge through virtual exploration in all presentation conditions, and generally performed no worse than matched TD children. However, they were not able to benefit from the conditions that facilitated acquisition of configural knowledge in TD children, that is, seeing a sketch map before exploring and exploring in survey (rather than route) view. As regards route retracing, individuals with DS paused more often than controls and tended to travel longer paths, which made them slower overall. Conclusions: DS reduces children's ability to benefit from additional survey information and may be related to difficulty in elaborating configural/simultaneous information.

Background: Recent studies have shown that individuals with Down syndrome (DS) are poorer than controls in performing verbal and visuospatial dual tasks. The present study aims at better investigating the dual task deficit in working memory in individuals with DS. Method: Forty-five individuals with DS and 45 typically developing children matched for verbal mental age completed a series of verbal and visuospatial working memory tasks, involving conditions that either required the combination of two tasks in the same modality (verbal or visual) or of cross-modality pairs of tasks. Results and conclusions: Two distinct deficits were found in individuals with DS: impairment in verbal tasks and further impairment in all dual task conditions. The results confirm the hypothesis of a central executive impairment in individuals with DS.

Background: Recent studies have demonstrated that individuals with Down syndrome (DS) are poorer than controls in spatial-simultaneous tasks, but not in spatial-sequential tasks. To explain this finding, it has been suggested that the simultaneous visuo-spatial working memory deficit of individuals with DS could be due to the request for processing more than one item at a time. The present study examines the possibility of reducing the difficulties encountered by DS individuals on spatial-simultaneous tasks by proposing a task that uses structured material. Method: Two tasks were administered to 20 children and adolescents with DS, and 20 controls matched for verbal mental age. The tasks involved memorising and recalling filled-cell positions in a series of matrices in which an increasing number of cells (1-7) were filled. In the structured condition the filled cells were displayed to form a pattern, whereas in the random condition they were randomly arranged. Results and Conclusions: Results showed that individuals with DS are able to take advantage of structured material for raising their performance, but to a less extent than typically developing children. (Contains 2 figures, 2 tables and 2 footnotes.)

Background: The present work is aimed at analysing executive function (EF) in adolescents with Down Syndrome (DS). So far, EF has been analysed mainly in adults with DS, showing a pattern of impairment. However, less is known about children and adolescents with this syndrome. Studying adolescents with DS might help us better understand whether performances on EF tasks of individuals with DS are determined by age or by Alzheimer disease, as some studies suggest, or whether their performances are directly related to DS cognitive profile. Method: A battery of EF tasks assessing set shifting, planning/problem-solving, working memory, inhibition/perseveration and fluency, as well as a tasks assessing sustained attention has been administered to a group of 15 adolescents with DS and 15 typically developing children matched for mental age. All EF tasks were selected from previous studies with individuals with intellectual disabilities or from developmental literature and are thought to be useful for the samples considered. Results: The present results revealed that the group of individuals with DS performed at a significantly lower level on tasks assessing set shifting, planning/problem-solving, working memory and inhibition/perseveration, but not on the tasks assessing fluency. In addition, individuals with DS demonstrated a greater number of errors and less strategy use for the sustained attention task. Conclusions: The results suggest a broad impairment in EF in adolescents with DS, and are consistent with several similar studies conducted with adults with DS. We assume that EF deficit is a characteristic of DS.

Background: Recent studies have demonstrated that individuals with Down syndrome (DS) present both central and verbal working memory deficits compared with controls matched for mental age, whereas evidence on visuospatial working memory (VSWM) has remained ambiguous. The present paper uses a battery of VSWM tasks to test the hypothesis that individuals with DS can also encounter specific difficulties in VSWM. Method: Four tasks were administered to 34 children and adolescents with DS and 34 controls matched for verbal mental age. In two of these tasks, participants had to remember a series of locations sequentially presented on a matrix (spatial-sequential WM); in another two, they had to remember locations simultaneously presented (spatial-simultaneous WM). Results and Conclusions: Results showed that individuals with DS are poorer than controls in the spatial-simultaneous tasks, but not in the spatial-sequential tasks. These findings were not due to a difference in speed of visuospatial processing. In fact, when performances of the two groups in VSWM were compared using speed measures as covariates, differences between groups remained. It is suggested that the simultaneous VSWM deficit of individuals with DS could be due to the request for processing more than one item at a time.

This editorial presents an introduction to and an overview of the current JIDR special issue on "Executive Function in Intellectual Disability." The articles included in this special issue provide a contemporary, in depth exploration of questions regarding the nature of EF in individuals with ID. Topics include the emergence of EF during early childhood in ID‐related conditions, the influence of EF on other domains of development, and the relationship between EF and adaptation throughout the lifespan. This editorial synthesizes the findings presented in this special issue and identifies methodological challenges that researchers will continue to face in future investigations of this important area. [ABSTRACT FROM AUTHOR]

Background: Previous research has explored executive functions (EFs) and adaptive behaviour in children and adolescents with Down syndrome (DS), but there is a paucity of research on the relationship between the two in this population. This study aims to shed light on the profile of EFs and adaptive behaviour in DS, exploring the differences by age and investigating the relationship between these two domains. Method: Parents/caregivers of 100 individuals with DS from 3 to 16 years old participated in the study. The sample was divided into preschoolers (3–6.11 years old) and school‐age children (7–16 years old). Parents/caregivers completed either the Preschool Version of the Behaviour Rating Inventory of Executive Function (for children 2–6.11 years old) or the Second Edition of the same Inventory (for individuals 7 + years old). Adaptive behaviour was assessed with the Vineland Adaptive Behaviour Scale – Interview, Second Edition. Results: Findings suggest that individuals with DS have overall difficulties, but also patterns of strength and weakness in their EFs and adaptive behaviour. The preschool‐age and school‐age children's EF profiles differed slightly. While both age groups showed Emotional Control as a relative strength and Working Memory as a weakness, the school‐age group revealed further weaknesses in Shift and Plan/Organise. As concerns adaptive behaviour, the profiles were similar in the two age groups, with Socialisation as a strength, and Communication and Daily Living Skills as weaknesses, but with a tendency for preschoolers to obtain intermediate scores for the latter. When the relationship between EFs and adaptive behaviour was explored, Working Memory predicted Communication in the younger group, while in the older group the predictors varied, depending on the adaptive domains: Working Memory was a predictor of Communication, Inhibit of Daily Living Skills, and Inhibit and Shift of Socialisation. Conclusion: As well as elucidating the EF profiles and adaptive behaviour in individuals with DS by age, this study points to the role of EFs in adaptive functioning, providing important information for targeted interventions. [ABSTRACT FROM AUTHOR]

Background: Working memory (WM) is generally considered an area of weakness in the cognitive profile associated with Down syndrome (DS). The great majority of studies explored WM in this population through a comparison with typical development (TD) on the basis of mental age or developmental level. However, it is also relevant to understand how these skills develop and whether such development could be more related to chronological or developmental level. In the present study, we explored cross‐sectional developmental trajectories of spatial‐sequential and spatial‐simultaneous WM in individuals with DS across chronological age and developmental level. Typically developing children (TD) of similar mental age were also included as a comparison group. Methods: Eighty‐four individuals with DS (aged between 7 and 30 years) and 327 children with TD (aged between 4 and 8 years) were administered with tasks to assess spatial‐sequential and spatial‐simultaneous WM, together with tasks to assess both general verbal and spatial developmental levels. Results and conclusion: Performance in spatial‐simultaneous WM task was lower compared with spatial‐sequential WM task in both groups. In the case of individuals with DS, the developmental trajectories of chronological age are better described through a segmented model showing increased performance until approximately 13 years of age, followed by a rather flat progress. In the case of TD children, developmental trajectories are better described through a linear model in the spatial‐simultaneous WM task when chronological age is considered; in the spatial‐sequential WM, the increase in performance with age was however characterised by a discontinuity at age 6. The increase in performance followed a linear pattern in both groups (DS and TD) without substantial differences between the types of measure used (verbal vs. spatial) when the developmental level is considered. [ABSTRACT FROM AUTHOR]

The nociceptive flexion reflex (NFR) of the lower limbs (RIII reflex) was examined bilaterally in 54 cluster headache (CH) patients suffering from episodic CH (ECH) and chronic CH (CCH). Fifteen ECH patients were examined in both remission and active phases. The RIII reflex threshold (Tr) and the threshold of pain sensation (Tp) were significantly reduced on the symptomatic side in patients with episodic CH during the bout. During the active phase of episodic CH an inverse correlation was found between the severity of CH (ratio: number of cluster periods/years of illness duration) and the Tp, which may suggest a role for secondary central sensitization in pain pathways. The lower Tr and Tp on the symptomatic side is in keeping with previous observations exploring pain mechanisms using different methods (i.e. corneal reflex, pain pressure threshold). On the whole, these data tie in with the view of an impairment of the pain control system, which parallels the periodicity of the disorder in the episodic form. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the reliability and validity of the Italian translation of the Unhelpful Thoughts and Beliefs about Stuttering (UTBAS) scales for adults who stutter, as there are no assessment tools currently available in Italy. The UTBAS scales provide a comprehensive stuttering-specific measure of the unhelpful thoughts and beliefs that can be used to screen for indicators of social anxiety in adults who stutter. Additionally, the UTBAS scales also allow the identification of negative thoughts and beliefs that negatively impact speech treatment outcomes., Method: The translation of the UTBAS scales into Italian (UTBAS-ITA) was completed using the forward-backward translation process and it was administered to 98 adults who stutter (AWS) and 98 adults who do not stutter (AWNS). Both groups were matched for gender and age. We also administered the UTBAS-ITA to 76 AWS a second time within a two-week interval to assess test-retest reliability. Additionally, we administered the State-Trait Anxiety Inventory and the Fear of Negative Evaluation Scale to 20 AWS to assess concurrent validity., Results: The UTBAS-ITA showed good power of discrimination between AWS and AWNS, high internal validity, high internal consistency, good construct validity, and good test-retest reliability., Conclusion: Since there is a scarcity of clinical assessment tools for adults who stutter in Italy, the UTBAS-ITA could serve as an assessment tool and outcome measure for clinical and research environments., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Parent-mediated intervention (PMI) is a potentially scalable approach for tailored interventions in neurogenetic conditions like Down syndrome (DS). Because PMIs require ongoing parent engagement, they must be developed in alignment with the needs of intended users. The present study examined caregiver opinions and preferences to inform the development of syndrome-informed interventions for children with DS., Method: Parents of children with DS (n = 34) participated in focus groups discussing PMI. Interviews were transcribed and a thematic analysis was applied to code the data., Results: Three themes were identified: advantages of PMI, disadvantages of PMI and preferred features of PMI. To align with parent preferences, future PMIs for children with DS should require a brief time commitment, blend intervention activities into daily routines and include family members in activities., Conclusions: Findings have implications for developing novel interventions to support early development in children with DS and other neurogenetic conditions., (© 2024 The Author(s). Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Impaired numerosity perception in developmental dyscalculia (low "number acuity") has been interpreted as evidence of reduced representational precision in the neurocognitive system supporting non-symbolic number sense. However, recent studies suggest that poor numerosity judgments might stem from stronger interference from non-numerical visual information, in line with alternative accounts that highlight impairments in executive functions and visuospatial abilities in the etiology of dyscalculia. To resolve this debate, we used a psychophysical method designed to disentangle the contribution of numerical and non-numerical features to explicit numerosity judgments in a dot comparison task and we assessed the relative saliency of numerosity in a spontaneous categorization task. Children with dyscalculia were compared to control children with average mathematical skills matched for age, IQ, and visuospatial memory. In the comparison task, the lower accuracy of dyscalculics compared to controls was linked to weaker encoding of numerosity, but not to the strength of non-numerical biases. Similarly, in the spontaneous categorization task, children with dyscalculia showed a weaker number-based categorization compared to the control group, with no evidence of a stronger influence of non-numerical information on category choice. Simulations with a neurocomputational model of numerosity perception showed that the reduction of representational resources affected the progressive refinement of number acuity, with little effect on non-numerical bias in numerosity judgments. Together, these results suggest that impaired numerosity perception in dyscalculia cannot be explained by increased interference from non-numerical visual cues, thereby supporting the hypothesis of a core number sense deficit. RESEARCH HIGHLIGHTS: A strongly debated issue is whether impaired numerosity perception in dyscalculia stems from a deficit in number sense or from poor executive and visuospatial functions. Dyscalculic children show reduced precision in visual numerosity judgments and weaker number-based spontaneous categorization, but no increasing reliance on continuous visual properties. Simulations with deep neural networks demonstrate that reduced neural/computational resources affect the developmental trajectory of number acuity and account for impaired numerosity judgments. Our findings show that weaker number acuity in developmental dyscalculia is not necessarily related to increased interference from non-numerical visual cues., (© 2024 The Author(s). Developmental Science published by John Wiley & Sons Ltd.)

Background: Persons with Down syndrome (DS) reveal adaptive functioning (AF) difficulties. Studies on AF in DS have focused mainly on describing the profile (i.e., strengths in socialization, and weaknesses in communication), while less is known about age-related differences. This study aimed to elucidate how AF changes with age in children and adolescents with DS, taking a cross-sectional developmental trajectory approach. Moreover, the contribution of both chronological age (CA) and mental age (MA) on AF development was explored., Method: This study involved 115 children and adolescents (between 3 and 16 years old) with DS. Parents were interviewed about their children's AF on communication, daily living and socialization skills. Children and adolescents with DS were assessed on their developmental level., Results: While participants' standard scores on AF decreased linearly over time, their age-equivalent scores increased with linear or segmented patterns, depending on the skill considered. CA and MA were related to daily living skills and socialization to much the same degree, while MA correlated more strongly than CA with communication., Conclusion: This study contributes to the understanding of how AF develops in children and adolescents with DS, showing that CA and MA both contribute to shaping the skills involved., (Copyright © 2023. Published by Elsevier Ltd.)

Down syndrome (DS) or trisomy 21 is the most common genetic cause of intellectual disability (ID), but a pathogenic mechanism has not been identified yet. Studying a complex and not monogenic condition such as DS, a clear correlation between cause and effect might be difficult to find through classical analysis methods, thus different approaches need to be used. The increased availability of big data has made the use of artificial intelligence (AI) and in particular machine learning (ML) in the medical field possible. The purpose of this work is the application of ML techniques to provide an analysis of clinical records obtained from subjects with DS and study their association with ID. We have applied two tree-based ML models (random forest and gradient boosting machine) to the research question: how to identify key features likely associated with ID in DS. We analyzed 109 features (or variables) in 106 DS subjects. The outcome of the analysis was the age equivalent (AE) score as indicator of intellectual functioning, impaired in ID. We applied several methods to configure the models: feature selection through Boruta framework to minimize random correlation; data augmentation to overcome the issue of a small dataset; age effect mitigation to take into account the chronological age of the subjects. The results show that ML algorithms can be applied with good accuracy to identify variables likely involved in cognitive impairment in DS. In particular, we show how random forest and gradient boosting machine produce results with low error (MSE <0.12) and an acceptable R 2 (0.70 and 0.93). Interestingly, the ranking of the variables point to several features of interest related to hearing, gastrointestinal alterations, thyroid state, immune system and vitamin B12 that can be considered with particular attention for improving care pathways for people with DS. In conclusion, ML-based model may assist researchers in identifying key features likely correlated with ID in DS, and ultimately, may improve research efforts focused on the identification of possible therapeutic targets and new care pathways. We believe this study can be the basis for further testing/validating of our algorithms with multiple and larger datasets., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

There is a host of research on the structure of working memory (WM) and its relationship with intelligence in adults, but only a few studies have involved children. In this paper, several different WM models were tested on 170 Japanese school children (from 7 years and 5 months to 11 years and 6 months). Results showed that a model distinguishing between modalities (i.e., verbal and spatial WM) fitted the data well and was therefore selected. Notably, a bi-factor model distinguishing between modalities, but also including a common WM factor, presented with a very good fit, but was less parsimonious. Subsequently, we tested the predictive power of the verbal and spatial WM factors on fluid and crystallized intelligence. Results indicated that the shared contribution of WM explained the largest portion of variance of fluid intelligence, with verbal and spatial WM independently explaining a residual portion of the variance. Concerning crystallized intelligence, however, verbal WM explained the largest portion of the variance, with the joint contribution of verbal and spatial WM explaining the residual part. The distinction between verbal and spatial WM could be important in clinical settings (e.g., children with atypical development might struggle selectively on some WM components) and in school settings (e.g., verbal and spatial WM might be differently implicated in mathematical achievement).

The purpose of this study was to identify developmental profiles associated with autism spectrum disorder (ASD) and global developmental delay (DD) in pre-school aged Italian children. Developmental profiles were evaluated by means of a standardized tool widely used for the assessment of psychomotor development in early childhood, the Griffiths III scales, recently adapted and standardized for the Italian population. Specifically, we compared the Griffiths III profiles of children with ASD and DD (ASD + DD) with those of children with DD alone. Moreover, we inspected the psychometric function of single items by comparing children with ASD + DD and children with DD with typically developing (TD) children from the Griffiths III normative sample. In this way, we aimed to isolate the effects of each diagnostic class on psychomotor abilities and on the psychometric function of single items. The ASD + DD and DD groups were found to share the presence of lower age equivalent scores relative to their chronological age in all the developmental domains considered: Foundations of Learning, Language and Communication, Eye and Hand Coordination, Personal-Social-Emotional and Gross Motor Skills. However, the DD group displayed a homogeneous profile with similar levels of delay in all developmental domains, while children with ASD + DD exhibited relative weaknesses in the Language and Communication and Personal-Social-Emotional scales. The analysis of the psychometric function drawn for each item has confirmed different profiles in social-communicative and non-verbal items between the two diagnostic groups and in relation to TD normative sample. The Griffiths III is a valid psychometric tool for identifying atypical developmental profiles and its use may be recommended during the diagnostic process of ASD and DD, to detect specific strengths and weaknesses and guide person-centered treatment., (© 2023 The Authors. Autism Research published by International Society for Autism Research and Wiley Periodicals LLC.)

Background: The role of domain-general cognitive abilities in the etiology of Developmental Dyscalculia (DD) is a hotly debated issue., Aims: In the present study, we tested whether WISC-IV cognitive profiles can be useful to single out DD., Methods and Procedures: Using a stringent 2-SD cutoff in a standardized numeracy battery, we identified children with DD (N = 43) within a clinical sample referred for assessment of learning disability and compared them in terms of WISC cognitive indexes to the remaining children without DD (N = 100) employing cross-validated logistic regression., Outcomes and Results: Both groups showed higher Verbal Comprehension and Perceptual Reasoning than Working Memory and Processing Speed, and DD scores were generally lower. Predictive accuracy of WISC indexes in identifying DD individuals was low (AUC = 0.67) and it dropped to chance level in discriminating DD from selected controls (N = 43) with average math performance but matched on global IQ. The inclusion of a visuospatial memory score as an additional predictor did not improve classification accuracy., Conclusions and Implications: These results demonstrate that cognitive profiles do not reliably discriminate DD from non-DD children, thereby weakening the appeal of domain-general accounts., Competing Interests: Conflict of Interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Parents of children with autism spectrum disorders (ASD) experience higher levels of stress than parents of typically-developing (TD) children, due to differences in their children's emotional functioning. The COVID-19 pandemic exacerbated the cognitive and practical demands on vulnerable populations and their families. The aim of this study was to examine parenting stress levels in parents of children ASD and TD children, considering the children's emotional functioning (i.e., anxiety and cognitive emotion regulation strategies), and stressful life events deriving from the COVID-19 pandemic. The study involved 64 parent-child dyads comprising children from 7 to 16 years old, divided into two groups: 32 (26 M) children and adolescents with ASD but no intellectual disability, and 32 (26 M) with typical development. Our results show that parents of children with ASD reported higher levels of stress, but factors relating to the child and the context had a different influence on parenting stress in the ASD and TD groups. The higher level of parenting stress in the ASD group seemed to relate more to the children's emotional characteristics, while the TD group was more affected by the unpredictable stressful events prompted by COVID-19. Families' mental health should be considered a core aspect of supporting parents having to deal with both their child's emotional adjustment and the challenges of the COVID-19 pandemic., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

A long-standing debate concerns whether developmental dyscalculia is characterized by core deficits in processing nonsymbolic or symbolic numerical information as well as the role of domain-general difficulties. Heterogeneity in recruitment and diagnostic criteria make it difficult to disentangle this issue. Here, we selected children ( n = 58) with severely compromised mathematical skills (2 SD below average) but average domain-general skills from a large sample referred for clinical assessment of learning disabilities. From the same sample, we selected a control group of children ( n = 42) matched for IQ, age, and visuospatial memory but with average mathematical skills. Children with dyscalculia showed deficits in both symbolic and nonsymbolic number sense assessed with simple computerized tasks. Performance in the digit-comparison task and the numerosity match-to-sample task reliably separated children with developmental dyscalculia from controls in cross-validated logistic regression (area under the curve = .84). These results support a number-sense-deficit theory and highlight basic numerical abilities that could be targeted for early identification of at-risk children as well as for intervention.

Background: The ability to place numbers on a visual "number line" is a hallmark of the understanding of numerical magnitude and it is a strong predictor of mathematical achievement., Aim: We examined whether the performance in the number line estimation task is more driven by mental age or experience with numbers in a sample of Italian children with Down syndrome (DS)., Method and Procedure: Sixty-three children with DS (M months = 128.62, SD = 30.73) and sixty-three typically developing children (M months = 54.98, SD = 6.34) matched one to one for mental age completed number line estimation tasks and other tests to assess their numerical knowledge., Outcomes and Results: No significant differences emerged between the two groups in terms of accuracy of positioning numbers on the 1-10 and 1-20 interval. In addition, the accuracy on the 1-10 interval was related to the ability to recognize numbers, while the accuracy on the 1-20 line was related to the ability to compare magnitudes., Conclusion and Implication: Results suggest that in individuals with DS the linear mapping of numbers is driven by mental age, but the accuracy of positioning numbers is also shaped by the experience with symbolic numbers. Therefore, the improvement of numerical estimation abilities should be a target of intervention programs., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Several models of working memory (WM) have been proposed in the literature. Most of the research on the architecture of WM is based on adults or older children, but less is known about younger children. In this study, we tested various models of WM on a sample of 739 Italian children, ranging in age from 3 to 8 years, primarily of European heritage and from medium to medium-high socioeconomic background. Participants were assessed with 12 WM tasks, systematically varying the modality and level of executive control required (based on the number of activities to be performed at once: retention alone, ignoring distractors, and dealing with dual tasks). We examined younger children ( n = 501, M age = 56.8 months, SD = 6.4, 48% boys) and older children ( n = 238, M age = 80.0 months, SD = 9.0, 58% boys) separately using multigroup confirmatory factor analyses. A Bayesian analytical approach was adopted. Our results suggested that a four-factor model distinguishing between verbal, visual, spatial-simultaneous, and spatial-sequential components of WM achieved the best fit. Overall, the WM structure was very similar in the two groups. We further explored this result with an additional model with a central executive factor loaded on high-control tasks only and found evidence for the presence of an executive control component. The contribution of this factor in terms of explained variance was only modest, however. Our findings demonstrate that it is important to distinguish between WM components in young children. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Down syndrome (DS) is characterised by several clinical features including intellectual disability (ID) and craniofacial dysmorphisms. In 1976, Jackson and coll. identified a checklist of signs for clinical diagnosis of DS; the utility of these checklists in improving the accuracy of clinical diagnosis has been recently reaffirmed, but they have rarely been revised. The purpose of this work is to reassess the characteristic phenotypic signs and their frequencies in 233 DS subjects, following Jackson's checklist. 63.77% of the subjects showed more than 12 signs while none showed less than 5, confirming the effectiveness of Jackson's checklist for the clinical diagnosis of DS. An association between three phenotypic signs emerged, allowing us to distinguish two sub-phenotypes: Brachycephaly, short and broad Hands, short Neck (BHN), which is more frequent, and "non-BHN". The strong association of these signs might be interpreted in the context of the growth defects observed in DS children suggesting decreased cell proliferation. Lastly, cognitive assessments were investigated for 114 subjects. The lack of association between the presence of a physical sign or the number of signs present in a subject and cognitive skills disproves the stereotype that physical characteristics are predictive of degree of ID., (© 2022. The Author(s).)

The Down syndrome (DS) phenotype is usually characterized by relative strengths in non-verbal skills and deficits in verbal processing, but high interindividual variability has been registered in the syndrome. The goal of this study was to explore the cognitive profile, considering verbal and non-verbal intelligence, of children and adolescents with DS, also taking into account interindividual variability. We particularly aimed to investigate whether this variability means that we should envisage more than one cognitive profile in this population. The correlation between cognitive profile and medical conditions, parents' education levels and developmental milestones was also explored. Seventy-two children/adolescents with DS, aged 7-16 years, were assessed with the Wechsler Preschool and Primary Scale of Intelligence-III. Age-equivalent scores were adopted, and Verbal and Non-Verbal indices were obtained for each individual. The cognitive profile of the group as a whole was characterized by similar scores in the verbal and non-verbal domain. Cluster analysis revealed three different profiles, however: one group, with the lowest scores, had the typical profile associated with DS (with higher non-verbal than verbal intelligence); one, with intermediate scores, had greater verbal than non-verbal intelligence; and one, with the highest scores, fared equally well in the verbal and non-verbal domain. Three cognitive profiles emerged, suggesting that educational support for children and adolescents with DS may need to be more specific., (© 2022. The Author(s).)

Air pollutants can potentially affect the development of children. However, data on the effect of exposure to air pollution during pregnancy and developmental outcomes in school children are rare. We investigated the link between prenatal exposure to particulate matters smaller than 10 microns (PM 10 ) and the development of school-age children in multiple domains. Cross-sectional data were collected in Italy between 2013 and 2014. Children aged between 5 and 8 years (n = 1187) were assessed on cognitive, communication, socio-emotional, adaptive, and motor developmental domains using the Developmental Profile 3 questionnaire. The monthly average concentration of PM 10 during the entire fetal period was linked to the municipality of residence of the children. The increase in the prenatal PM 10 was associated with a decrease in the cognitive score during the second (+13.2 µg/m 3 PM 10 increase: -0.30 points; 95%CI: -0.12--0.48) and third trimesters of pregnancy (-0.31 points; 95%CI: -0.11--0.50). The communicative domain was also negatively influenced by PM 10 increases in the second trimester. The development of cognitive and communicative abilities of children was negatively associated with the exposure to PM 10 during the period of fetal development, confirming that exposure to air pollution during pregnancy can potentially hinder the development of the brain.

Down Syndrome (DS) is the most common genetic alteration responsible for intellectual disability, which refers to deficits in both intellectual and adaptive functioning. According to this, individuals with Down Syndrome (DS) reach developmental milestones (e.g., sitting, walking, and babbling) in the same order as their typically developing peers, but later in life. Since developmental milestones are the first blocks on which development builds, the aims of the current study are to: (i) expand the knowledge of developmental milestone acquisition; and (ii) explore the relationship between developmental milestone acquisition and later development. For this purpose 105 children/adolescents with DS were involved in this study, divided in two groups, Preschoolers ( n = 39) and School-age participants ( n = 66). Information on the age of acquisition of Sitting, Walking, Babbling, and Sphincter Control was collected, together with cognitive, motor, and adaptive functioning. Sitting predicted later motor development, but, with age, it became less important in predicting motor development in everyday life. Babbling predicted later language development in older children. Finally, Sphincter Control emerged as the strongest predictor of motor, cognitive, language, and adaptive skills, with its role being more evident with increasing age. Our data suggest that the age of reaching the milestones considered in the study has an influence on successive development, a role that can be due to common neural substrates, the environment, and the developmental cascade effect.

Background: The analysis of developmental trajectories of visuospatial abilities in individuals with Down Syndrome (DS) remains an unexplored field of investigation to examine in depth. The study aimed to fill such a gap by examining changes in two visuospatial abilities: spatial visualization (the ability to manage spatial stimuli) and mental rotation (the ability to rotate spatial stimuli)., Method: Eighty-seven participants with DS, aged between 7 and 53 years (forty-seven males and forty females), completed spatial visualization and mental rotation tasks. Changes in these two abilities were analyzed in relation to chronological age and developmental level, the latter derived from Raven's Colored Progressive Matrices., Results: Chronological age was linearly associated with spatial visualization performance, whereas mental rotation performance increased until 14 years of age and then decreased. Developmental level was linearly associated with increased performance in spatial visualization, the trend in mental rotation was segmented with an increase after 5 years of age. Furthermore, developmental trajectories in mental rotation depended on the rotation degree., Conclusion: Chronological age explains a modest quote of variance. Developmental level better describes changes in spatial visualization and mental rotation of individuals with DS.

Background: Numeracy is an area of difficulty for children with Down syndrome (DS). It has been demonstrated that The Number Race, a non-commercial adaptive computer game designed to foster basic mathematical abilities, represents a promising instrument to enhance these skills in children with DS when delivered by an expert in a clinical setting., Aims: In the present study, we assessed the efficacy of The Number Race when administered at home by properly instructed and remotely supervised parents., Methods and Procedures: Basic numerical skills were assessed before and after training, as well as at three-months follow-up. Performance of children with DS who worked at home with the parent (PG) was compared with that of children who received the training by an expert (EG). For both groups, the training lasted ten weeks, with two weekly sessions of 20-30 min., Outcomes and Results: Results show that both groups improved across various measures of numerical proficiency, including the overall score of the numeracy assessment battery, while only the EG showed an improvement in a measure of mental calculation. The improvements were maintained three months after the end of the training., Conclusions and Implications: These findings confirm the efficacy of The Number Race and extend it to an home-based setting, whereby parents administer the training with external supervision., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Analyzing navigational abilities and related aspects in individuals with Down syndrome (DS) is of considerable interest because of its relevance to everyday life. This study investigates path learning, the conditions favoring it, and the cognitive abilities involved. A group of 30 adults with DS and 32 typically-developing (TD) children matched on receptive vocabulary were shown a 4 × 4 Floor Matrix and asked to repeat increasingly long sequences of steps by walking on the grid. The sequences were presented under two learning conditions, one called Oral instructions (participants received verbal instructions such as "turn right" or "turn left"), the other Observation (participants watched the experimenter's moves). Participants were also assessed on verbal and visuospatial cognitive measures. The results showed a similarly better performance in both groups when the Floor Matrix task was administered in the Observation as opposed to the Oral instructions condition. As for the relation with cognitive abilities, in the Floor Matrix task in the Oral instructions condition, individuals with DS showed an effect of both verbal and visuospatial abilities, which was only positive for verbal ability. The effect of verbal and visuospatial abilities was negligible in the TD group. In the Observation condition, performance was predicted by sequential working memory in both groups. Overall, these results shed light on path learning in individuals with DS, showing that they benefited from the Observation condition, and that the involvement of their cognitive abilities depended on the learning condition., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Meneghetti, Toffalini, Lanfranchi, Roch and Carretti.)

This work investigates the role of metabolite levels in the intellectual impairment of subjects with Down syndrome (DS). Homocysteine, folate, vitamin B12, uric acid (UA), creatinine levels and MTHFR C677T genotype were analyzed in 147 subjects with DS. For 77 subjects, metabolite levels were correlated with cognitive tests. Griffiths-III test was administered to 28 subjects (3.08-6.16 years) and WPPSI-III test was administered to 49 subjects (7.08-16.08 years). Significant correlations were found among some metabolite levels and between homocysteine levels and MTHFR C677T genotype. Moreover, homocysteine, UA and creatinine levels resulted increased with age. We did not find any correlation between metabolites and cognitive test score in the younger group. Homocysteine showed statistically significant correlation with WPPSI-III subtest scores when its level is ≥ 7.35 µmol/L, remaining correlated in higher thresholds only for non-verbal area scores. Vitamin B12 showed correlations with all WPPSI-III subtest scores when its level is < 442 pg/mL. The relevance of the present findings is the detection of a specific metabolite threshold related with a better or worse cognitive score, suggesting that vitamin B12 and homocysteine may have a role in cognitive development in children with DS.

Individuals with Down syndrome (DS) present reduced basic numerical skills, which have a negative impact on everyday numeracy and mathematical learning. Here, we evaluated the efficacy of the adaptive (non-commercial) computerized game "The Number Race" in improving basic numerical skills in children with DS. The experimental group (EG; N = 30, M age-in-months 118, range 70-149) completed a training playing with "The Number Race", whereas children in the control group (CG; N = 31, M age-in-months 138, range 76-207) worked with software aiming at improving their reading skills. The training lasted 10 weeks with two weekly sessions of 20-30 min each. We assessed both groups' numerical and reading skills before and immediately after the end of the training, as well as at a 3-months follow-up. We found weak evidence for post-training groups differences in terms of overall numeracy score. However, the EG displayed substantial improvements in specific numerical skills and in mental calculation, which were maintained over time, and no improvement in reading. Conversely, the CG showed improvements in their reading skills as well as in number skills but to a lesser extent compared to the EG. Overall, "The Number Race" appears as a suitable tool to improve some aspects of numeracy in DS.

Background: Botulinum toxin (BT) is an effective and safe treatment for spasticity, with limited evidence in multiple sclerosis (MS). We aim to describe the use of BT for the management of MS spasticity in the clinical practice, its combination with other anti-spastic treatments in MS and possible MS clinical correlates., Methods: This is a multicentre cross-sectional observational study including 386 MS patients, receiving BT for spasticity in 19 Italian centres (age 53.6 ± 10.9 years; female 228 (59.1%); disease duration 18.7 ± 9.2 years; baseline Expanded Disability Status Scale (EDSS) 6.5 (2.0-9.0))., Results: BT was used for improving mobility (n = 170), functioning in activities of daily living (n = 56), pain (n = 56), posturing-hygiene (n = 63) and daily assistance (n = 41). BT formulations were AbobotulinumtoxinA (n = 138), OnabotulinumtoxinA (n = 133) and IncobotulinumtoxinA (n = 115). After conversion to unified dose units, higher BT dose was associated with higher EDSS (Coeff = 0.591; p < 0.001), higher modified Ashworth scale (Coeff = 0.796; p < 0.001) and non-ambulatory patients (Coeff = 209.382; p = 0.006). Lower BT dose was used in younger patients (Coeff = - 1.746; p = 0.009), with relapsing-remitting MS (Coeff = - 60.371; p = 0.012). BT dose was higher in patients with previous BT injections (Coeff = 5.167; p = 0.001), and with concomitant treatments (Coeff = 43.576; p = 0.022). Three patients (0.7%) reported on post-injection temporary asthenia/weakness (n = 2) and hypophonia (n = 1)., Conclusion: BT was used for spasticity and its consequences from the early stages of MS, without significant adverse effects. MS-specific goals and injection characteristics can be used to refer MS patients to BT treatment, to decide for the strategy of BT injections and to guide the design of future clinical trials and observational studies.

Trisomy 21 (Down syndrome, DS) is the main human genetic cause of intellectual disability (ID). Lejeune hypothesized that DS could be considered a metabolic disease, and we found that subjects with DS have a specific plasma and urinary metabolomic profile. In this work we confirmed the alteration of mitochondrial metabolism in DS and also investigated if metabolite levels are related to cognitive aspects of DS. We analyzed the metabolomic profiles of plasma samples from 129 subjects with DS and 46 healthy control (CTRL) subjects by 1 H Nuclear Magnetic Resonance (NMR). Multivariate analysis of the NMR metabolomic profiles showed a clear discrimination (up to 94% accuracy) between the two groups. The univariate analysis revealed a significant alteration in 7 metabolites out of 28 assigned unambiguously. Correlations among the metabolite levels in DS and CTRL groups were separately investigated and statistically significant relationships appeared. On the contrary, statistically significant correlations among the NMR-detectable part of DS plasma metabolome and the different intelligence quotient ranges obtained by Griffiths-III or WPPSI-III tests were not found. Even if metabolic imbalance provides a clear discrimination between DS and CTRL groups, it appears that the investigated metabolomic profiles cannot be associated with the degree of ID.

This study aimed to draw a cross-task comparison on visuospatial processing in autism spectrum disorder without intellectual disability. Participants with autism spectrum disorder were matched with typically developing individuals on general intelligence and perceptual reasoning index. The two groups were subsequently compared on visuospatial processing speed, visuo-perceptual, visuo-constructive, and visuospatial working memory tasks. Our results revealed similar performances between autism spectrum disorder and typically developing individuals on measures of visuospatial processing speed and visuospatial working memory. The autism spectrum disorder group showed slower reaction times than the typically developing group in the visuo-perceptual task, when stimuli were characterized by a minimum level of perceptual cohesiveness, revealing weaker spatial integration abilities. Concerning the visuo-constructive domain, no differences between the autism spectrum disorder and the typically developing group emerged for the unsegmented condition, revealing that our participants with autism spectrum disorder were similar to the typically developing group in the local analysis of the stimuli. The discussion takes into account the role of individual differences on visuospatial intelligence, task requirements, and cognitive domains to clarify the visuospatial processing skills of individuals with autism spectrum disorder.

Environment learning is essential in everyday life. In individuals with Down syndrome (DS), this skill has begun to be examined using virtual exploration. Previous studies showed that individuals with DS can learn and remember paths in terms of sequences of turns and straight stretches, albeit with some difficulty, and this learning is supported by their cognitive abilities. This study further investigates environment learning in the DS population, newly examining their ability to learn a path from actual movements, and to learn increasingly long paths, and how their performance relates to their visuo-spatial abilities and everyday spatial activities. A group of 30 individuals with DS and 30 typically-developing (TD) children matched for receptive vocabulary performed a 4 × 4 Floor Matrix task in a grid comprising 16 squares (total area 2.3 × 2.3 meters). The task involved repeating increasingly long sequences of steps by actually moving in the grid. The sequences were presented in two learning conditions, called Observation (when participants watched the experimenter's moves), or Map (when they were shown a map reproducing the path). Several visuo-spatial measures were also administered. The results showed a clear difference between the two groups' performance in the individual visuo-spatial measures. In the Floor Matrix task, after controlling for visuo-spatial reasoning ability, both groups benefited to the same degree from the Observation condition vis-à-vis the Map condition, and no group differences emerged. In the group with DS, visuo-spatial abilities were more predictive of performance in the Floor Matrix task in the Observation condition than in the Map condition. The same was true of the TD group, but this difference was much less clear-cut. The visuo-spatial working memory and visualization tasks were the strongest predictors of Floor Matrix task performance. Finally, the group with DS showed a significant relation between Floor Matrix task performance in the Observation condition and everyday spatial activity. These results enlarge on what we know about path learning in individuals with DS and its relation to their visuo-spatial abilities. These findings are discussed within the frame of spatial cognition and the atypical development domain., (Copyright © 2020 Meneghetti, Toffalini, Lanfranchi and Carretti.)

One of the most important sources of predictability that human beings can exploit to create an internal representation of the external environment is the ability to implicitly build up subjective statistics of events' temporal structure and, consequently, use this knowledge to prepare for future actions. Stimulus expectancy can be subjectively shaped by hierarchically nested sources of prediction, capitalizing on either local or global probabilistic rules. In order to better understand the nature of local-global proactive motor control in Down Syndrome, in the present study a group of participants with Down Syndrome (DS group; n = 28; mean age 29.5 ± 13 years; range 10-54) and a group of typically developing participants matched by either gender or mental age (TD-MA group; n = 28; 5.6 ± 1 years; range 4-8) were administered a novel motor preparation task, defined as the Dynamic Temporal Prediction (DTP) task. In the DTP, the temporal preparation to imperative stimuli is implicitly shaped by the local increase of expectancy. This is manipulated trial-by-trial as a function of the preparatory foreperiod interval (Stimulus-Onset Asynchrony or SOA). In addition, temporal preparation can be also implicitly adjusted as a function of global predictive context, so that a block-wise SOA-distribution bias toward a given preparatory interval might determine a high-order source of expectancy, with functional consequences on proactive motor control adjustment. Results showed that in both groups motor preparation was biased by temporal expectancy when this was locally manipulated within-trials. By contrast, only the TD-MA group was sensitive to global rule changes: only in this cohort was behavioral performance overall impacted by the SOA probabilistic distribution manipulated between-blocks. The evidence of a local-global dissociation in DS suggests that the use of flexible cognitive mechanisms to implicitly extract high-order probabilistic rules in order to build-up an internal model of the temporal properties of events is disrupted in this developmental disorder. Moreover, since the content of the information to be processed in the DTP task was neither verbal nor spatial, we suggest that atypical global processing in Down Syndrome is a domain-general rather than specific aspect characterizing the cognitive profile of this population., (Copyright © 2020 Mento, Scerif, Granziol, Franzoi and Lanfranchi.)

Background: Little is currently known about borderline intellectual functioning (BIF), a condition characterized by an intelligence quotient between one and two standard deviations below the average, that affects about 14% of the population., Aims: The present study aimed to analyze the intellectual profile of school-aged children with BIF., Method and Procedure: The WISC-IV was administered to 204 children with BIF attending Italian primary and lower secondary school, and their profile was compared with that of a control group of typically developing (TD) children., Results: The WISC-IV profile of the children with BIF differed from that of the TD children, and the former's performance was worse than the latter's in all the measures considered. The children with BIF also showed significant differences between the four main factor indices, scoring lowest for working memory, while the TD control group's profile was flat (as expected on the grounds of standardization criteria). No differences were found between the profiles of children with versus without a comorbid neurodevelopmental disorder., Discussion: Our results support the hypothesis that individuals with BIF have a characteristic profile with specific weaknesses., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The current study investigated profiles of vagal withdrawal in response to a challenging task in preschoolers. Also, the association between those profiles and conceptual shifting ability was assessed. Electrocardiogram of 43 four-year-olds was registered during a sequence of games including a win phase and a lose phase, while conceptual shifting ability was assessed via a standardized test. Cluster analyses revealed three profiles of cardiac vagal response to the task. Children in the first cluster displayed significant vagal withdrawal, children in the second cluster showed nonsignificant vagal withdrawal, while children in the third group displayed vagal augmentation to the challenge. These profiles differentiated preschoolers' conceptual shifting ability. Specifically, children with vagal withdrawal had the best performance in categorization and flexibility tasks and committed fewer perseverative errors compared to children who showed blunted vagal withdrawal or vagal augmentation to the challenge. Implications for theory and practice are discussed., (© 2018 Wiley Periodicals, Inc.)

Background: Neurological and neurodegenerative diseases are multifactorial and their causes are not well understood yet. Among the relevant risk factors, pesticides and the productive activities in which they are used are included., Objectives: To evaluate the association of mortality from neurological diseases within the Province of Pavia (Italy) with the agricultural activities, as a proxy of pesticides exposure., Methods: Population data for 2012 were provided by the local health unit (ATS) and by the registry office of the Regional Health Service. Spatial analyses were carried out by both a classical and Bayesian approach, to obtain a mortality map of the relative risk for neurological diseases in the Province of Pavia. Spatial distribution of main agricultural activities within the same territory, used as proxy of pesticides use, was made possible by data from the Geoportale Territoriale of the Lombardy region. Finally, a comparison between spatial distribution of mortality from neurological diseases and spatial distribution of main agricultural activities has been conducted., Results: Mortality for neurological diseases in the Province of Pavia in 2012 was 4.41 for men and 6.53 for women per 10,000 subjects living in this area. Female mortality for neurological diseases showed a cluster in the Oltrepò district, where viticulture and fruit/horticulture are more common than elsewhere. More precisely, Bayesian relative risk (RR) had higher values in comparison with the median RR of the Province (100.8), with a posterior probability (PP) between 0.75 and 0.95 (not significant). Similarly, mortality for Parkinson's disease in women showed RR greater than the median value of the Province (100.6), with PP between 0.25 and 0.75 (not significant)., Conclusions: Notwithstanding the ecological nature of the study, our results suggest the need to further investigate the possible link between pesticides exposure or related activities and neurological and neurodegenerative diseases, particularly Parkinson's disease. An ad hoc study on a random sample of the population living in the Province of Pavia, with the collection of individual data by means of standardized questionnaire, would allow to control for biases usually present when an ecological study design is applied.

Although certain visuospatial abilities, such as mental rotation, are crucially important in everyday activities, they have been little explored in individuals with Down syndrome (DS). This study investigates: i) mental rotation ability in individuals with DS; and ii) its relation to cognitive abilities and to everyday spatial activities. Forty-eight individuals with DS and 48 typically-developing (TD) children, matched on measures of vocabulary and fluid intelligence, were compared on their performance in a rotation task that involved detecting which of two figures would fit into a hole if rotated (five angles of rotation were considered: 0°, 45°, 90°, 135°, 180°). Participants were also assessed on their visuospatial and verbal cognitive abilities, and on their parents and/or educators reports regarding their everyday spatial activities. Results showed that: (i) individuals with DS were less accurate in mental rotation than TD children, with larger differences between the groups for smaller angles of rotation; individuals with DS could not mentally rotate through 180°, while TD children could; (ii) mental rotation ability was related to fluid intelligence and to spatial activities (though other cognitive abilities are also involved in the latter) to a similar degree in the DS group and the matched TD children. These results are discussed with regard to the atypical development domain and spatial cognition models., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Recent studies have suggested that the spatial-simultaneous component of working memory (WM), which is involved when stimuli are presented simultaneously, is selectively impaired in individuals with Down syndrome (DS). The main objective of the present study was to examine whether WM performance can be enhanced in individuals with DS by analyzing the immediate and maintenance effects of a training program. For this purpose, 61 individuals with DS were randomly assigned to three groups: one trained on simultaneous components of visuospatial WM; one serving as an active control group, that completed activities on vocabulary; and one serving as a passive control group, that only attended the pre- and post-test and follow-up assessments. The efficacy of the training was analyzed in terms of specific (spatial-simultaneous WM tasks), near transfer (spatial-sequential and verbal WM tasks), far transfer (spatial abilities, everyday competences), and maintenance effects (with a follow-up at 1 month). The results showed an overall significant effect on the WM on the group receiving the training. The benefit was generally specific, however, with some transfer to other WM tasks, but only in the immediate (post-test) assessment., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Few studies on individuals with Down syndrome (DS) have explored how they learn space. The present study examines space learning from verbal descriptions in individuals with DS, and explores the role of external cues (such as a sketch map). Twenty-eight individuals with DS and 28 matched typically-developing (TD) children listened to route or survey descriptions with or without seeing a corresponding sketch map (Description+Sketch Map [D+SM] and Description alone [D], respectively). After hearing each description, they performed tasks that involved recognizing, arranging sequentially, and locating landmarks. The results showed that individuals with DS performed less well in recognizing landmarks and arranging them sequentially. The D+SM condition produced general benefits in both groups' accuracy, though the improvement in locating landmarks was greater in the TD than in the DS group. In both groups, the D+SM condition prompted a better performance than the D condition when participants arranged landmarks sequentially after hearing a description from a route perspective, but not from a survey perspective. Overall, our results show that individuals with DS benefited when a spatial description was associated with a corresponding sketch map, albeit to a lesser degree than TD children. The findings are discussed in the light of the literature on DS and on spatial cognition in the TD domain., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The present study aims to explore the impact of a numerical skills training program on the basic mathematical skills and logical thinking in children with Down syndrome (DS). The training program was built specifically for children with DS, bearing the strengths and weaknesses of their particular cognitive profile in mind. Two groups of children with DS took part in the study. All children were tested before and after the training on measures of numerical skills and logical thinking. One group of 27 children was trained in numerical skills twice a week for 2 months, for about 30min per session. A control group of 9 children was not involved in any training session. After training, children in the intervention group performed better in numerical tests, while those in the control group did not. These results suggest that our training program is both feasible and effective for children with Down syndrome., (Copyright © 2015 Elsevier Ltd. All rights reserved.)