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Purpose: Dyadic synchrony is positively associated with social competence. Although children diagnosed with Autism Spectrum Disorder (ASD) and children diagnosed with Down Syndrome (DS) both have trouble with dyadic synchrony, the origin of their difficulties is fundamentally different. In this mixed method study, we investigated differences in dyadic synchrony and social behavior between children diagnosed with ASD and DS. Methods: Twenty-seven children diagnosed with ASD (10 cisgender females; Mage = 10.98 years; SD = 2.21) and twenty-five children diagnosed with DS (11 cisgender females; Mage = 11.91 years; SD = 2.27) performed a collaborative drawing task with a parent in which they had to synchronize their drawing movements. We continuously tracked their dominant hand movements using wearable accelerometers, and performed Cross-Recurrence Quantification Analysis to extract synchrony measures. Additionally, we compared the social behaviors (interpersonal synchrony, emotion regulation, and social cognition, motivation, and confidence) of these children using quantitative parental questionnaires. Results: Parent-child synchrony measures were significantly higher for children diagnosed with ASD. Yet, parents were significantly more positive about the social behaviors of children diagnosed with DS. No significant correlation between the synchrony and questionnaire measures was found. Conclusion: While children diagnosed with ASD synchronize better during a collaborative task, the social behavior of the children diagnosed with DS (including social synchrony) is more positively evaluated by their parents. Possible reasons for this discrepancy are discussed.

Background: Parents' conceptualizations of adulthood for their emerging adults with Down syndrome have the potential to impact the transition planning process as families prepare for life after graduation. Aims: This study aimed to explore parent perceptions of the meaning of adulthood for their emerging adults with Down syndrome. Methods: In this qualitative study, we interviewed 11 parents of emerging adults with Down syndrome using phenomenological methodology and analysed these data using thematic analysis. Results: Three topics emerged: (1) Parents' constructions of the meaning of adulthood; (2) Parents' perceptions about the transition to adulthood; and (3) Parents' perceptions of current adult life skills. Ten themes arose out of these topics. Conclusions: Parents expressed ambivalence about the meaning of adulthood for their emerging adults with Down syndrome, sharing that in some ways they were adults and in others they were not. The meaning of adulthood was closely tied to obtained skills, particularly those related to personal safety.

Background: Down syndrome (DS) is a neurodevelopmental disorder of genetic origin with a cognitive-behavioural profile that distinguishes it from other syndromes. Within this profile, language difficulties are particularly marked, having been more studied in childhood than in adulthood. More generally, there is a paucity of research on the prosodic skills of individuals with DS, despite the relevance of this linguistic component for effective communication. Aims: This study aimed to analyse, for the first time, the prosodic profile of Spanish-speaking teenagers and young adults with DS. We hypothesized that participants with DS would show significantly lower skills for the perception and production of prosodic functions and forms when compared to peers with intellectual disability (ID) of unknown origin. We also hypothesized that teenagers and young adults with DS would have better prosody perception than prosody production. Methods & Procedures: The final sample included in the study comprised 28 Spanish-speaking teenagers and young adults with DS and 29 teenagers and young adults with other ID matched on chronological age and nonverbal cognition. Their prosodic skills were tested by means of the Profiling Elements of Prosody for Speech and Communication battery. This battery allows for the separate evaluation of the comprehension and expression of the communicative functions of prosody and the discrimination and production of the forms that carry out such functions. Outcomes & Results: In the prosody function tasks, which are the most adaptive tasks for the communicative process, we found, as expected, significantly lower scores on the turn-end, chunking, and focus tasks in the group with DS. However, no significant between-group differences were found for the affect tasks. Participants with DS also had significantly lower scores on the prosodic form tasks than participants with other ID. The results of the comparison between prosodic perception and production skills showed that a generalization about a better profile in comprehension versus production is not possible and that there is a dependence on the demands of the prosodic task undertaken. Conclusions & Implications: The findings contribute to the ongoing development of the language profile of teenagers and young adults with DS and imply the need to design prosodic intervention programs based on their specific profile.

Purpose: The purpose of the paper is to describe the development and implementation of a specialized Virtual Learning Environment (VLE) designed to enhance the knowledge and skills related to sustainability in students with Down Syndrome. This VLE serves as a means to make sustainable concepts more accessible and comprehensible to this specific student group, with the aim of promoting their engagement and understanding of sustainability, environmental awareness, recycling, and sustainable construction. The ultimate goal is to empower students with Down syndrome by providing them with a tailored educational tool that facilitates their learning in a manner that is engaging and effective. Design/methodology/approach: The approach outlines the overarching plan for creating the e-learning platform, including the technological choices and design considerations necessary to make it effective and accessible for students with Down Syndrome. It's a fundamental component of the methodology, as it sets the direction for the platform's development and aligns with the objectives of the study. And also encompass the strategy for teaching and learning sustainability aspects to students with Down syndrome. Findings: Positive Feedback from Tutors and Professionals: The feedback from tutors and professionals is generally positive, with 91.4% finding the platform to be well-organized and 88.6% considering the content adequate and understandable. This suggests that the VLE met the needs and expectations of educators and professionals involved in the learning process. Utility for Professional Practice: Approximately 80% of tutors and professionals found the platform useful for their professional practice, indicating that it has practical applications beyond student learning. This information highlights the success and potential impact of the VLE for this specific target group. Research limitations/implications: The study may not have explored the depth of sustainability concepts covered within the VLE. Future research could delve into the specifics of the content and its effectiveness in teaching complex sustainability topics. Practical implications: The incorporation of universal design principles in the VLE development could serve as a model for creating inclusive e-learning platforms. This has broader implications for improving digital accessibility in education. The positive feedback from tutors and professionals suggests the importance of interdisciplinary collaboration in education. Professionals from various fields, including special education and sustainability, can work together to create effective and inclusive learning tools. Social implications: This study can contribute to the broader discussion on inclusive education and the effective use of technology to enhance learning experiences for individuals with disabilities. Originality/value: The study addresses a crucial gap in the field of sustainability education by focusing on students with Down syndrome. It highlights the importance of making sustainability education inclusive and accessible to a diverse range of learners, including those with disabilities. This originality contributes to the broader discourse on inclusive education and environmental awareness. The development of a specialized Virtual Learning Environment (VLE) for this specific target group is an original contribution. It demonstrates the potential for adapting educational technology to meet the unique needs of students with Down syndrome, potentially serving as a model for future educational tool development.

Background: The meanings of neurodevelopmental conditions are socially and culturally defined. We explored how parents of a child with Down syndrome experienced public and professional understandings of Down syndrome. Method: Qualitative interviews with 25 parents of a child with Down syndrome living in Denmark. From a reflexive thematic analysis, we developed themes describing understandings (i.e., attitudes or perceptions) of Down syndrome. Results: The parents experienced that the Down syndrome diagnosis acted as a 'label'; this had perceived positive and negative consequences for the child. The parents felt others understood Down syndrome as severe and undesirable. This attitude was tied to the existence of prenatal screening. Finally, to the parents, professional support for their child expressed an understanding of children with Down syndrome as valued individuals. Conclusions: Parents encountered ambiguous understandings of Down syndrome. This should be recognised by professionals who may shape such understandings.

Background: People with intellectual disabilities may experience frailty earlier than the general population. This scoping review aimed to investigate how frailty is defined, assessed, and managed in adults with an intellectual disability; factors associated with frailty; and the potential impact of COVID-19 on frailty identification and management. Method: Databases were searched from January 2016 to July 2023 for studies that investigated frailty in individuals with intellectual disabilities. Results: Twenty studies met the inclusion criteria. Frailty prevalence varied between 9% and 84%. Greater severity of intellectual disability, presence of Down syndrome, older age, polypharmacy, and group home living were associated with frailty. Multiagency working, trusted relationships and provision of evidence-based information may all be beneficial in frailty management. Conclusion: Frailty is common for people with intellectual disabilities and is best identified with measures specifically designed for this population. Future research should evaluate interventions to manage frailty and improve lives.

Background: Chewing difficulty, poor oral health, inadequate and imbalanced nutrition are serious health problems in individuals with intellectual disabilities. The participants' chewing abilities, oral health and nutritional status were analysed in this study. Methods: Forty-five adult participants with intellectual disabilities were included. Anthropometric measurements, oral health assessments, chewing ability evaluations and dietary intake analyses were conducted. Results: A 56.8% of the participants were classified as overweight or obese. Teeth grinding was reported in 33.3% of the participants, while 40.0% experienced drooling. All participants with Down syndrome and 58.6% of the participants with developmental delay had chewing difficulties. Inadequate nutrient intake was observed and the fibre, vitamins B1, B3, B9, sodium, phosphorus and iron intakes were significantly lower than reference values in those with chewing difficulty (p < 0.05). Conclusions: Chewing difficulties were associated with lower intake of certain nutrients, highlighting the importance of addressing oral health and dietary counselling in this population.

This study evaluated the efficacy of an 8-week (two sessions/week; 60 min/session) adapted soccer intervention on skill performance and retention in 30 adults (18 men and 12 women) ages 17-40 years with autism spectrum disorder, Down syndrome, and intellectual disability. Of these 30 participants, 18 completed a 1-month retention test. The program included behavior supports and adaptations for participants with varying levels of behavioral needs. Dribbling, kicking a moving ball, kicking a stationary ball, throw-ins, trapping, and a composite skill score were examined. Linear mixed-effect regression revealed a significant time main effect with improvements from pretest to posttest and pretest to retention for all skills. In addition, modest offline gains (i.e., posttest < retention) were observed for throw-ins, kicking a moving ball, and the composite skill score. A significant main effect of diagnosis was observed such that participants with autism spectrum disorder had better performance on kicking a moving ball than those with Down syndrome and intellectual disability. Finally, a significant main effect of level of function was observed. This program enabled adults with various disabilities to acquire fundamental soccer skills that may lead to meaningful participation in community soccer programs.

The aim of the present study is to find new emerging lines of research in education with the use of information and communication technologies (ICT). To this end, we carried out a meta-analysis selecting an index, which contained scientific articles, and which provided free access to complete documents. The search covered five years, 2017-2021 in which 748 were identified. For the analysis the articles were read in order to identify information and record it. Previously, categories were established such as the date, country, continent, language, level of schooling or demographics of the population of publication and the kind of study and area of research. With respect to the demographics we identified that the aged were the category, which had been studied the least. With reference to years of schooling, pre-school and graduate levels had the fewest articles. That said, we found that the majority of the articles were aimed at education and technology in general. However, it is important to point out that the areas with limited research such as autism, rural area, inclusive education, disabilities, cyberbullying, Indigenous affairs, social exclusion, and down syndrome. These findings show the emerging lines of research to which studies should be expanded with further knowledge.

This study aims at investigating the impact of visual arts activities on the socialization and stress management of individuals with special needs. This is a qualitative research study that employs "action research" and our data were collected based on the observations of teachers. Over a 20-week period, visual arts activities were carried out with 27 individuals with special needs, including six with autism, seven with Down syndrome, and 14 with moderate to severe intellectual disabilities, who received education at the third level in the "Fehmi Cerrahoglu Special Education Practice School" in Ordu province during the 2020- 2021 and 2021-2022 academic years. The study group included a counselling teacher and 19 special education teachers, who observed the activities and their effects on the socialization levels and stress management of educable individuals with special needs. The data obtained from semi-structured interviews were analyzed using content analysis. Most of the participating teachers agreed that visual arts activities contributed to the socialization and stress management of individuals with special needs, and the study found that these activities played an important role in the inclusion of individuals with special needs in society and led to a decrease in stress symptoms.

It is aimed in this study to analyze the effects of the Montessori education method on children with Down syndrome and autism having special training who have received and not received Montessori education through the Eurofit test batteries selected for motor skills and physical fitness. A total of 20 male children with Down syndrome and autism in the age range of 12 to 16 and receiving and not receiving Montessori education at two different special education and rehabilitation centers in Kayseri were included in the study. The treatment group included a total of 10 children, 5 with Down syndrome and 5 with autism, and the control group of 10 children, 5 with Down syndrome and 5 with autism. While the volunteers included in the treatment group received Montessori education, those included in the control group received a traditional education. In the study, the volunteers performed the selected Eurofit tests including flamingo balance, plate tapping, sit and reach, handgrip and standing long jump tests. When the results of the Eurofit test batteries of the treatment and control groups were examined, plate tapping and standing long jump test results were found significant in the comparison of the pretest and posttest of the treatment group (p < 0.05). In the pretest and posttest comparison of the control group students, a significant difference was determined in the sit and reach test (p < 0.05). In the posttest comparison of the control and treatment groups, a statistically significant difference was determined between the pretest and posttest measurements of the plate tapping and between the pretest and posttest measurements of the standing long jump (p<0.05). In the pretest comparison of the control and treatment groups, no statistically significant difference was found between the pretest and posttest of flamingo balance, pretest and posttest of plate tapping, pretest and posttest of sit and reach, pretest and posttest of standing long jump and pretest and posttest of handgrip measurements of the control and treatment groups (p>0.05). Consequently, the use of Montessori education materials supports the big and small muscle groups of children with disabilities since most of them learn about an object through touch. In our study, when some activity and motor skills of the children with down syndrome and autism in the special rehabilitation school that uses the Montessori education method were analyzed, it was observed that there was an improvement in their physical activities and some motor skills according to the results of plate tapping, standing long jump and sit and reach tests. It is recommended that education programs can be prepared by using Montessori Approach as part of the education programs applied in preschool education institutions and that they can be used more widely together with traditional education programs.

The aim of this study was to compare bibliometric indicators of scientific productivity in physical activity (PA) in children and adolescents with Autism spectrum disorder (ASD) and Down syndrome (DS) in the PubMed database. A bibliometric study was conducted for the last 5 years (2017 to 2021). The data collected for each article were: year of publication, language of publication, country, journal name, and type of paper. The results showed that there was higher scientific productivity in the population with DS (20 studies) relative to their counterparts with ASD (31 studies). The language of publication in both cases was English. There were 10 countries that published on PA in ASD and 14 countries that published on DS. Overall, the greatest interest in publishing on PA in children and adolescents with ASD was in North America (6 studies), followed by Asia (5 studies) and Europe (4 studies). In the DS population it was in Europe (13 studies), North America (9 studies) and South America (4 studies). Nineteen journals were identified that published in the ASD population and 29 journals in DS. Six experimental studies were identified in ASD and 7 in DS. There was a higher scientific productivity with original studies. There was a positive trend of increasing scientific productivity over the years in both populations. We suggest the need to promote research on PA in both populations, regardless of the type of study, as it is an indicator of overall health status.

Eye tracking research technologies are often used to study how individuals attend visually to different types of AAC displays (e.g. visual scene displays, grid displays). The assumption is that efficiency of visual search may relate to efficiency of motor selection necessary for communication via aided AAC; however, this assumption has not received direct empirical study. We examined the relation between speed of visual search and speed of motor selection of symbols. Ten individuals on the autism spectrum (AS; Study 1) and nine with Down syndrome (DS; Study 2) participated in a search task using simulated AAC displays with a main visual scene display (VSD) and a navigation bar of thumbnail VSDs. Participants were given an auditory prompt to find one of four thumbnail VSDs in the navigation bar. Eye tracking technologies measured how long it took participants to fixate visually on the thumbnail VSD, and recorded how long it took participants to select the thumbnail VSD with a finger. A statistically significant relationship emerged between visual fixation and selection latencies, confirming the positive relationship between visual processing and motor selection for both groups of participants. Eye tracking data may serve as a useful proxy measure for evaluating how display design influences selection of AAC symbols, especially when individuals are unwilling or unable to comply with traditional behaviorally-based assessment tasks.

Background: Individuals with Down syndrome are an at-risk population for severe COVID-19 outcomes, due to genetic predispositions and comorbidities. The current study focused on differences between persons with and without Down syndrome regarding age and severity of disease. Method: We used medical statistics to compare patients with and without Down syndrome who were admitted to Swiss hospitals (2020 and 2022) with a COVID-19 diagnosis. Differences in age, hospitalisation characteristics, mortality, and additional diagnoses were investigated. Results: Results revealed a lower median age and greater risk of intensive care unit admission and mortality among patients with Down syndrome. No differences were found in length of hospital stay. Conclusions: There is some evidence of increased vulnerability in people with Down syndrome compared to other patients, particularly in terms of mortality rates. However, compared to studies from other countries, the situation of people with Down syndrome does not appear to be particularly critical.

In this study, we aimed to analyze the incremental effects of sensory integration therapy (SIT) plus neurodevelopmental therapy (NT) versus NT alone on the attention and motor skills in children with Down syndrome (DS). We randomly assigned into experimental (i.e. SIT + NT; n = 21) and control (i.e. NT alone; n = 21) groups. While NT was applied to both groups for six weeks, SIT was applied simultaneously to the experimental group for six weeks. Participants' motor functions (Bruininks-Oseretsky Test of Motor Proficiency--Short form (BOT-2 SF)) and attention skills (Stroop TBAG (Turkish Scientific and Technological Research Association) Form) were evaluated before and after treatment (6 weeks later). Stroop TBAG and BOT-2 SF scores of the groups were similar at the baseline (p > 0.05). Significant improvement from baseline was observed in both BOT-2 SF, and Stroop TBAG results in both groups (p < 0.05). In addition, the improvement in both BOT-2 SF and Stroop TBAG results was found to be greater in the experimental group compared to the control group (p < 0.01). There were clear advantages to adding SIT to NT alone when seeking to improve motor and attention skills in children with DS.

Aims: To determine the effect of a 16-week fitness program (strength vs. aerobic) on different indicators of body composition and components of health-related physical fitness in youths with Down syndrome. Methods and procedures outcomes: Fifty adolescents (19 girls and 31 boys; average age, 18.33 ± 1.42 years) with Down syndrome were recruited and randomized to two groups (strength group vs. aerobic group). Adolescents allocated in the aerobic group carried out a physical activity program three times a week for 16 weeks meanwhile adolescents allocated in the strength group performed a fitness program three times a week for 16 weeks. Results: The exercise group had significant improvements in all health-related physical fitness variables (p < 0.05) but not on body composition. Conclusions and implications: A sixteen week fitness program consisting of three sessions of 60 min is able to increase levels of health-related physical fitness but not on body composition in youths with Down syndrome. The aerobic program does not seem to show significant differences.

The current study examined the effectiveness of a reading curriculum of explicit instruction on the letter-sound knowledge of a sample of elementary-aged students with Down syndrome. The procedures were adapted from prior research (King et al., 2020; Lemons et al., 2018; Lemons et al., 2015). Three participants between 9 and 11 years old participated in the study. Participants were provided with five lessons or 5 tiers of data points on letter-sound knowledge, wherein they practiced identifying initial letter-sounds from highly imageable and decodable words. Unique to this study was the addition of explicit instruction procedures in spelling and measurement of improved spelling skills for both taught and untaught words. We used a multiple probe design across intervention lessons. Letter-sound accuracy increased for all three participants. Results for the spelling outcomes were mixed, with most students making minimal progress. Improvements in letter-sound knowledge did not naturally transfer to the spelling outcome, supporting the idea that explicit instruction may be necessary to support the transfer of skills for children with Down syndrome.

Literacy skills can assist in the navigation and enjoyment of adult life. For individuals who have reached adulthood without strong literacy skills, opportunities for continued literacy learning are few. Redesigning AAC technologies to support literacy skill development could extend literacy learning opportunities for adults with developmental disabilities who have limited speech. The current preliminary study evaluated an AAC technology feature designed to support literacy development. The study used a multiple probe across participants design. Three adults with Down syndrome who had limited speech and only basic decoding skills participated. Results suggest the participants made modest gains in decoding accuracy after interacting using the AAC app with the literacy supportive feature, though performance was highly variable. Results also offer emerging evidence that, for two participants, some generalization to encoding performance may have also been achieved. Results showed that, for all the participants, interacting using the literacy supportive feature increased their reading confidence. Altogether, the study's results show preliminary evidence that the feature can support adults with Down syndrome in their ongoing literacy learning, though access to formal instruction is still critical. Future research is needed to continue to explore this and other AAC technology redesigns to increase learning opportunities for the people who use the technology every day to communicate.

Background: The Australian Commission on Safety and Quality in Health Care recommends the development of reasonable adjustments to Comprehensive Care Standard to better suit the needs of people with intellectual disability. Method: An audit of adults with Down syndrome attending a mainstream internal medicine outpatient clinic was undertaken to describe their biopsychosocial profile, identify previously developed reasonable adjustments to clinical service and to consider their alignment with comprehensive care. Results: Of 54 adults, 31 (57%) male, average age 36 years (17.5-68 years), there were multiple syndromal and non-syndromal co-morbidities, 10 deaths (9 expected), from dementia. All had some degree of intellectual disability with all requiring disability supports to assist in their healthcare and an active health-disability interface in most cases. Conclusions: Reasonable adjustments to usual clinical content, process, knowledge, and organisation were identified, which appeared to facilitate application of comprehensive care. These were predominantly influenced by intellectual disability, disability supports, and the health-disability interface rather than the disease profile.

Proper treatment of developmental disabilities requires health workers to have adequate knowledge of etiology and referral procedures. There is a dearth of research on knowledge of developmental disabilities among health workers in Ghana. The purpose of this study was to document knowledge about developmental disorders, causes, and referral procedures among health workers. Researchers used a successive free-listing method to interview 37 health workers. Developmental disabilities which present with physical symptoms were the most salient disorders identified among health workers, while learning disabilities and attention deficit disorder were largely overlooked. The most commonly listed developmental disabilities were cerebral palsy, Down syndrome, and autism spectrum disorder. Respondents had limited knowledge about the causes of and referral resources for developmental disabilities. Results show the need for continuing medical education, public awareness, and enhanced resources to support the identification and care of children with developmental disabilities in Ghana.

Introduction: This article reports the physical abilities and physical wellness of three groups of children with different neurodevelopmental disabilities--Autism, Down Syndrome and Intellectual Disability. Methods: The causal-comparative research method was implemented in this study. The participants comprised 32 students with moderate intellectual disabilities, 18 with autism spectrum disorder, and 22 with Down Syndrome. The body mass index (BMI), flexibility, standing long jump, sitting height, stroke length, and medicine ball throwing levels were measured for physical fitness, and the groups were compared afterward. The Kruskal Wallis-H Test and Mann-Whitney U Test were applied to determine the differences between the groups' physical fitness averages for the statistical analysis. Results: Statistically significant differences were obtained in BMI, standing long jump, stroke length, and medicine ball throwing variables (p < 0.05). However, no statistically significant difference was discovered for the flexibility and sitting height variables (p > 0.05). The BMI, sitting height, and stroke length levels for the group with autism spectrum disorder were higher than the other groups, as the flexibility levels of the group with Down Syndrome were higher than the other groups. Students with intellectual disabilities were demonstrated to have better values than other groups regarding standing long jump and medicine ball throwing performances. Conclusions: Objective information about the physical fitness of individuals with children with different neurodevelopmental disabilities was obtained. In addition, the data obtained with these children will contribute to future plans for movement training as well as the content and frequency of the interventions, and will guide the development of new strategies to develop physical abilities and physical wellness.

Infants with Down syndrome are more likely to experience feeding problems and mothers are likely to require more feeding support than mothers of typically developing infants. During the COVID-19 pandemic, many feeding support services changed from face-to-face to online, which impacted some maternal feeding experiences negatively, but no studies to date have explored the impact for mothers of infants with Down syndrome. Thematic analysis was conducted on semi-structured interviews from thirteen new mothers of infants (aged 8-17 months) with Down syndrome in the UK. Three superordinate themes were generated: (1) Every baby with Down syndrome has a unique journey; (2) There's no point asking, they won't know; and (3) Lack of in-person support. Many mothers expressed frustrations over health professionals' lack of Down syndrome specific knowledge resulting in unmet needs, further magnified due to the nature of the virtual support being offered. Moreover, mothers struggled with reduced social support from other mothers when encountering feeding problems. These results hold real-world implications for health professionals who could provide more specialised face-to-face feeding support to mothers of infants with Down syndrome. This should be prioritised for children's overall development and mothers' wellbeing.

Sleep problems are common in children and adolescents, particularly those with Neurodevelopmental Disorders. With the changes in daily habits resulting from the COVID-19 pandemic, we have analyzed sleep characteristics, during social isolation, in Brazilian children and adolescents aged between 4 and 12 years with Autism Spectrum Disorder (N = 267), Down Syndrome (N = 74), and typical development (N = 312). The ASD group presented with worse indicators of sleep habits in the Children's Sleep Habits Questionnaire (CSHQ-BR) and fell asleep later during the pandemic. The entire group started fall asleep and waking up later during the pandemic - as well as waking up more often during the night. These results may contribute to parental guidance and sleep habit-related interventions during and after the COVID-19 pandemic.

Background: Sedentary behaviour (SB) among adults with Down syndrome (DS) may differ based on personal or environmental factors. Objective: Investigate differences in SB levels and patterns of adults with DS based on sex, age, and residence-type across weekdays and weekends. Methods: Thirty-four adults with DS (15 men; 37 ± 12 years) underwent accelerometry-based measurements of sedentary time, bouts, and breaks for 7 days. We evaluated differences with 2 × 2 mixed-model (group-by-day) ANOVA. Results: Younger (19-36 years) individuals had less sedentary time (p = 0.042), and shorter (p = 0.048) and fewer (p = 0.012) bouts than older (37-60 years) individuals. Group home residents had more bouts on weekends than adults living with parent/guardians (p = 0.015). Conclusions: Adults with DS spent half their waking hours in SB of short bouts. Age and residence may influence SB.

Introduction: Narratives are enriched by taking the perspective of the protagonists, which can be expressed using reported speech. Nevertheless, the use of reported speech is unaddressed internationally among individuals with Down syndrome. Method: Narratives of 28 children and adolescents with Down syndrome were collected using a non-verbal picture book. Occurrence and forms of reported speech were analysed and compared to typically-developing children (TD; n = 33). Results: Participants from both populations use reported speech in their narratives with a comparable proportion. Nevertheless, differences appear concerning forms of direct speech with persons with Down syndrome using more free direct speech than TD-children. Discussion: The results suggest that children and adolescents are able to implement the use of reported speech regardless of their syntactic impairments. Concerning the occurring forms of direct speech, the results might point to cognitive impairments that manifest in limited consideration of the interlocutor's knowledge.

Background: A comprehensive multidisciplinary medical guideline for adults with Down syndrome is lacking in the Netherlands. In this study, we aim to explore parents' views on multidisciplinary care and identify which aspects of health care they find most important in the context of developing such a guideline. Method: This qualitative study used semi-structured interviews. Nineteen interviews were conducted with parents of adults with Down syndrome. The main themes and subthemes were identified from the transcripts by using the framework method. Results: Four main themes were identified which should be addressed in the guideline according to the parents: parents' support in medical care, patient-centred care, important medical topics and the organisation of medical care. Conclusions: This study provides insights into parents' opinions about medical care for adults with Down syndrome. These insights are used in the construction of a guideline to improve medical care for adults with Down syndrome.

This article introduces a set of teaching strategies to enhance second language learning for students with Down syndrome (DS) enrolled in an English course covering material from the first two years of primary school. A set of instructional support strategies has been defined and integrated into an online learning software, developed ad hoc to teach the basic vocabulary of the English subject syllabus of the two first courses of primary school. A controlled experiment was carried out with 20 students with DS, who were divided into two groups: control and experimental. The control group was given a simplified version of the software, while the experimental group had access to the complete software with personalized instruction. Prior to the experiment, all participants undertook the same level test (pretest) in order to assess their initial knowledge level of English. After finishing the learning stage, a posttest was provided to the students to assess their learning. In both groups, results in the posttest were consistently better than in the pretest, supporting the positive effect of the learning software as an instructional tool. In addition, learning gains were significantly higher in the experimental group, that used the proposed instructional aids.

Background: The home literacy environment (HLE) has rarely been examined for individuals with neurodevelopmental disorders, including individuals with Williams syndrome and Down syndrome. Method: The current study surveyed carers of individuals with Down syndrome (n = 48) and Williams syndrome (n = 18) in the United Kingdom (UK). Results: The study reports that individuals with Down syndrome were rated higher in general reading skills and writing, while the Williams syndrome group scored higher for speaking. Yet, individuals with Down syndrome were more likely to engage in informal activities than instructional activities and the frequency of informal activities related to reading outcomes for those with Down syndrome but not Williams syndrome. Additionally, this study reports that age was not related to the HLE for both groups. Conclusion: This is the first study to report on the HLE of individuals with Williams syndrome and supports the key role of the HLE in the development of literacy skills for individuals with Williams syndrome and Down syndrome.

Background: Siblings of children with intellectual disability have unique family experiences, varying by type of disability. Methods: Parents of children with Down syndrome (156) or with Rett syndrome (149) completed questionnaires relating to sibling advantages and disadvantages, experiences of holidays and recreation, and perceived availability of parental time. Qualitative responses were analysed using thematic analysis. Results: Positive personality traits, an optimistic outlook, enhanced skills, and rich relationships were strong and consistent parental perceptions for siblings in both disability groups. Parents of children with Rett syndrome were more likely to rank themselves lower on time availability, and to report sibling difficulties with social engagement and family holidays. Conclusions: Parental responses appeared to be influenced by disability type, and reflective of child capabilities. Perceptions of sibling experience should be supplemented by data collected directly from siblings to fully understand their unique perspective, and the ways in which their experiences could be enhanced.

This study aiming to compare the effectiveness of Cognitive Orientation to Daily Occupational Performance (CO-OP) and Conductive Education (CE) approaches on motor skills, activity limitation and participation restrictions in children with Down Syndrome (DS). Twelve children were randomly assigned into two groups. Twelve-week CO-OP or CE intervention (period-1) followed by a 12-week washout period. Same interventions were crossed over for another 12 weeks (period-2). The Performance Quality Rating Scale (PQRS), Canadian Occupational Performance Measure (COPM) and the Bruininks Oseretsky Test of Motor Proficiency Second Edition-Brief Form (BOT2-BF) were used for outcome measurements. CO-OP was effective in the improvement of task-specific activity performance, while both approaches have similar effects on the improvement of perceived performance, satisfaction, and motor skills performance.

This study explores sex-differences in (a) rates and profiles of autism symptoms as well as in (b) the contribution of intellectual quotient (IQ) to autism symptom presentation in Down syndrome (DS). Participants were 40 males and 38 females with DS, aged 6 to 23 years. Autism symptoms were rated through the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2). Results show no sex differences in the ADOS-2 Calibrated Severity Scores (CSS). However, only females with DS who are classified as DS-Only have higher scores on verbal IQ than those classified as DS + autism. Furthermore, associations between IQ and all CSSs are found for females, but not for males. Findings suggest that verbal cognition may play differential roles for females and males with DS.

Down syndrome is the most common form of intellectual disability. However, there is a paucity of educational research focused on this vulnerable segment of learners especially in the present novel situation. This paper aimed to explore how teachers tailor remote special education for children with down syndrome amid the COVID-19 pandemic in the Philippines. It draws from a phenomenological qualitative study that collected information from online interviews with nine special education teachers handling children with down syndrome. The results revealed five themes: (1) contextualize individual educational plans; (2) meet sensory and movement needs; (3) emotionally connect with children; (4) communicate often with families; and (5) collaborate with community. This study provides practical insight into the enabling practices that teachers use to design the remote special education for children with down syndrome amid the current crisis.

Down syndrome (DS) is a complex condition associated with multiple medical, developmental, and behavioral concerns. A prospective, longitudinal clinical database was integrated into a specialty Down Syndrome Program, with the goals of better understanding the incidence, course, and impact of co-occurring medical, neurodevelopmental, and mental health conditions in DS. We describe the process of developing the database, including a systematic approach to data collection and database infrastructure, and report on feasibility, challenges, and solutions of initial implementation. Between March 2018 and November 2021, data from 842 patients (ages 4.8 months to 26 years) was collected. Challenges included caregiver form completion as well as time and personnel required for successful implementation. With full integration into clinical visit flow, the database proved to be feasible. The database enables identification of patterns of development and health throughout the lifespan and it facilitates future data sharing and collaborative research to advance care.

This study aimed to learn about the experiences of families of individuals with a dual diagnosis of Down syndrome (DS) and autism spectrum disorder (ASD) (DS-ASD), and to document the journey from early concerns to diagnosis and intervention. Caregivers completed an online survey describing their journey raising a child with DS-ASD. Survey responses were analyzed qualitatively and coded into categories to highlight common themes. Stereotypy, severe communication impairments, and behavioral difficulties prompted caregivers to pursue further evaluation. There was a mean 4.65-year gap between first noticing symptoms and receiving an ASD diagnosis. Several therapeutic interventions were identified as beneficial, including behavioral and communication support. Caregivers expressed frustration and described high levels of stress and social isolation. The diagnosis of ASD in children with DS is often delayed, and caregivers' initial concerns are frequently dismissed. Raising a child with DS-ASD can lead to social isolation and elevated caregiver stress. More research is needed to tailor diagnostic algorithms and therapeutic interventions to the unique needs of this patient population. Caregivers yearn for improved understanding of DS-ASD, more targeted therapies and educational programs, and more overall support.

Purpose: Understanding students' home literacy environments can help speech-language pathologists, teachers, and other educators partner with families to promote language and literacy learning. This study focused on gaining insight into the views of parents of elementary-age students with intellectual and developmental disabilities who had complex communication needs related to supporting children's language and literacy learning in the home. Method: This qualitative study was conducted during the COVID-19 pandemic, when many schools were utilizing remote or hybrid learning arrangements. Participants were 37 parents of students with complex communication needs in kindergarten to fourth grade. Most children had either autism or Down syndrome, and they ranged from primarily communicating prelinguistically (e.g., gestures and nonword vocalizations) to using some two to three word phrases in different modes (e.g., speech, sign, and aided augmentative and alternative communication [AAC]). Each parent was interviewed three times over the 2020-2021 school year, and data were analyzed using an inductive qualitative approach. Results: Findings showed patterns of commonalities and differences in parents' experiences, including related to their (a) goals and values about communication, language, and literacy; (b) perceptions and experiences with roles supporting language and literacy; and (c) satisfaction with supports and progress in these areas. Conclusion: This study provides important insight into the views of parents related to home literacy that can be used to improve the design and delivery of interventions for school-age students with complex communication needs and their families.

Creating digital educational materials, individualized and customized, for students with special needs is necessary; these individuals need materials that are developed especially for them. When materials are created for students with disability, it is vital to consider their disability situation, age, interest, and level of skills. There are some studies that implemented these types of materials, but these are not development studies. They focused on the effects of the material but not how it should be. There is a lack of study in the literature focusing on design considerations when developing interactive multimedia materials for students with special needs. Thus, there is a need for creating digital educational materials for students with special needs and an investigation of analyzing, developing, and integrating materials into special education. The present study aims to reveal what should be considered when developing interactive multimedia materials for students with special needs. This designed-based research was conducted with four students, three males and one female, two of whom have an intellectual disability, one has Down syndrome, and one is autistic. In addition, data were collected from two special education teachers and five experts during the material development phase. The study had four phases, and the fourth phase lasted six weeks. Results show that materials for students with special needs should be interactive, flexible, individualized, and simple; the design should not be tiered; sounds and effects should be dynamic, and if possible, concepts can be arranged by the teacher.

Objectives: Characterise the circumstances associated with death during admission of adults with Down syndrome (DS) and to identify predictors of mortality. Patients and Methods: Observational study based on data on all emergent admissions of adults with DS to hospitals of the Spanish National Health System between 1997 and 2014. We analysed epidemiological and clinical variables. Results: We analysed admissions of 11,594 adults with DS, mean age 47 years. 1715 patients died (15%), being the highest mortality (35%) in individuals aged 50-59. A past medical history of cerebrovascular disease (aOR 2.95 [2.30-3.77]) or cancer (aOR 2.79 [2.07-3.75]), gross aspiration's admission (aOR 2.59 [2.20-3.04]), immobility (aOR 2.31 [1.46-3-62]), and readmission within 30 days (aOR 2.43 [2.06-2.86]) were identified as predictors of mortality. Conclusions: Adults with DS have a high in-hospital mortality rate. The main predictors of death were cerebrovascular disease, cancer, early readmission, and conditions commonly associated with advanced dementia.

Background: Previous literature suggests that children with Down syndrome (DS) have difficulties in cognitive and affective components of Theory of Mind (ToM). However, the nature of the distinction between cognitive and affective ToM has not yet been addressed in depth in this population. Aims: This work is aimed at studying the cognitive and affective ToM in children with DS. Methods and Procedures: Cognitive ToM tasks (first-order false belief) and affective ToM tasks (Test of Emotion Comprehension) were administered to 30 children with DS (aged from 4 to 12 years) and to 60 typically developing (TD) children (aged from 2 to 12 years). TD children were divided into 2 groups: a Language control group and a Chronological age control group. Results: Results suggest that children with DS have difficulty with both the cognitive and affective ToM components, even when compared to the language control group. In contrast to children with typical development, children with DS have a better performance in affective ToM. Conclusions: We discuss our results in the light of prior studies describing the difficulties of children with DS in ToM tasks and the role of language in ToM development.

This study evaluated the appropriateness of scoring the Behavior Rating Inventory of Executive Function--Preschool (BRIEF-P) using age-equivalent scores generated from multiple measures of cognition and language among school-age children with Down syndrome (DS). Subscale T scores for 95 children with DS were contrasted using standard scoring on the Behavior Rating Inventory of Executive Function--Second edition (BRIEF-2; based on chronological age) to alternate scoring using the BRIEF-P (based on age equivalent) for patterns of subscale intercorrelations, differences in mean scores, and agreement on findings from clinical cut-off scores. Results with children with DS suggested using (1) the BRIEF-P for children ages 2-5 years old, (2) the BRIEF-2 with chronological-age scoring or the BRIEF-P with age equivalent scoring (with some caveats) for research on children ages 5-10 years old, and (3) the BRIEF-2 for children ages 11 and older.

Young children with Down syndrome (DS) often demonstrate impaired oral vocabulary development; however, few intervention studies have focused on this population. One promising method to improve the oral vocabulary of young children with DS may be to train their parents to intervene at home. In this study, we used tele-education methods (e.g., videoconferences, email) to coach parents to implement an adapted version of Down Syndrome LanguagePlus (DSL+). Four children with DS (ages 5-6 years) participated in the multiple probe across behaviors (i.e., stories) single-case research design study. Increasing trends during baseline and data variability precluded confirmation of a functional relationship; however, results indicated that all participants increased their scores on mastery measures of targeted vocabulary. Three of the four parents implemented DSL+ with high fidelity and responded favorably to social validity interviews.

Research supports the efficacy of intensive literacy instruction for children with moderate intellectual disabilities and Down syndrome (DS). However, much of the literature features measures closely aligned with evaluated interventions. Despite their increasing role in instruction, curriculum-based measures (CBM) are rarely featured in reading studies involving DS. Increasing the use of CBM in research has the potential to provide insight into the effectiveness of intervention and address concerns regarding the utility of approaches predicated on CBM. This single-case design study used CBM to examine the performance of children with DS (N = 17) who had largely exhibited gains on intervention-aligned measures following an intensive reading intervention. Results of multilevel modeling were mixed, with significant (p < 0.05) effects relegated to letter- and first-sound fluency. No more than 29% of participants met goals created using a procedure derived from CBM. Findings have implications for future studies and implementation of literacy interventions for children with DS.

The causal relationship between emotional outbursts and emotion dysregulation is proposed to be heterogeneous, but cultural influences have not been considered despite established cultural differences in emotional processes (e.g., increased motivation to suppress emotions in interdependent cultures). Responses to the Brazilian Portuguese version of the Emotional Outburst Questionnaire were collected from 327 caregivers of young people (6-25 years) with autism spectrum disorder, Down's syndrome, or intellectual disability. Responses were compared to a previous sample of 268 responses from the English version of the questionnaire. The latent factor structure of the contextual items was measurement invariant across both versions. The Brazilian responses were classified into three distinct clusters (Sensory Sensitivity; Perceived Safety; Perceived Unsafety) which considerably overlapped with the English clusters.

The performance of children and young adults with Down syndrome (DS) on reading subskills and nonword reading was investigated. The performance of the participants with DS (N = 42) was compared to that of typically developing (N = 36) peers matched on fluid intelligence abilities. The study accounted for the different depths in orthography presented by the two languages. The independent samples t-test, Mann-Whitney U-test, ANCOVA and correlation analysis were used to analyse the data. This study identified that the participants with DS had several strengths, such as nonword reading, visual discrimination (VD) and phonological awareness. Verbal short-term memory, visual perceptual processing skills other than VD and rhyming skills were identified as weaker in DS compared with the control group. Results call for educators to expose readers with DS to a phonological approach to reading while accommodating difficulties in VSTM.

Introduction: The VO[subscript 2] max test is the gold standard measure for aerobic fitness. A standardised treadmill protocol was developed years ago for individuals with Down syndrome but with variations in terms of starting speed, load increases and time spent at each stage. However, we realised that the most widely used protocol for adults with Down syndrome, trouble participants with high treadmill speeds. Consequently, the purpose of the current study was to determine whether an adapted protocol provided improved maximal test performance. Method: Twelve adults (33 ± 6 years) randomly performed two variations of the standardised treadmill test. Results: The protocol that added another incremental incline stage increase yielded a significant improvement in absolute and relative VO[subscript 2] peak, time to exhaustion, minute ventilation and heart rate max. Conclusion: A treadmill protocol with the addition of an incremental incline stage allowed for a significant improvement in maximal test performance.