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What does research tell us about developing the reading skills of children with Down syndrome? Kelly Burgoyne examines the evidence


Increasing numbers of children with Down syndrome are educated in mainstream primary schools and have access to the same levels of literacy teaching as typically-developing children. Though there is wide variability in the level of reading skill children with Down syndrome achieve, many are able to attain useful levels of literacy (Buckley & Johnson-Glenberg, 2008) and some children acquire reading skills that are in line with, or in advance of, their chronological age (Groen et al., 2006). Evidence-based guidance on how best to teach children with Down syndrome to read is clearly needed to encourage best practice. This article will review the current state of research on the subject.

Children with Down syndrome typically demonstrate relatively good visual skills (Fidler et al., 2005). This has led to a belief that they are visual learners and the suggestion that a sight word or “look and say” approach to the teaching of reading (that is, teaching whole words with no emphasis on letter-sound relationships) should be followed for this group. This approach can increase the number of words children are able to correctly identify, and may present a useful way to get young children started on reading. There is also some suggestion that, for children with Down syndrome, knowing a bank of sight words facilitates the development of other reading skills, such as decoding (Lemons & Fuchs, 2010a), and that reading instruction should start with this approach before progressing to other training (Buckley et al., 1996), though more work is needed to confirm this suggestion. There are, however, clear limitations to the sight word approach; it does not provide children with a strategy to read untrained words and therefore does not allow them to become independent readers (Cupples & Iacono, 2002). As such, the whole word approach should not be considered the only or most effective way in which to teach children with Down syndrome to read. If higher levels of reading ability are to be attained, reading instruction must include a wider range of components (Buckley et al., 1996).  

It is well-established that phonological awareness and letter knowledge are essential to the development of alphabetic reading for typically-developing children (Muter et al., 2004). Alphabetic reading requires an understanding of the relationships between the sounds in spoken words and the letters which represent those sounds. Mastering the alphabetic principle equips children with a strategy for decoding new words and to become more independent readers. Explicit instruction in this principle characterises the phonics approach to the teaching of reading. UK policy reflects the evidence base supporting this approach, advising high-quality systematic phonic work (within a language rich curriculum) as best practice in the teaching of early reading (DfES, 2006; DCSF, 2009).  Furthermore, for struggling readers, explicit and intensive phonics-based intervention has been shown to be effective in several rigorous evaluations (DCSF, 2007; Duff & Clarke, in press).  
As yet, it has been unclear whether this approach is also an important way to teach children with Down syndrome how to read. Early research with children with Down syndrome claimed that reading skills in this group developed in the absence of phonological awareness skills (Cossu et al., 1993). However, more recent work indicates that though phonological awareness skills are typically delayed in this group relative to typically developing groups, they nevertheless play a role in the reading development of individuals with Down syndrome (Lemons & Fuchs, 2010b). Accordingly, research has begun to evaluate the effectiveness of a phonological-based approach to the teaching of reading for this group.

Children with Down syndrome can make progress in specific phonological awareness skills following training. Kennedy and Flynn (2003) reported gains in targeted phonological awareness skills and spelling for three children with Down syndrome following eight hours of one-on-one instruction delivered over four weeks. Similarly, van Bysterveldt et al. (2006) found children made significant progress in letter-sound knowledge, print concepts and phoneme awareness following a parent-delivered intervention which directed children’s attention to letters and sounds within words.  

More recent work has evaluated teaching methods that combine phonological training with reading instruction. Goetz et al. (2008) incorporated phoneme-awareness training in the context of learning letter sounds and book reading, with work on sight word learning and speech activities. Trained learning support assistants delivered the programme to individual children in daily 40 minute sessions. Over an eight-week period, children receiving the intervention made greater gains in phoneme awareness, letter-knowledge, word and non-word reading than a waiting control group, who began to make progress once they started the intervention. A follow-up test conducted five months after the intervention had ended showed that the gains were maintained. Similarly, Lemons and Fuchs (2010a) trained tutors to deliver an intervention combining training in phonological awareness, phonics, reading decodable, sight and nonsense words and reading connected text to 24 children with Down syndrome. Following six weeks of intervention, all children were found to have made significant gains on one or more targeted skills, with some improving in more than one aspect of reading.      

The available evidence suggests that, as for typically-developing children, phonics-based instruction can lead to gains in early reading skills for many children with Down syndrome, though growth in phonological awareness appears to be more limited. However, the majority of studies have been characterised by small sample sizes and short-term training periods, few studies include a control group and none have used randomised controlled trials (RCTs), which are considered the gold-standard in intervention research (Torgerson et al., 2006).

Furthermore, whilst this type of intervention is effective for many children, it does not work for everyone; a number of children, both in typically developing groups and those with Down syndrome, show disappointing response  to this type of intervention (Goetz et al., 2008; Hatcher et al., 2006). These “poor responders” tend to have additional weaknesses in oral language skills (Whiteley et al., 2007) and recent work (Duff et al., 2008) suggests that combining reading intervention with language teaching may be more effective for these children. The language difficulties of children with Down syndrome are well documented (Abbeduto et al., 2007); intervention which targets both reading and language may also be most effective for this group (Buckley et al., 1996; Burgoyne, 2010).

This question is currently being addressed. In the largest study of its type to date, a team of researchers at Down Syndrome Education International and the University of York are evaluating a programme of reading instruction combined with targeted language work (REVI+) for children with Down syndrome. Results from this study will be available in 2012.

The focus of this article has been on developing foundational reading and decoding skills. The goal of reading, however, is to understand what is read, and this involves additional skills to those involved in word recognition (Oakhill et al., 2003). Whilst there is considerably less research on comprehension than on reading accuracy, a growing body of evidence suggests that reading comprehension is typically an area of difficulty for children with Down syndrome, falling approximately twelve to eighteen months behind word reading ability (Buckley et al., 1996). The discrepancy between accuracy and comprehension is comparable to that seen in “poor comprehenders”, leading to comparisons with this group: Poor comprehenders have difficulties with comprehension despite age appropriate reading accuracy (Nation et al., 2004) and exhibit oral language difficulties such as poor vocabulary knowledge (Catts et al., 2005) similar to those found in children with Down syndrome. Indeed, the reading comprehension difficulties of children with Down syndrome correlate with difficulties in language comprehension (Roch & Levorato, 2009).  

Few studies have explored methods of supporting comprehension in children with Down syndrome; however, recent work with poor comprehenders suggests that targeting language skills can be an effective way of improving comprehension. Clarke et al. (2010) reported three intervention approaches (oral language, text based and combined) which had a significant impact on the reading comprehension skills of poor comprehenders. This work highlighted the important role of vocabulary skills in reading comprehension and suggested that weaknesses in this area could be one of the underlying causes of reading comprehension failure in this group. Given the similar profiles of this group to children with Down syndrome, this research holds promise for effective intervention for the reading comprehension difficulties of children with Down syndrome; future work is needed to evaluate these methods for this group.

In conclusion, it is clear that many children with Down syndrome are able to acquire some level of reading skill given appropriate instruction and exposure to print. Research evidence is accruing which suggests that effective instruction for this group should incorporate a range of components including phonological awareness, letter-sound knowledge and phonics skills alongside sight word work and experience with reading books. As many children with Down syndrome will experience difficulties understanding what they read, instruction should also aim to foster comprehension, and support for underlying language difficulties may be one way to approach this. Despite a growing understanding of reading in children with Down syndrome, there are still many questions that remain to be answered, for example, how best to modify teaching for those who do not respond to phonics-based reading instruction, and how best to support the development of reading comprehension in this group. More large-scale, rigorous and scientific research is needed to address these questions before practitioners have clear evidence on how best to teach children with Down syndrome how to read. 



Further information

Dr Kelly Burgoyne is a research psychologist with Down Syndrome Education International:
www.downsed.org

References

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