Parental Reports of Spoken

Language Skills in Children

With Down Syndrome

Eva Berglund
Department of Psychology Spoken language in children with Down syndrome and in children in a normative
Stockholm University group was compared. Growth trends, individual variation, sex differences, and
Stockholm, Sweden performance on vocabulary, pragmatic, and grammar scales as well as MaxLU
and (maximum length of utterance) were explored. Subjects were 330 children with
College of Health and Down syndrome (age range: 1–5 years) and 336 children in a normative group
Caring Sciences (1;4–2;4 years;months). The Swedish Early Communicative Development
Falun, Sweden Inventory–words and sentences (SECDI–w&s) was employed. Performance of
and children with Down syndrome at ages 3;0 and 4;0 was comparable with that of
Uppsala University Hospital children in the normative group at ages 1;4 and 1;8 respectively. In comparison
Uppsala, Sweden with children in the normative group of similar vocabulary size, children with
Down syndrome lagged slightly on pragmatic and grammar scales. The early
Mårten Eriksson development proceeded in most cases with exponential or logistic growth. This
University of Gävle stresses the great potential of early intervention.
Gävle, Sweden
KEY WORDS: Down syndrome, language, parental reports, normative group,
Iréne Johansson SECDI
University of Karlstad
Karlstad, Sweden

T
he aim of the present study was to examine growth trends and
individual variation in spoken-language development in a repre-
sentative sample of Swedish children with Down syndrome.
Pueschel and Hopmann (1993) have commented on the great need to
acquire “good normative studies of the communication and language
skills associated with Down syndrome, as helpful guidelines for both
parents and professionals” (p. 354). The current study is the first large-
scale study of a national sample of children with Down syndrome in
which normative data are provided. We also studied sex-related differ-
ences in language among children with Down syndrome and children in
the normative group. The data included vocabulary size, pragmatic skills,
grammar skills, and maximum length of utterance (MaxLU) from the
Swedish Early Communicative Development Inventory–words and sen-
tences (SECDI–w&s; see Berglund & Eriksson, 2000).
Only a few studies have produced general results regarding the com-
municative development of children with Down syndrome. General find-
ings concern the developmental timetable and the existence of consider-
able variability across children. Some previous studies involved only a
few subjects and can thus be regarded as case studies in the sense that
they offer examples but present no normative data (e.g., Gillham, 1990).
Although a number of the studies encompass groups of children observed
at specific ages (e.g., Stroeminger, Winkler, & Cohen, 1984), most include
no information as to whether the children investigated were enrolled in

Journal of Speech, Language, and Hearing Research • Vol. 44 • 179–191 • February 2001 • ©American
Berglund Speech-Language-Hearing
et al.: Language in Children With DownAssociation
Syndrome 179
1092-4388/01/4401-0179

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 specific language-stimulation programs or if they had
additional deficiencies. Children with Down syndrome
often suffer from eye disorders; cardiac disorders; asth-
ma; allergies or immunologic diseases; impairment of
hearing; and various gastroenterological, neurological,
orthopaedic, and endocrinological complaints.
Because there are very few studies describing com-
municative development in children with Down syn-
drome in terms of either general trends or variability
across children, our primary aim was to provide infor-
mation relevant to researchers and clinicians in this
area. The age at which children with Down syndrome
start to talk and, in particular, when their first words
are uttered was one focus of the study. Several studies
have shown that some children with Down syndrome
utter their first words when they are 12 to 24 months
old, though substantial individual variation exists. Other
studies have noted, however, that it is not until age 3;9
that some children with Down syndrome uttered their
first words (Gillham, 1990; Stroeminger et al., 1984). In
general, the development of a first vocabulary is ex-
tremely slow in children with Down syndrome (Gillham,
1990).
We also wished to describe individual variation in
spoken-language development. Inasmuch as there is
extensive variation in the age at which first spoken
words appear, there is also considerable variability in
later communicative development. Gillham’s (1990) sub-
jects reached the 50-word level between the ages of 3;6
and 6;0. In their age 3;0 subjects, Stroeminger et al.
(1984) found that vocabulary size ranged from 0 to 85
words. There is also sizeable variation in the develop-
ment of mean length of utterance (MLU; Brown, 1973).
Caselli et al. (1998) found that children with Down syn-
drome were severely delayed in reaching developmen-
tal stages and that the children exhibited individual
differences. Caselli et al. also found that children with
Down syndrome were more advanced in lexical compre-
hension and gestures than in lexical production. Also
Chapman, Seung, Schwartz, and Kay-Raining Bird
(1998) found a specific expressive language impairment
in their subjects. However, they found no evidence of a
critical period for language development nor of a “syn-
tactic ceiling” of MLU. In a longitudinal study, Fowler
(1988) found that at age 4:0, the highest MLU scores
obtained by three children were 1.5, 2.2, and 2.2 (pp.
236–238); at age 5;0 the highest scores of five children
were 1.9, 2.2, 2.3, 3.7, and 3.8. One criterion for inclu-
sion in Fowler’s sample was that the child should pro-
duce two-word utterances. Accordingly, performance in
the Fowler study is expected to be higher than the aver-
age performance of children with Down syndrome.
In summary, the studies reviewed here indicate that
there is extensive individual variation in children with
180 Journal of Speech, Language, and Hearing Research • Vol. 44 • 179–191 • February 2001
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Down syndrome, both in terms of age at onset of spoken
language and in later performance. To our knowledge,
however, the magnitude of variation in relation to age
has never been the primary focus of previous studies.
Children with Down syndrome have often been
matched with unaffected children in terms of nonverbal
mental age (see Chapman, 1995). When such matching
has been used, the large variability in the groups of chil-
dren with Down syndrome has proven to be similar to
or greater than the variability among unaffected chil-
dren. Yet, there is also considerable variation in the per-
formance of unaffected children (Bates, Dale, & Thal,
1995; Berglund & Eriksson, 2000; Eriksson & Berglund,
1999; Fenson et al., 1994). Miller, Sedley, Miolo, Rosin,
and Murray-Branch (1991, cited in Chapman, 1995)
found that when spoken and signed words were added
children with Down syndrome who used manual signs
obtained vocabulary scores similar to those of their un-
affected peers matched on mental age. When vocabu-
laries increased in magnitude, the child mostly added
spoken words.
To identify the ages at which the performance of
children with Down syndrome parallels the performance
of unaffected children was a further aim of this study.
Mervis (1990), for example, compared the performance
of children with Down syndrome at age 3;0 to that of
unaffected children at age 1;6, suggesting similar quali-
tative aspects of conceptual development but slower
vocabulary development in children with Down syn-
drome. In a study by Mundy, Sigman, Kasari, and
Yirmiya (1988) children with Down syndrome with a
mean age of 3;8 obtained expressive language scores
comparable to those of unaffected children at age 1;6.
Bates et al. (1995) found that infants with Down syn-
drome lagged several months or years behind unaffected
infants in communicative abilities, measured by the
American Communicative Development Inventories:
Infant version (CDI: Infants; see Fenson et al., 1993).
In the period covered by CDI: Toddlers (Fenson et al.,
1993), the delay was found to be approximately 2 years
(Bates et al., 1995). Smith, von Tetzchner, and Michalsen
(1988) found that about half of their subjects with Down
syndrome at age 5;0 had scores comparable to those of
unaffected children at age 2;6 on the McCarthy scales
of children’s abilities, whereas the remaining children
with Down syndrome had lower scores. Delay was more
pronounced with regard to language skills as opposed
to their general cognitive functioning among children
with Down syndrome. Interestingly, the delay was
present in nonverbal communication as well as in speech,
suggesting that the language problems among children
with Down syndrome are not merely articulatory in
nature. Miller (1995) found a language-specific delay in
a comparison of children with Down syndrome and un-
affected children matched on mental age. He reported
 that 65% of children with Down syndrome performed at
vocabulary levels below the 10th percentile of unaffected
children (i.e., the performance of the lowest scoring 10%
of the unaffected children); the rate of vocabulary learn-
ing was slower than general cognitive development
among children with Down syndrome. Harris (1983)
found that children with Down syndrome between the
ages of 2;6 and 6;9 performed comparably to unaffected
children between the ages of 1;5 and 2;5 on MLU. Fi-
nally, Fowler’s (1988) subject, Rebecca, reached the age
2;4 MLU level of Brown’s (1973) subjects (Adam and
Sarah) at about age 5;0.
The evidence strongly suggests developmental de-
lay among children with Down syndrome. Whereas the
first spoken words may appear at the expected time,
spoken language development proceeds at a slower pace.
The age 1;6 level is reached at about ages 3;0 to 3;8 by
children with Down syndrome. Further, there is large
individual variation with respect to onset of language
and later performance.
In the studies thus far reviewed a variety of lan-
guage measures, such as size of vocabulary, MLU, the
McCarthy Scale, and expressive language scores, were
employed. Some findings suggest that there are irregu-
larities in the development of language skills. From sev-
eral studies, there are reports of specific limitations in
the development of syntax (both production and com-
prehension) but no such deficiencies in vocabulary
(Beeghly, Weiss-Perry, & Chapman, 1995; Chapman,
Schwartz, & Kay-Raining Bird, 1991; Cicchetti, 1990;
Miller, 1995). Bates et al. (1995), for instance, reported
dissociation between grammar scores and vocabulary
in children with Down syndrome (i.e., children with
Down syndrome had lower grammar scores than their
unaffected peers despite matching vocabulary). However,
it was not clear whether the difference in rate of devel-
opment between vocabulary and syntax (grammar) was
already present at the first stages of development. In
our study, therefore, we regarded it as crucial to exam-
ine differences between children with Down syndrome
and unaffected children on pragmatic skills, grammar
skills, and maximum length of utterance (MaxLU) when
vocabulary was treated as a covariate.
Few studies have documented sex-related language
differences in children with Down syndrome. Nonethe-
less, evidence of sex differences in language abilities in
children with Down syndrome was noted in the results
from a parental questionnaire study (Buckley & Sacks,
1987). In children under the age of 14, 70% of the girls
and 46% of the boys used sentences of five or more words,
whereas in children over the age of 14, 77% of the girls
and 70% of the boys used such sentences. To our knowl-
edge, the only study directly addressing the issue of sex
differences in language skills is that of Beeghly et al.
(1990). Those authors reported that girls tended to
progress more rapidly than boys did.
Aims
The primary aim of this study was to describe the
spoken-language development of children in a nation-
wide sample of Swedish children with Down syndrome
and then to compare their development with that of
unaffected children in a normative group. The study
addressed three target problems: (1) growth trends and
individual variation in language performance, (2) sex
differences in language performance, and (3) differences
between children in the normative group and children
with Down syndrome.
Method
Participants
Group With Down Syndrome
The group with Down syndrome comprised 330 chil-
dren (124 girls and 206 boys) between the ages of 1 and
5;6 (see Table 1). The subjects constituted approximately
45% of all children with Down syndrome born in Swe-
den during 1991–1995. (The percentage is based on data
from Sweden’s Medical Birth Register.) Our subjects
constitute an even larger proportion of the actual popu-
lation because perinatal mortality among children with
Down syndrome is very high (as high as 10% to15%
over the first 5 years of life). For 102 of the children
(31%), parents indicated that their child had additional

Table 1. Number of children with Down syndrome as a function of age, gender, additional deficiencies, and use of manual signs.

Age in years;months

1 1;6 2 2;6 3 3;6 4 4;6 5 5;6 Total

Girls 12 14 15 8 11 19 11 15 11 8 124
Boys 29 17 15 15 20 17 37 21 19 16 206
Additional deficiencies 9 11 5 6 6 12 15 17 11 10 102
Manual signs 30 26 27 20 28 30 45 34 26 22 288
Total number of children 41 31 30 23 31 36 48 36 30 24 330

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 deficiencies: 14% had cardiac disorders, 7% had ear com-
plaints or frequent otitis media, 15% had eye disorders,
and 5% had neurological or orthopedic problems.
Most of the children were enrolled in language-
stimulation programs where speech and manual signs
were used simultaneously (n = 288, 87%). Among one-
year-olds, 73% used manual signs, whereas in the older
age groups the proportions varied between 83% and 94%.
Parents did not indicate which words their child signed.
Other communication aids were letters, used by 32 of
the children (10%), and computers, used by 28 (8%); both
methods were used more commonly by older children.
Parents did not give more detailed descriptions of how
their children used letters or computers. Seven chil-
dren used pictograms (2%), and one child used BLISS
symbols.
Offices from all regions of Sweden responsible for
services for children who are mentally delayed recruited
the subjects. Criteria for inclusion were specified age
range (preschool age) and diagnosis of Down syndrome.
The local offices distributed the SECDI to parents, who
then returned the completed inventory to the research
group. If necessary, reminders were sent to parents by
the local offices. Because we did not make a special re-
quest for medical records, the data of children with such
conditions as translocation or mosaicism are not reported
separately.
Before data collection, staff members at the local
offices were contacted by telephone in order to obtain
information on the number of potential subjects in the
relevant ages. During data collection, approximate re-
gional response rates were recorded. To examine whether
there was any general effect of differential response rates
on language and communicative skills, we compared
children from regions with a response rate over 60% with
those from regions with a lower response rate. For this
comparison, we employed data on vocabulary perfor-
mance in that this is a measure of the earliest develop-
ing language skill of the measures used in the present
study. A two-way ANOVA (age by response group) was
conducted, where children were divided into five groups
according to age. Whereas the age effect was significant
(p < 0.01), indicating that older children obtained higher
scores, the response rate by region was not (p = 0.91).
Thus, we aggregated the scores of children from regions
with different response rates in subsequent analyses.
The Normative Group
The children with Down syndrome were compared
with a representative sample of unaffected children be-
tween the ages of 1;4 and 2;4. The sample was drawn
from the Swedish Birth Register and included two thirds
of all Swedish children born on two specific days. The
data, which were derived from Berglund and Eriksson
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(2000), comprised 900 reports on 336 children from two
cohorts. Each child was measured on one to three occa-
sions. The children were followed over 6 months. Paren-
tal reports were requested three times during this period.
The chief inclusion criterion was that the child should be
able to speak Swedish. A few children who lived abroad
and were recently internationally adopted or who were
diagnosed as developmentally delayed were excluded. A
response rate of 88% was obtained. In total, 476 reports
on girls and 424 reports on boys were collected.
Instrument and Procedure
The SECDI–w&s, as described in Berglund and
Eriksson (2000), was used to obtain scores for vocabu-
lary, pragmatic skills, and grammar skills. The vocabu-
lary score was computed from all words the parents had
indicated their child produced from a 710-item check-
list containing words from 21 semantic categories. De-
viation from standard pronunciation was accepted.
Pragmatic skills is here used in a restricted sense to
denote the ability to communicate about future or past
events, about absent objects or persons, and to express
ownership, disregarding linguistic form. These achieve-
ments increase the child’s competence “to do things with
words” but do not themselves reflect different commu-
nicative functions. The parents answered five questions
about their child’s pragmatic skills. Two measures of
grammar were employed. The grammar score was cal-
culated from questions about whether the child com-
bined words and whether he or she used morphological
markers for the possessive form, definite singular, defi-
nite plural, plural marking of nouns, and past tense of
verbs. The child received a score of 1 on items in the
pragmatic and grammar scales if the parent reported
that the child occasionally performed the target behav-
ior and a score of 2 if this occurred often. The MaxLU
score is a MLU count (in morphemes) of examples of
three long utterances the parents recently had heard
their child produce. Reliability scores for vocabulary,
pragmatic, and grammar were examined previously in
the normative group. Intra-individual test-retest scores
(i.e., percentage of items the child performed with a
similar or larger score 3 months later) were calculated
for the normative group (Berglund & Eriksson, 2000).
The test-retest reliability scores for the 19–22 month
interval in children in the normative group are given
in Table 2 for each language skill measure. Also, the
Cronbach alpha scores for 22-month-old children (n =
311) are specified.
Additional information on the validity and reliabil-
ity measures in relation to the SECDI–w&s was reported
in Berglund and Eriksson (in press). The use of paren-
tal reports on language of mentally delayed children was
discussed in Berglund (1992) and in Miller, Sedley, and
 Table 2. Description of scales and measures. Reliability scores were the normative group between the ages of 16 and 25
intra-individual test-retest scores in the 19–22 month interval in months were used, as well as all data of children with
children in the normative group. Cronbach alpha was calculated in Down syndrome. To make the analysis feasible, scores
22-month-old children. of zero in vocabulary, pragmatic skills, and grammar
skills were changed to 0.01. Language development, in
No. Max Cronbach
measures yielding significant sex effects, were modelled
items score Reliability alpha
by using the best-fitting equations for each sex sepa-
Vocabulary 710 710 92% 0.99 rately. To describe development in measures without
Pragmatic skills 5 10 88% 0.81 significant sex effects, the total scores were used.
Grammar skills 6 12 93% 0.83
MaxLU 3

Note. MaxLU was MLU calculated over 1–3 long utterances written
Results
down by parents. A score of 0 was given if children did not use any The results of the growth trend and individual varia-
words. A score of 1 was given if the parent had not given any tion in language performance are reported separately
examples of long sentences and the child had a vocabulary of 1–100
for each of the four language measures. Next, we ex-
words (indicated in the vocabulary section). The MaxLU score was
plore age and sex differences in language skills. An
coded as missing if the parent had not given any examples of long
sentences and had indicated that the child combined words (item 6 -
evaluation of which regression functions best repre-
grammar skills) or if the parent had not given any examples of long sented the language skills of children was also under-
sentences and the child had a vocabulary of more than 100 words taken. Finally, we present the development of the prag-
(indicated in the vocabulary section). matic and grammar scales in children with Down
syndrome as they compare with those of children in the
normative group matched for vocabulary size or MaxLU.
Miolo (1995). Parents of children with Down syndrome
are able to describe the language skills of their children
and are as competent as parents of unaffected children. Developmental Trends
Vocabulary Scores
Statistical Procedures Some of the children with Down syndrome uttered
The children with Down syndrome were divided into their first spoken words by their first birthday. Propor-
10 age groups. These half-year groups were used for tions of children passing the milestones of 1, 2, 10, and
descriptions of developmental trends and individual 50 spoken words at various ages are shown in Table 3,
variations on the four language measures. Number and together with maximum language scores for each age
sex of children in each age group are given in Table 1. group. A majority of the children used more than 10
Developmental trends and individual variation were words at age 2. The 50-word milestone was passed by
described by median values and first and third quartile more than half of the children at about age 4.
for all language measures (vocabulary size, pragmatic Median vocabulary scores (50th percentile) increased
skills, grammar score, and MaxLU). In addition, the 10th steadily with age: 0 words in 1-year-olds, 10.5 words in
and 90th percentiles are also given for vocabulary size, 2-year-olds, 16 words in 3-year-olds, 53 words in 4-year-
the scale with the greatest variation. For the five age olds, and 198 words in 5-year-olds (see Figure 1). To il-
groups representing whole years, proportions of children lustrate the large individual differences, in each age
using more than 1, 2, 10, and 50 words were reported.
The same age groups were used to test age and sex ef-
fects in the ANOVAs for each of the language measures. Table 3. Percentage of children passing the 1-word, 2-word, 10-
word, and 50-word milestones and the maximum number of words
We also sought to determine which equation—lin- reported for the best-performing child in each age group.
ear, exponential, or logistic—best fit the data. Of course,
linguistic skills cannot proceed exponentially in the long Age in years
run. Proficient users acquire by definition few new fea-
tures. Hence, logistic equations have greater face valid- 1 2 3 4 5
ity than exponential functions in early language devel- 1 word 12 80 90 98 94
opment. However, logistic growth curves in the present 2 words 7 77 90 98 92
stages of language development might reflect ceiling 10 words 3 53 81 88 91
effects of the employed scales rather than a genuine 50 words 0 3 23 54 73
pattern of language acquisition. Therefore, we model Maximum number 11 71 165 668 655
both logistic and exponential equations as well as lin- of words
ear equations. In this analysis all data of children in

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 Figure 1. Developmental trends in vocabulary among children with group there were children who did not use any words at
Down syndrome: 10th, 25th, 50th, 75th, and 90th percentiles. all, and there were also a number of older children who
had a vocabulary of more than 600 words.

Pragmatic Skills
Pragmatic skills were measured using five items
from the SECDI (maximum score 10 points). There
seems to be a ceiling effect for pragmatic scores, whereby
the 75th percentile lies close to the maximum score be-
yond age 4;6 (see Figure 2). Yet, 19% of the parents of
the 5-year-olds did not indicate that their children per-
formed any of the pragmatic activities. The pragmatic
skills section of the SECDI contains one item indicating
whether a child understands when the parent talks
about absent persons or objects. This was the first prag-
matic skill developed in most of the children and was
mastered by 19% of the children at age 1;6, by 40% at
age 2, 62% at age 3, 81% at age 4, and 79% at age 5.
Figure 2. Developmental trends in pragmatic skills among children
with Down syndrome 25th, 50th, and 75th percentiles.
Grammar Score
The grammar score section of the SECDI comprises
six items, yielding a maximum score of 12 points. There
were examples of children who combined words (13%)
or used morphological markers (3%) at age 2, though
the overall median score for grammar skills did not rise
above 0 until after age 3;6 (see Figure 3).

MaxLU
A score of 1 on the MaxLU indicates that a child
uses single words only, and at least 25% of the children
in all age groups had a score of 1 (or did not use any
words). As a consequence the 25th percentile is not dis-
played in Figure 4. A higher score indicates that a child
uses at least two-word expressions (or two-morpheme
utterances). Most of the children age 4 and over com-
bined words; nonetheless, there were over 25% who did
Figure 3. Developmental trends in grammar skills among children
with Down syndrome: 25th, 50th, and 75th percentiles.
Figure 4. Developmental trends in Maximum Length of Utterance
among children with Down syndrome: 50th and 75th percentiles.

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 Table 4. Results of two-way ANOVAs (age by sex) performed on Developmental Comparisons for the
the four communicative and language measures.
Different Language Measures
Age groups F Df p We examined the R2 values to evaluate which func-
tions were most efficient in representing the different
Vocabulary score 1, 2, 3, 4, 5
distributions. Three kinds of function (linear, exponen-
Age 23.79 4 <.01
Sex 4.49 1 <.05
tial, and logistic) were examined for each language mea-
Age × Sex 1.15 4 ns sure in both groups of children (see Table 5). The expo-
nential and logistic growth curves yielded identical
Pragmatic score 2, 3, 4, 5
values and had the highest R2 values for vocabulary size,
Age 15.54 3 <.01
Sex 7.48 1 <.01
grammar skills, and MaxLU, regardless of group. Fur-
Age × Sex .46 3 ns ther, linear functions yielded the best fit for pragmatic
skills, regardless of group. The ages when children with
Grammar score 3, 4, 5
Down syndrome and children in the normative group
Age 14.52 2 <.01
Sex 2.17 1 ns
performed similarly are illustrated in Figure 5, each
Age × Sex 1.55 2 ns panel of which illustrates either a linear or exponential
regression plot depending on which type yielded the
MaxLU score 3, 4, 5
highest explained variance.
Age 14.02 2 <.01
Sex 1.57 1 ns
Age × Sex .49 2 ns Table 5. The statistic characteristics for three kinds of regression
equation representing the growth (i.e., by age) factor for the four
communicative and language measures.
not combine words, even among those age 5;6. Median
group scores for maximum length of utterances suggest Group –
that there are wide plateaus in the syntax development Measure Equation R2 B constant
of children with Down syndrome. It should be noted,
however, that a few children performed at quite ad- DS – Vocabulary Linear .315 7.490 –194.05
Exponential .414 .0825 1.186
vanced levels.
Logistic .414 .921 .843
Pragmatic skills Linear .379 .146 –2.105
Effects of Age and Sex Exponential .307 .094 .023
To examine whether there were any effects of age Logistic .307 .910 43.463
and sex on the various language measures, two-way Grammar skills Linear .251 .105 –2.819
ANOVAs (age by sex) were performed. For vocabulary Exponential .382 .127 .0005
(the earliest developing skill), performance at ages 1, 2, Logistic .382 .880 1837.40
3, 4, and 5 was examined. Pragmatic skills (developing MaxLU Linear .314 .075 –.878
slightly after the first utterances) were analyzed for the Exponential .373 .030 .503
age 2, 3, 4, and 5 groups. For analyses of grammar and Logistic .373 .970 1.987
MaxLU scores (late-developing skills), the age 3, 4, and NG – Vocabulary Linear .347 30.806 –485.11
5 groups were considered. All analyses revealed signifi- Exponential .414 .298 .150
cant effects of age. The age effects were further explored Logistic .414 .742 6.666
by one-way ANOVAs and Tukey post hoc tests (p < .05). Pragmatic skills Linear .375 .589 –6.942
In the case of vocabulary, 1-, 2-, and 3-year-olds did not Exponential .159 .230 .025
differ significantly, yet 4-year-olds produced significantly Logistic .159 .794 39.858
higher scores than the younger children, and 5-year-olds Grammar skills Linear .315 .538 –8.714
produced significantly higher scores than 4-year-olds. Exponential .366 .556 3.4 × 10–6
In pragmatic skills, the scores of 2-, 3-, and 4-year olds Logistic .366 .574 296057
differed significantly, yet 4- and 5-year-olds did not dif- MaxLU Linear .347 .344 –4.427
fer significantly (close to ceiling). The grammar scores Exponential .393 .135 .132
of 3-, 4-, and 5-year-olds differed significantly. Finally, Logistic .393 .874 7.584
in MaxLU, 3-year-olds produced significantly shorter
Note. For Vocabulary, Pragmatic, and Grammar skills a score of 0 was
utterances than 4- and 5-year-olds, who did not differ altered to a score of 0.01 to make possible the examination of logistic
significantly. and exponential functions. Children with Down syndrome (DS) age 1–5
The effects of sex for vocabulary and pragmatic skills years and children in the normative group (NG) age 16, 19, 22, and
were significant. Girls scored higher than boys did. No 25 months were included in the analysis.
age-by-sex interaction was revealed (see Table 4).

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 Figure 5. A. Estimated vocabulary development in girls and boys from the normative group (NG) and in children with Down syndrome (DS):
exponential growth. B. Estimated development of pragmatic skills in girls and boys from the NG group and in children with DS: linear
growth. C. Estimated development of grammar for children in the NG group and in children with DS: exponential growth. D. Estimated
development of MaxLU in children from the NG group and in children with DS: exponential growth.

A B

C D

Furthermore, we wanted to explore whether the
early word growth could be described by a growth func-
tion other than an exponential one. To test this possibil-
ity we performed an analysis in which only children with
vocabularies of 50 or fewer words were included. (This
is before the vocabulary spurt is expected to occur.) The
linear function (R2 = 0.181) and exponential and logistic
functions yielded close results (R2 = 0.174). Hence, it
seems that linear, exponential, and logistic functions il-
lustrate the growth of the small vocabularies (<50 words)
about equally well.
Data for boys and girls are plotted separately in Fig-
ure 5 (A and B), illustrating the developmental trends,
matched for age, for the skills with significant sex differ-
ences (vocabulary size and pragmatic skills). In the vo-
cabulary plot (A) we used exponential regression, and in
the pragmatic plot (B) we used linear regression because
these kinds of functions yielded highest explained vari-
ance. The girls scored higher than the boys in both
groups of children, and the differences between girls with
Down syndrome and boys with Down syndrome were
larger than the differences between girls and boys in
the normative group for both vocabulary size and prag-
matic skills.
Developmental Differences: Pragmatic
Scale, Grammar Scale, and MaxLU
Three stepwise regression analyses (with entering
criterion of F < .05 and removal criterion of F > .10)
were computed to explore differences between children
with Down syndrome and children in the normative
group on the pragmatic scale, on the grammar scale,
and on MaxLU. Vocabulary size and sex were added to
the models in addition to group (children with Down

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 syndrome and children in the normative group) to con- Table 6. Stepwise regression analyses (vocabulary, group, and
trol the possible influences from these variables. Vocabu- sex) on MaxLU, the Grammar scale, and the Pragmatic scale
lary size entered first in all three equations, explaining significant variables.
most of the variance. Group entered all equations in the
second step. Although always significant, the increase Variable Df SE B b R2
in explained variance caused by group was small: .036 Pragmatic scale (model) 1221 .58
for the pragmatic scale, .004 for MaxLU, and .002 for Vocabulary .00 .69
the grammar scale. Children in the normative group Group .12 .20
with vocabulary equal to that of children with Down Grammar scale (model) 1102 .88
syndrome generally scored slightly higher on all three Vocabulary .00 .87
scales. Sex never entered the models (see Table 6). Group .12 .04
MaxLU (model) 1108 .59
Developmental Differences on Single Vocabulary .00 .75
Skills for Subjects Matched for Group .10 .07

Vocabulary
The order of development of single pragmatic skills
To further explore the differences between children
was strikingly similar between children, regardless of
with Down syndrome and children in the normative group,
group, when matched on vocabulary size. The main or-
logistic regressions were computed for the individual items
der was the following: “understood when parent talked
of the pragmatic scale and the grammar scale. Vocabu-
about absent objects,” “talked about absent owner,” “talked
lary size, MaxLU, and sex were included in the models
about absent object,” “talked about future events,” and
as covariates. These analyses revealed that children in
“talked about past events.” Also the order in develop-
the normative group more often than children with Down
ment of grammatical markers was strikingly similar
syndrome with a similar vocabulary size talked about
between children with Down syndrome and children in
ownership, talked about missing things, and understood
the normative group. Children first started to combine
talk about missing things. Further, children in the nor-
words; thereafter they used genitive markers; and use
mative group more often than children with Down syn-
of definite singulars, definite plurals, and indefinite plu-
drome marked genitives and the definite and indefinite
rals appeared before the use of past tense. Children also
forms in singular. Boys spoke slightly more about past
started to combine words at similar percentages over
times than girls did (see Table 7).
the different vocabulary size.

Table 7. Results of logistic regressions, with different kinds of single skills as dependent variables, and size
of vocabulary, MaxLU, sex, and group (Down syndrome vs. normative group) as covariates. Method:
forward entering–Wald.

Vocabulary MaxLU Sex Group

Wald R Wald R Wald R Wald R

Pragmatic skills
Speaks about …
passed time 138.42 .30 26.42 .13 4.75 .04 B NE
future 103.92 .26 39.18 .16 NE NE
missing things 78.54 .23 17.56 .10 NE 11.55 .08 NG
Understands talk about
missing things 61.18 .23 NE NE 74.10 .26 NG
Speaks about owners 59.64 .20 16.90 .10 NE 22.69 .12 NG

Grammar skills
Genitive markers 147.24 .33 17.82 .11 NE 5.33 .05 NG
Definite singular 268.33 .47 NE NE 9.05 .08 NG
Definite plural 130.39 .37 4.26 .05 NE NE
Indefinite singular 131.70 .36 15.46 .11 NE 7.62 .07 NG
Past tense 117.80 .36 12.24 .11 NE NE
Combines words 69.99 .23 89.80 .26 NE NE

Note. NE = not in equation. B = Boys highest. NG = Children from the normative group highest.

Berglund et al.: Language in Children With Down Syndrome 187

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Discussion
Growth Trends and Individual Variations
in Language Performance
We found that the first word appears approximately
one year after birth in about 10% of the children with
Down syndrome and that after 2 years 80% had begun
to talk. Furthermore, some children with Down syn-
drome start to talk at about the same age as children in
the normative group (cf. Eriksson & Berglund, 1999).
In this respect, we agree with Chapman (1995) that the
rate of acquisition is slower in most children but not
necessarily the onset of lexical acquisition. However,
between 10% and 20% of the children with Down syn-
drome had less than 10 words in their spoken vocabu-
laries when they were 3 to 5 years old, and there were
some children who had not started to talk at all, regard-
less of age.
The 50-word milestone was achieved by about 25%
of the children with Down syndrome at age 3, by about
50% at age 4, and about 75% at age 5. Thus, a substan-
tial proportion of the children in our study attained this
level at an earlier age than Gillham’s (1990) subjects.
At age 3;0 our subjects had an average vocabulary of
36.0 words (range: 0–165 words), which can be compared
with the Stroeminger et al. (1984) finding of a mean of
18.5 words (range: 0–85 words). The discrepancy partly
might be explained by the use of different language
measures in the two studies.
The majority (87%) of children in this study used
speech and manual signs simultaneously. Therefore, the
children with Down syndrome with the smallest spo-
ken vocabularies are slightly underestimated in terms
of the size of their “total” vocabularies in relation to chil-
dren in the normative group. However, when the vocabu-
laries increase in size, children with Down syndrome
mostly add spoken words to their repertoire (Miller et
al., 1991, cited in Chapman, 1995). Hence, the higher
vocabulary scores in the present study should be close
to the total vocabularies of children with Down syn-
drome. However, it would be expedient of future studies
in this area to assess the children’s manual vocabular-
ies as well.
Our language predictions from linear regression and
exponential equations indicate that the performance of
36-month-old children with Down syndrome parallels
the performance of unaffected children at about 16
months old (see Figure 5[A–D]). This finding confirms
the result of Mervis (1990) that, on average, 3-year-old
children with Down syndrome perform similarly to un-
affected children at age 1;6.
We noted that 48-month-old children with Down
syndrome performed at a level approaching that of
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20-month-old unaffected children. Mundy et al. (1988)
compared children with Down syndrome at age 3;8 with
unaffected children at age 1;6, thus making a compari-
son between groups that we found had matching results
in this study. Bates et al. (1995) reported that children
with Down syndrome lagged approximately 2 years be-
hind unaffected subjects over the period covered by CDI:
Toddlers, and our results are also in line with this find-
ing. In our study, 3-year-olds lagged by about 20 months
and 4-year-olds by about 28 months.
Smith et al. (1988) obtained similar results for 5-
year-old children with Down syndrome and unaffected
children at age 2;6 in terms of performance on the
McCarthy scales of children’s abilities. However, they
found that delay in language skills of children with Down
syndrome was even more prolonged. This finding seems
comparable to our result regarding magnitude of delay.
Harris (1983) found the MLU of children with Down
syndrome between ages 2;6 and 6;9 years was compa-
rable to that of unaffected children between ages 1;5
and 2;5. Our results indicate that about 5% to 10% of
children with Down syndrome combine words in the
period from age 2 to 2;6 and that about 70% do so at age
5;6. In this respect, Harris’s findings are in accord with
ours.
In the comparison of different growth functions, we
observed almost identical patterns in the children with
Down syndrome and the children in the normative
group, suggesting common growth patterns across chil-
dren independent of the presence of dysfunction. An ex-
ponential or a logistic curve yielded the highest ex-
plained variance (R2) in three of the measures, whereas
the development of pragmatic skills was better described
by a linear equation. That the pragmatic scale was dif-
ferent from the other scales suggests that the develop-
ment measured by the pragmatic scale may be governed
by other cognitive or linguistic principles. However, more
data on the development of pragmatic skills and their
relations to other measures are needed before this issue
can be settled conclusively.
Robinson and Mervis (1998) have explored indi-
vidual growth curves of vocabularies in children with
Williams or Down syndrome. They found that a logistic
growth curve was most typical and that growth rate was
negatively correlated with a linear fit. However, in 3 of
the 5 children with Down syndrome in the Robinson and
Mervis study, language development was best charac-
terized by linear growth. In the present study, we found
that several of the measures are best described by expo-
nential or logistic curves. As we have shown here, lin-
ear, exponential, and logistic equations yield about the
same explained variance before the 50-word milestone
is reached. Thus, it seems that the Robinson and Mervis
findings are compatible with our group data.
 The Significance of Sex Differences
in Language Skill
Our study confirms earlier findings of sex differences
in language skills of children with Down syndrome
(Beeghly et al., 1990; Buckley & Sacks, 1987). Signifi-
cant sex differences in our study were found for both
vocabulary and pragmatic skills, on which girls on av-
erage perform better than boys do. However, in contrast
to Fenson et al. (1994) among others who reported small
but consistent differences between unaffected boys and
girls, Berglund and Eriksson (2000) and Eriksson and
Berglund (1999) found no differences between boys and
girls among unaffected Swedish-speaking children. It
therefore becomes important to ask if there are factors
associated with Down syndrome that are responsible for
the superior language performance of girls as compared
to boys among children with Down syndrome. One such
set of factors would be if boys with Down syndrome had
more additional deficiencies than girls with Down syn-
drome. Yet, in analyzing additional deficiencies in the
present study group, Berglund (1998) found no differ-
ence in the distribution between boys and girls. We there-
fore suggest that more research should be devoted to
explaining the sex differences in language skills among
children with Down syndrome.
Language Skills Among Children
With Down Syndrome and Children
in the Normative Group
The order of development of single items on the
grammar and the pragmatic scales was strikingly simi-
lar on the part of children with Down syndrome and
children in the normative group. However, when matched
on vocabulary size, children with Down syndrome lagged
behind children in the normative group on the pragmatic
scale, on the grammar scale, and on MaxLU. This effect
was small but was probably somewhat underestimated
because only the spoken vocabularies of children with
Down syndrome were counted. Their total vocabular-
ies with manual signs included would have been larger,
thus emphasizing the lag (cf. the results on lexical com-
prehension and gestures by Caselli et al., 1998). A lag
in grammar skills is in accord with the findings of Miller,
Miolo, Sedey, and Murray-Branch (1993, cited in
Chapman, 1995) and Wiegel-Crump (1981). The lag in
pragmatic skills among children with Down syndrome
as compared with children in the normative group
matched on vocabulary size was actually greater than
the lag in grammar skills. A lag in pragmatic skills is
related to the often-cited restriction among children
with Down syndrome to “talk about here and now” (cf.
Layton & Sharifi, 1978; Leudar, Fraser, & Jeeves, 1981;
Rondal, 1978, all cited in Chapman, 1995). However, the
present findings do not suggest an inability on the part
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of children with Down syndrome to talk about absent
objects, owners, and past and future situations. They
just did it a little later than the children in the norma-
tive group.
Limitations of the Study
Because the study used a parental questionnaire, in-
formation dealing with nonverbal mental age could not
be obtained. For children who have small spoken vocabu-
laries and who use signs to facilitate communication, their
true vocabularies might have been underestimated.
Another limitation is that because we used paren-
tal questionnaires for the whole population of preschool
children with Down syndrome in Sweden, it was not fea-
sible to obtain medical records. Thus, such important
information as hearing status was not available. None-
theless, we did ask parents a global question about the
health conditions of their child. Berglund (1998) ana-
lyzed the potential detrimental effects that additional
deficiencies have on vocabulary scores. If a child had
ear disorders or a hearing impairment, this was signifi-
cantly associated with increased risk for low vocabulary
scores, but only when the child had other deficiencies
(e.g., eye disorders, cardiac disorders, or neurological or
orthopaedic problems). Having an ear or hearing disor-
ders alone did not yield a significantly increased rela-
tive risk for low vocabulary scores. Obviously, these find-
ings suggest that medical records on hearing or screening
of hearing status (and the presence of other deficien-
cies) should be included in language studies of children
with Down syndrome.
Implications of Findings on Language
Therapy in Children With Down
Syndrome
The timetables from this study on the development
of language skills in children with Down syndrome are
clinically useful. Using timetables makes it possible to
give parents a reasonable idea about the language de-
lay in their child and what to expect in the development
of spoken vocabulary. Because of significant sex differ-
ences in language skills, parents need to be informed
about how this affects their child. According to the mea-
sures used here, children with Down syndrome are mainly
delayed and only marginally deviant in their language
skills. However, the vocabulary develops slightly ahead
of pragmatic and grammar skills. Therefore, it seems
important that language stimulation programs pay spe-
cial attention to pragmatic and grammar skills.
The form of the developmental function for various
linguistic skills also has possible implications for lan-
guage stimulation programs. Other things being equal,
a small improvement in a skill with an exponential or
logistic function yields a higher later payoff than an
Berglund et al.: Language in Children With Down Syndrome 189
 improvement of equivalent size in a linearly developing
skill. Taken together with the argument above and the
present finding of a linear development of pragmatic
skills a good case can be made for developing programs
directed at stimulating grammar skills in children with
Down syndrome. However, other things are rarely equal,
and there are probably causal links between different
linguistic skills. For example, it seems reasonable that
a basic categorization of the world in the past, in the
present, and in the future, as assessed by the pragmatic
scale, is necessary before the particular grammatical
form that marks these categories in language can be
acquired. If this is true, training programs should focus
on the pragmatic skills before tackling grammar skills.
A lexicon-driven model for the acquisition of grammar
is also consistent with the present findings. However,
such a model must explain why children with Down syn-
drome in general need a somewhat larger vocabulary
than children in the normal group to reach a correspond-
ing level of grammar. A likely explanation would be in
terms of weaker representational or computational re-
sources in children with Down syndrome.
Acknowledgments
The research in this paper was supported by grants
from the Centre for Caring Sciences, Uppsala University;
the Dalarna Research Institute; the Mayflower Foundation;
the Research and Development Department of Gävleborg
County Council; Falun College of Health and Caring
Sciences; and the department of Caring Sciences at Gävle
University. The authors are indebted to Professor Håkan
Stattin at the Department of Psychology, Örebro University,
for valuable methodological advice and comments on the
manuscript. Professor Gunilla Preisler at the Department of
Psychology, Stockholm University, also provided useful
comments on the manuscript; and Professor Lennart Bodin,
Örebro University, helped with the statistics. Tomas
Berglund, Gothenburg University, helped with coding of
the data.
References
Bates, E., Dale, P. S., & Thal, D. (1995). Individual
differences and their implications for theories of language
development. In P. Fletcher & B. MacWhinney (Eds.), The
handbook of child language (pp. 96–151). Oxford, U.K.:
Basil Blackwell.
Beeghly, M., Weiss-Perry, B., & Cicchetti, D. (1990).
Beyond sensorimotor functioning: Early communicative
and play development of children with Down syndrome. In
D. Cicchetti & M. Beeghly (Eds.), Children with Down
syndrome: A developmental perspective (pp. 329–368).
Cambridge, U.K.: Cambridge University Press.
Berglund, E. (1992). The validity of parental and teacher
predictions of the word knowledge of retarded and non-
retarded children (No. 2). Falun, Sweden: Falun Univer-
sity College of Health Sciences.
190 Journal of Speech, Language, and Hearing Research • Vol. 44 • 179–191 • February 2001
Downloaded From: http://jslhr.pubs.asha.org/ by a La Trobe Univ User on 02/04/2016
Terms of Use: http://pubs.asha.org/ss/rights_and_permissions.aspx
Berglund, E. (1998). The relative risk of low vocabulary
scores among children with Down syndrome and addi-
tional deficiencies (No. 847). Reports from the Department
of Psychology, Stockholm University. Stockholm, Sweden.
Berglund, E., & Eriksson M. (2000). Communicative
development in Swedish children 16–28 months old: The
Swedish Early Communicative Development Inventory–
words and sentences. Scandinavian Journal of Psychology,
41, 133–144.
Berglund, E., & Eriksson, M. (in press). Reliability and
content validity of a new instrument for assessment of
communicative skills and language abilities in young
Swedish children. Logopedics, Phoniatrics, Vocology.
Brown, R. (1973). A first language: The early stages.
Cambridge, MA: Harvard University Press.
Buckley, S., & Sacks, B. (1987). The adolescent with
Down’s syndrome: Life for the teenager and for the family.
Portsmouth, U.K.: Portsmouth Down’s Syndrome Trust.
Caselli, M. C., Vicari, S., Longobardi, E., Lami, L.,
Pizzoli, C., & Stella, G. (1998). Gestures and words in
early development of children with Down syndrome.
Journal of Speech, Language, and Hearing Research, 41,
1125–1135.
Chapman, R. S. (1995). Language development in children
and adolescents with Down syndrome. In P. Fletcher & B.
MacWhinney (Eds.), The handbook of child language (pp.
641–663). Oxford, U.K.: Basil Blackwell.
Chapman, R. S., Schwartz, S. E., & Kay-Raining Bird,
E. (1991). Language skills of children and adolescents
with Down syndrome: I. Comprehension. Journal of
Speech and Hearing Research, 34, 1106–1120.
Chapman, R. S., Seung, H. K., Schwartz, S. E., & Kay-
Raining Bird, E. (1998). Language skills of children and
adolescents with Down syndrome: II. Production deficits.
Journal of Speech, Language, and Hearing Research, 41,
861–873.
Eriksson, M., & Berglund, E. (1999). Swedish early
communicative development. First Language, 19, 55–90.
Fenson, L., Dale, P. S., Reznick, J. S., Thal, D. J., Bates,
E., Hartung, J. P., Pethick, S., & Reilly, J. S. (1993).
Communicative development inventories: User’s guide and
technical manual. San Diego: Singular.
Fenson, L., Dale, P. S., Reznick, J. S., Bates, E., Thal,
D. J., & Pethick, S. J. (1994). Variability in early
communicative development. Monographs of the Society
for Research in Child Development, 59.
Fowler, A. E. (1988). Determinants of rate of language
growth in children with DS. In L. Nadel (Ed.), The
psychobiology of Down syndrome (pp. 217–245). Cam-
bridge, MA: MIT Press.
Gillham, B. (1990). First words in normal and Down
syndrome children: A comparison of content and word-
form categories. Child Language Teaching and Therapy,
6, 25–32.
Harris, J. (1983). What does mean length of utterance
mean? Evidence from a comparative study of normal and
Down’s syndrome children. British Journal of Disorders of
Communication, 18, 153–169.
Layton, T., & Sharifi, H. (1978). Meaning and structure of
Down’s syndrome and nonretarded children’s spontaneous
 speech. American Journal of Mental Deficiency, 83,
439–445.
Leudar, I., Fraser, W. I., & Jeeves, M. A. (1981). Social
familiarity and communication in Down syndrome.
Journal of Mental Deficiency Research, 25, 133–142.
Mervis, C. B. (1990). Early conceptual development of
children with Down syndrome. In D. Cicchetti & M.
Beeghly (Eds.), Children with Down syndrome: A develop-
mental perspective (pp. 252–301). Cambridge, U.K.:
Cambridge University Press.
Miller, J. (1995). Individual differences in vocabulary
acquisition in children with Down syndrome. In Etiology
and pathogenesis of Down syndrome (pp. 93–103). New
York: Wiley-Liss.
Miller, J. F., Miolo, G., Sedey, A., & Murray-Branch, J.
(1993). The emergence of multiword combinations in
children with Down syndrome. Poster presented at the
Symposium for Research in Child Language Disorders,
Madison, WI.
Miller, J. F., Sedley, A. L., & Miolo, G. (1995). Validity of
parent report measures of vocabulary development for
children with Down syndrome. Journal of Speech and
Hearing Research, 38, 1037–1044.
Miller, J. F., Sedey, A., Miolo, G., Rosin, M., & Murray-
Branch, J. (1991). Spoken and sign vocabulary acquisi-
tion in children with Down syndrome. Poster presented at
the American Speech-Language-Hearing Association
convention, Atlanta.
Mundy, P., Sigman, M., Kasari, C., & Yirmiya, N. (1988).
Nonverbal communication skills in Down syndrome
children. Child Development, 59, 235–249.
Pueschel, S. M., & Hopmann, M. R. (1993). Speech
and language abilities of children with Down syndrome.
In A. Kaiser & D. Gray (Eds.), Enhancing children’s
Downloaded From: http://jslhr.pubs.asha.org/ by a La Trobe Univ User on 02/04/2016
Terms of Use: http://pubs.asha.org/ss/rights_and_permissions.aspx
communication (pp. 335–362). Baltimore: Brookes
Publishing.
Robinson, B. F., & Mervis, C. B. (1998). Vocabulary growth
curves of children with Williams or Down syndrome. Paper
presented at the 19th Symposium on Research in Child
Language Disorders. University of Wisconsin–Madison,
June 4–6.
Rondal, J. (1978). Maternal speech to normal and Down’s
syndrome children matched for mean length of utterance.
In C. E. Meyers (Ed.), Quality of life in severely and
profoundly mentally retarded people: Research foundations
for improvement (pp. 6–7). Washington, DC: American
Association on Mental Deficiency.
Smith, L., von Tetzchner, S., & Michalsen, B. (1988). The
emergence of language skills in young children with Down
syndrome. In L. Nadel (Ed.), The psychobiology of Down
syndrome (pp. 145–165). New York: Bradford.
Stroeminger, A. Z., Winkler, M. R., & Cohen, L. T. (1984).
Speech and language evaluation. In S. M. Pueschel (Ed.),
The young child with Down syndrome (pp. 253–261). New
York: Human Sciences Press.
Wiegel-Crump, C. A. (1981). The development of grammar
in Down’s syndrome children between the mental ages of
2–0 and 6–11 years. Education and Training of the
Mentally Retarded, February, 24–30.
Received March 17, 1999
Accepted October 20, 2000
DOI: 10.1044/1092-4388(2001/016)
Contact author: Eva Berglund, PhD, Uppsala University
Hospital, Department of Nursing Research and Develop-
ment, S–751 85, Uppsala, Sweden.
Email: eva.berglund@adm.uas.lul.se
Berglund et al.: Language in Children With Down Syndrome 191