Early Manual Sign Intervention: Eight-year Follow-up of Children with Down Syndrome

Kaisa Launonen
University of Helsinki, Department of Phonetics
P.O. Box 35, FIN-00014
University of Helsinki, Finland
ISAAC Biennial Conference Dublin 1998, 24-27th August
UCD Dublin Ireland, Proceedings (371-372)
  Reprinted with the permission of the International Society for Augmentative and Alternative Communication

Efforts which aim at preventing or reducing future problems for infants who are at biological risk, are in the focus of intervention strategies in many countries. These early efforts are assumed to enhance and strengthen the early development of the children who take part in the interventions, and make a foundation for improved future skills and quality of life. There is, however, a lack of controlled studies that evaluate the long-term effects of such intensified early intervention activities (Casto 1987; Sameroff 1994). In the present study, two groups of children with Down syndrome were compared with each other. The research group (N=12) consisted of children whose families took part in an early intervention programme. Manual signs were taught to the families in order for them to augment the communicative and language development of the children, and the active communicative role of the child was emphasized. The intervention lasted from when the children were six months till they were three years old. The children of the control group (N=12) did not take part in the programme; other forms of support and intervention were the same for the two groups. The development of the children up to the age of five years has been reported in Launonen (1996). This paper presents results from the follow-up at eight years.

When the children were eight years old, five years had passed since the intervention programme was terminated. At this age, the children had received full-time instruction at school for at least six months. The parents of one child in the control group did not want to take part; thus, there were eleven children in this group. The evaluation consisted of assessments made by the present author (free conversation about the school and hobbies of the child, event-picture descriptions, and Reynell Developmental Language Scales), and a questionnaire that was filled in by each child's teacher. The purpose of the questionnaire was to evaluate the children's social adaptation, interaction skills, and communication and language skills within the school setting.

There were significant differences between the social and linguistic skills of the two groups. Both on the assessments made by the author and the questionnaire filled in by the teacher, the research group had better skills than the control group, especially in interaction, language comprehension, and reading and writing. At eight years, eight of the children in the research group and five of the children in the control group used spoken language as their main means of communication; two children in the research group used mainly manual signs; and one child in each group combined manual signs and spoken words. There were five children in the control group (and only one in the research group) who did not have any functional, verbal means of expressive communication at the age of eight years. These five children also showed very poor interaction and language skills.

The findings of the present study suggest that early intervention with manual signs and emphasis on the active communicative role of the infant, may have long-term effects on the development of children with Down syndrome. On the average, interaction and language skills were more advanced in the group of children who had taken part in the early intervention programme. This suggests that the programme contributed to forming each child's communicative environment in accordance with its needs and abilities. Signed communication was an essential part of this beneficial environment, which provided the child and the other members of the family with the means for more reciprocal interaction. Building up on this early basis, also the later development of interaction and language skills appears to have been supported.


Casto, C. (1987). Plasticity and the handicapped child. A review of efficacy research. In J.J. Gallagher and C.T. Ramey (Eds.), The Malleability of Children. Baltimore: Paul H. Brookes, pp. 103-113.

Launonen, K. (1996). Enhancing communication skills of children with Down syndrome: Early use of manual signs, von Tetzchner, S. & Jensen, M.H. (Eds.) Augmentative and Alternative Communication. European Perspectives. London: Whurr, pp. 213-231.

Sameroff, A. (1994). Ecological perspectives on longitudinal follow-up studies. S.L. Friedman & H.C. Haywood (Eds.) Developmental follow-up. Concepts, domains, and methods. San Diego: Academic Press, pp. 45-64.