Down syndrome is a genetic disorder involving an extra copy of chromosome 21, known as Trisomy 21. Because of known etiology and, therefore, relatively homogeneous composition, children with Down syndrome have often been the focus of study for those who want to test limits of developmental theories and to understand the nature of atypical development (e.g., Lanfranchi et al. 2004; Vicari et al. 2002). In the context of teaching children with Down syndrome reading skills, the bulk of attention of researchers and educators has been on decoding processes such as phonological awareness, vocabulary, and word and letter recognition (Cupples and Iacono 2000; Kay-Raining Bird et al. 1999; Laws and Gunn 2002). There is growing recognition, though, that efforts to develop these basic language skills should be complemented by fostering comprehension skills (Fowler et al. 1995; Moni and Jobling 2001). There also has been an increase in research aiming to understand the nature of these children’s narrative comprehension skills and to determine how the development of these skills might be stimulated (Boudreau and Chapman 2000; Seung and Chapman 2003). In the present study, we draw on recent insights from cognitive science to help us understand these children’s narrative comprehension skills and the relation of those skills to basic language skills related to beginning reading.

Children with Down syndrome typically manifest cognitive impairments, and they show further delay in the development of reading comprehension compared to that of reading decoding (Byrne et al. 2002; Fowler 1995; Laws and Gunn 2002; Rynders 1997). For instance, average decoding achievement by adolescent and young adults with Down syndrome is at the 3.9–4.2 grade level (Rynders 1997) and 8.5 age level (Fowler et al. 1995). In comparison, average reading comprehension achievement is commensurate to 2.9–3.0 grade level and 7.9 age level. This discrepancy raises important issues. For example, the fact that there is a further delay in reading comprehension suggests that developing comprehension skills at an early age in children with Down syndrome—in addition to reading decoding skills—is important for increasing their chances for reading and academic success. But the fact that young children with Down syndrome have limited decoding abilities suggests that it will be particularly difficult for them to develop (reading and general) comprehension skills within the context of traditional reading activities using printed materials.

Compared to their development of reading comprehension, individuals with Down syndrome have less severe problems in comprehension of oral language, vocabulary, and non-verbal short-term memory (Fowler 1995; Lanfranchi et al. 2004; Laws and Bishop 2003; Miller et al. 1995; Seung and Chapman 2003). Results of a handful of studies on narrative comprehension reflect the relative strength in language comprehension ability of individuals with Down syndrome. Narratives produced by individuals with Down syndrome (12–26 years of age), prompted by a wordless picture story, contained plot lines, thematic contents, and protagonists’ misadventures more than would be expected on the basis of these individual’s expressive language (i.e., performed better than comparison children with a similar mean length of utterance; Miles and Chapman 2002). Likewise, when presented with short audiotaped stories and asked to recall content words, individuals with Down syndrome (average age 16.39 years) outperformed their language-production-matched comparison children without disabilities and performed more like syntax-comprehension-matched comparison children (Seung and Chapman 2003). Similar findings have been obtained for narrative recall of a brief wordless movie by individuals with Down syndrome (Boudreau and Chapman 2000); narratives of individuals with Down syndrome (age range 12–26 years old) were commensurate with those of mental-age-match comparison children and significantly longer and more complex than those of expressive language-age-match comparison children.

In educational and political circles there is an emphasis on early diagnosis and intervention for academic difficulties for all children, including children with disabilities (for example, the 2004 Reauthorization of Individuals with Disabilities Education Act). We aim to contribute important information regarding the nature of narrative comprehension ability of children with Down syndrome because narrative comprehension ability plays an important role in subsequent reading development (Paris and Paris 2001, 2003; van Kraayenoord and Paris 1996). Such information would have important implications for early diagnosis and interventions for children with Down syndrome.

To address aims of this study we draw on recent findings from research on children’s narrative comprehension in psycholinguistics and cognitive science. First, there is overwhelming evidence that, during reading, successful readers identify meaningful connections between events in the text, with causal connections playing a particularly important role (Graesser et al. 1994; van den Broek 1990). These connection-building processes result in the construction of a semantic network of what the text is about in the reader’s mind (Kintsch and van Dijk 1978; Trabasso et al. 1984). One important property of this mental network is that events and facts vary in their number of semantic connections to other parts of the text. This property has been found to be a strong determiner of the psychological salience of the different parts of the text. Readers perceive events or facts that have many connections to be more important than those with fewer connections. Likewise, the more connections an event or fact has, the better it is remembered and the more often it is included in a summary of the text (Fletcher and Bloom 1988; Goldman and Varnhagen 1986; Graesser and Clark 1985; Trabasso and van den Broek 1985; van den Broek 1989). In this study, we assess comprehension of young children with Down syndrome by focusing on their sensitivity to the semantic network of the narrative. This approach allows us to consider both quantitative and qualitative aspects of the children’s comprehension, that is, not only the quantity of the connections in children’s’ representations of the narratives but also quality in terms of sensitivity to number of causal connections.

Second, in typical development, children engage in similar comprehension processes when reading as they do when looking at picture stories, when listening to stories, or during television viewing (Lynch et al. 2008; Trabasso and Nickels 1992; van den Broek et al. 1996). This indicates that comprehension skills relevant to reading comprehension start developing well before children become conventional readers (Paris and Paris 2001, 2003; van Kraayenoord and Paris 1996). In this context, it is crucial that we consider how comprehension skills develop in children with Down syndrome. To address this, we assess children’s comprehension skills using different media, particularly aural and televised stories. This approach allows us to examine children’s comprehension skills independently of reading ability and explore similarities across media (i.e., television vs. audio). Additionally, we explore the relation between comprehension of young children with Down syndrome and skills that have been found to play a crucial role in early reading development (i.e., basic language skills)—vocabulary, phonological awareness, and letter-naming skills.

The findings of this study will provide information that is particularly pertinent for language and reading instruction of children with Down syndrome. For instance, if these children’s comprehension skills assessed using different media are closely related to each other, then it may be possible to teach comprehension skills in non-reading contexts that would later transfer to reading. This is critical because children with Down syndrome show considerable delay in developing early reading skills such as decoding and, therefore, waiting for these children to master early reading skills before teaching comprehension will result in the loss of valuable time.

Three research questions guided our study. First, are young children with Down syndrome sensitive to the causal structure of complex, authentic, age-appropriate stories? Second, is the narrative comprehension of these children similar or different across presentation media (i.e., television and audio)? Third, is the narrative comprehension of young children with Down syndrome related to their basic language skills?

Methods

Participants

Twelve 6- and 7-year old children with Down syndrome participated in our study. Four were girls and eight were boys; participants’ ages ranged from 6 years and 2 months to 7 years and 2 months (M = 6 years 8 months, SD = 3.84 months). Eleven were in kindergarten; one was in the first grade. Ten children attended public schools; one attended a private school and one was home-schooled. All participating children were Caucasian, spoke English as their first language, and came from intact families. Two-thirds of the fathers and half of the mothers of participants had 4-year college or graduate education. All children were reported by parents as having Trisomy 21 Down syndrome. Information about the children’s intellectual functioning is not available. The children’s mean receptive language age, as assessed by Peabody Picture Vocabulary Test—III (see below for description), was 3 years 2.92 months (SD = 9.75 months, range = 2 years 1 month to 4 years 3 months).

Materials and Instruments

Narrative comprehension

We used two narratives, one presented audio-visually (i.e., televised through video-tape) and the other aurally (i.e., on an audio-tape) as part of the story comprehension assessment. The televised story, Autumn Leaves, was a 12-min episode from a children’s television series, The Rugrats. The aurally presented story, the Cat’s Purr, was a story based on an American folk tale. The aural presentation of the story was 7 min long. Eight simple line-drawings of scenes from the story were present as the children listened to the story to keep children engaged in listening. The drawings did not convey any major points of the story plot. Both stories were selected to have a standard, but complex, story structure in which the protagonist made several attempts to achieve a desired goal.

Both stories had been used in prior research (Kendeou et al. 2007; Lynch et al. 2008; van den Broek et al. 2005) on children’s comprehension. In these studies, the stories were pre-tested to ensure they were age appropriate with typically developing 4- and 6-year old children. During each pre-test, ten children were asked to listen to the story and to tell the experimenter everything they could remember after the story was finished. They were also asked if there was anything they did not understand from the story, and whether they thought the story would be appropriate for children their age, younger or older than them. Finally, they were asked to rate the degree to which they liked the story.

For each narrative, we created comprehension questions to prompt further recall from the participants after free recall of the story, eight questions for the television story and seven questions for the aural story. These questions aimed at different levels of inference-making by addressing four aspects of the narrative structure: events that were central to the causal structure, events that were peripheral to the causal structure, characters’ goals, and the general theme of the story. Examples of the comprehension questions are ‘When Chuckie spilled his juice on the tree, what did the kids think that the juice did to the tree?’ and ‘Why wouldn’t Cat let Rat play his drum?’

Basic Language Skills

The following tests were used to assess basic language skills for early reading development: (a) The Peabody Picture Vocabulary Test—III (PPVT; Dunn and Dunn 1997) to assess vocabulary; (b) the onset-recognition fluency subtest of The Dynamic Indicators of Basic Early Literacy Skills (DIBELS) assessment (Kaminski and Good 1996) to assess phonological awareness; and (c) the Letter Identification subtest of the Woodcock Reading Mastery Test (WRMT; Woodcock 1987) to assess knowledge of alphabet letters. The PPVT (Dunn and Dunn 1997) is an individually administered, norm-referenced measure of receptive vocabulary. The reliability coefficients reported by authors range from 0.86 to 0.97. The DIBELS onset-recognition fluency subtest (Kaminski and Good 1996) is a standardized, individually administered measure of phonological awareness. The alternate form reliability coefficients range from 0.36 to 0.91. The WRMT (Woodcock 1987) is a standardized, individually administered measure of reading ability; the authors reported internal consistency reliability coefficients that are ranging from 0.68 to 0.98.

Procedure

Each participating child accompanied by his or her parent(s) was invited to the university lab for the assessment of narrative comprehension and basic language skills. All sessions were videotaped. Children participated in two separate sessions; two sessions were separated by 1–2 week(s). During the first session, each child first completed the Rugrats Familiarity Test and the PPVT. Then the child was presented with the television story (i.e., Autumn Leaves) and assessed for his/her narrative comprehension through free recall and comprehension questions. The Rugrat’s familiarity task was to assess the degree of children’s previous exposure to the TV series. Although the Rugrats is a well-known cartoon show, no participating children identified the characters of the show during this familiarity test. During the second session, each child completed the DIBELS subtest, the WRMT Letter Identification subtest, listened to the aural story (i.e., The Cat’s Purr) and was assessed on narrative comprehension through free recall and comprehension questions. The second session included two measures of language skills (DIBELS and WRMT), as compared to one measure (PPVT) during the first session. The two sessions lasted a similar period of time because the PPVT took longer to administer than the other two measures.

The structure of the two sessions (e.g., sequence of tasks presented) was held constant. The TV story was presented during the first session because we wanted to ensure continued participation of the children and parents by presenting the story through a more engaging medium (i.e., the television) first. To guard against the practice effect, there was a 1–2 week interval between the two sessions. Parents of participating children were present in the room where their children were tested. This ensured that participating children felt comfortable in the new environment with unknown adults (i.e., researchers). Parents were given a questionnaire to complete during the session.

Each session started with a short period for the children to become comfortable, followed by assessment of basic language skills. After a short break, children were presented with the television story (first session) or the aural story (second session). The children were instructed to watch or listen closely so they could answer questions after the story was over. During aural story presentation, the children looked at line-drawings that accompanied the story. Immediately after each story was completed, children’s comprehension of the narrative was assessed through the free-recall and comprehension question tasks.

For the free recall task, the children were asked to “tell everything you remember from the story from the beginning.” If a child did not recall any narrative events spontaneously, the experimenter asked a more specific prompting question, “What happened at the beginning of the story?” The children were prompted to continue to recall the story (i.e., “What else do you remember?”) until they indicated that they could not recall anything else. Because young children often have difficulty spontaneously reporting what they remember from narratives, slightly more specific prompting questions were then asked. Based on the sequence of episodes of each narrative determined in advance, for each episode a child remembered, the experimenter asked before/after questions in the following form: “You remembered X. What happened before X?” and “What happened after X?” These questions were not asked if the child had previously recalled the episodes that provided the answer to the follow-up questions. Once all possible “before/after” questions were asked and answered, the children were asked the comprehension questions that were specific to each story (i.e., the comprehension question task). Three children showed signs of frustration during the recall task and refused to respond to the experimenter’s request for recall or answering the questions. When reasonable attempts to redirect the child were not successful even with parental assistance, the experimenter terminated the session, and the child’s recall up to that point was included in the data analysis.

Coding

Prior to data collection, the prompt stories were parsed into individual events. The detailed parsing procedures are described in the previous studies of children’s reading comprehension (Kendeou et al. 2007; Lynch et al. 2008; van den Broek et al. 2005). Individual events generally comprised of subject–verb phrases. The televised narrative consisted of 231 events and the aurally presented narrative of 167 events. The causal structure of each narrative and the number of connections of each event to other events in the narrative were determined based on procedures described by Trabasso and van den Broek (1985). Causal relations between all events in the story were identified according to principles of causality (Mackie 1980; van den Broek 1990).

Children’s responses to the narrative comprehension tasks (i.e., free recall and comprehension questions) were transcribed verbatim from the videotapes and audiotapes of the experimental sessions. Because the participating children often made gestures as well as verbal responses while responding to the experimenter’s requests and questions, description of non-verbal responses that were pertinent to the situation were included in the transcription. The first author parsed children’s verbal and non-verbal responses into events applying procedures similar to those used for the parsing of the narratives. Each parsed, recalled event was compared to the events in the original narrative. When there was a close match between the recalled event (e.g., “they going to the park”) and an event in the original narrative (e.g., ‘Kids are in the park’), that event was marked as ‘recalled’ and the event code from the original story was assigned to the recall. Recalled events that did not match an event in the original story but were judged to be related to the story by the coders were categorized as summary, inference, or elaboration. Because children with Down syndrome often exhibit delays in expressive language and articulation problems, we used coding criteria that focused on content, rather than form (e.g., lengths, syntax errors), following procedures similar to those used by Miles and Chapman (2002). For example, one to two word phrase responses were given credit when it was possible to connect the response to the event(s) of the prompt story (e.g., “popped out” [with a gesture of raising both arms] to the original story event of ‘leaves scatter’).

The first and second authors, both doctoral level students at the time of the study, coded 20% of transcripts in common to establish and practice the coding scheme. During the practice coding, each coded the transcript independently and compared the codes and the matched events (in the original story). Disagreements were resolved through discussion. These transcripts were coded again after the coding scheme was finalized. An additional 25% of the transcripts were coded by these authors independently to determine inter-rater reliability. Inter-rater agreement was reliably high for both the television story (K = 0.95) and the aural story (K = 0.96), both p’s <0.001.

Variables

For each child, there were two separate but parallel sets of measures of comprehension: one set for the televised story and the other for the aural story. Each set of comprehension measures included total number of story events recalled, total number of the unique story events recalled (excluding repeated events), and total number of unique high-connection story events recalled (i.e. events central to the causal structure of the narrative). When a child gave the same story-related response twice (for example, recalled the same event during the recall phase and while responding to different comprehension questions), two responses were included in the calculation of the number of total story events recalled, but the responses were counted as only one (unique) response in computation of the number of unique story events recalled. The number of total story events recalled and the number of unique story events recalled were measures of overall recall. A highly connected event was operationally defined as an event with four or more causal connections to other events in the narrative structure. This is a measure of sensitivity to the causal structure, because events with many connections play a central role in the structure of the narrative compared to events with few causal connections (Fletcher and Bloom 1988; O’Brien and Myers 1987; Trabasso and van den Broek 1985)

For the basic language skills measures (i.e., PPVT, WRMT, and DIBELS), raw scores were used in the data analyses because they give more variability compared to the derived scores (i.e., standard scores). For the PPVT, age-equivalent scores were computed to give some information about the language ability level of participating children (see the Participants section).

Results

We conducted several analyses to address our research questions. First, we examined whether young children with Down syndrome were sensitive to the causal structure of complex, authentic, age-appropriate stories. Second, we determined whether the narrative comprehension of these children was similar across presentation media (i.e., television vs. audio). Third, we examined the degree to which narrative comprehension in children with Down syndrome was related to their basic language skills.

Sensitivity to Causal Structure

Table 1 presents the descriptive summary of participating children’s performance on story comprehension tasks and measures for basic language skills. In the first set of analyses, we examined whether children with Down syndrome were sensitive to the causal structure of the narratives when exposed to authentic, complex, age-appropriate stories. We compared the proportion of unique events in children’s recalls that had many connections (i.e., events with four or more causal connections, or ‘highly connected events’) to the proportion of such events in the original narratives. The average percentage of highly connected unique events that children recalled (as a percentage of the total number of unique events recalled) was 46.57% (SD = 21.94%) for the TV story, whereas in the original Autumn Leaves story 27.78% of the unique story events were highly connected events. To test whether 46.57% was significantly different from 27.78%, we computed a one sample t-test using 28% as the predicted value. This test was significant, t (10) = 2.81, p = 0.02, indicating that children with Down syndrome recalled events with many connections more often than events with few connections of the TV story.

Table 1 Descriptive summary of narrative comprehension by children with Down syndrome
Full size table

Participating children recalled very few events during the comprehension tasks after the aural story. Percentage of highly connected unique events recalled can be computed only from 7 of the children, resulting in low statistical power. The average percentage of highly connected unique events recalled (out of the total number of unique events recalled) by these children was 53.47% (SD = 39.01%) for the aural story, which was higher than the percentage of such events in the original Cat’s Purr story (31.11%). Thus, for the aural story the participating children recalled events with many connections more frequently than events with fewer connections. However, a one-sample t-test with 31% as predicted value showed that this large difference was not reliable, t (6) = 1.52, p = 0.18.

Similarities in Narrative Comprehension across Media

To address the second research question, the extent to which children with Down syndrome’s narrative comprehension skills generalized across media, we performed a series of Wilcoxon Signed Ranks Tests. Because the television story was longer and, consequently, included more unique events (231 events) than did the aural story (167 events), any observed differences may have been a function of the number of story events to which the children were exposed in each medium rather than media differences per se. To guard against this possibility, we made adjustment to the comprehension data for lengths of the original story by converting data to proportions of the number of unique story events present in the original story. The analysis showed no media effects on any of the recall measures, with children recalling the same proportion of events from the television story and the aural story. Specifically, there were no significant differences between the two media with respect to the proportion of total events (Z = −0.66, p = 0.51), the proportion of unique events (Z = −1.78, p = 0.07), and the proportion of unique events with many connection (Z = −1.36, p = 0.17) recalled.

In addition, Spearman’s rho correlations were computed to examine the inter-correlations among different measures of narrative comprehension across different presentation media. As can be seen at the lower right of Table 2, measures of television and aural story comprehension were significantly intercorrelated within as well as across the two presentation media. Specifically, the measures of comprehension for the television story were significantly related to one another with correlations ranging from r = 0.94 to r = 0.98, and the comprehension measures for the aural narrative were significantly related to one another with correlations ranging from r = 0.91 to r = 0.96. Importantly, measures of comprehension were strongly related across media, with correlations between the same measures for different media ranging from r = 0.68 to r = 0.85.

Table 2 Spearman rho correlations among basic language and comprehension measures for children with Down syndrome
Full size table

Narrative Comprehension and Basic Language Skills

To address the third research question, concerning the relation between comprehension measures and basic language skills, Spearman’s rho correlation analyses were conducted. As can be seen at the upper left of Table 2, measures of basic language skills (i.e., PPVT, DIBELS, WRMT) showed weak to moderate intercorrelations (r = −0.45 to r = 0.33), none of them statistically significant. Similarly, measures of basic language skills showed weak to moderate correlations to measures of narrative comprehension, again none statistically significant. These ranged from r = 0.28 to r = 0.46 for the television story, and from r = −0.03 to r = 0.49 for the aural story. Thus, there is no evidence that differences in comprehension ability were related to differences in basic language skills.

Discussion

In this study, we explored the nature of narrative comprehension in children with Down syndrome. Specifically, we investigated children’s sensitivity to the semantic, causal structure of the narrative, the extent to which their comprehension skills generalize across different media, and the relation between their comprehension and basic language skills. With respect to out first question, results demonstrated that children with Down syndrome are sensitive to the causal structure of authentic, age-appropriate narratives. For the televised stories, children recalled events with many connections more often than events with few connections. With respect to our second question, the results demonstrated that children’s comprehension ability generalizes across different media (i.e., television and audio). Not only did they recall a similar proportion of events from the television and the aural story, direct comparisons showed their narrative comprehension measures to be interrelated, both within and across the two media. Finally, with respect to our third question, the results demonstrated that comprehension skills develop separately from basic language skills in young children with Down syndrome. Indeed, comprehension skill measures were not related to any of the basic language skill measures (phonological awareness, vocabulary, letter identification).

Findings show that young children with Down syndrome are sensitive to the causal structure of the television narratives they comprehend. The obtained pattern is similar to the general comprehension pattern observed in young children without disabilities and adults (e.g., Graesser and Clark 1985; Trabasso et al. 1984; van den Broek 1990). This finding is important because it provides evidence of the quality of these children’s mental representation of narratives they comprehend rather than just the quantity of their comprehension. Even if children with Down syndrome tend to remember less than children without Down syndrome, they selectively remember events that are structurally important to the coherence of the narrative as a whole. This focus on structural importance, in turn, is an important step in identifying the theme or main idea of narratives. The fact that this pattern was obtained with more complex stories and younger participants (i.e., 6- and 7-years old) than typically included in studies of children with Down syndrome makes the findings even more remarkable. These children’s memory for the stories was far from a random collection of individual events; their selective memory for highly connected events suggests that they were identifying connections as they were processing the narratives. Thus, comprehension skills in children with Down syndrome may be more sophisticated than previously thought.

Our findings did not provide evidence that young children with Down syndrome are sensitive to the causal structure of the aural narratives they comprehend, most likely due to low statistical power. Even though the average percentage (53.47%) of high connection events in children’s recall from the aural story was also higher than that (31.11%) of the original Cat’s Purr story, this difference did not reach statistical significance probably due to the small number of participants. In this study, the comprehension task after the aural story turned out to be a more difficult task than that after the television story. Overall, children recalled very few events of the aural story with only six children producing two or more recall responses. The better recall after the television story (vs. after audiotaped stories) is consistent with what has been observed in comprehension of typically developing preschoolers (Gibbons et al. 1986).

Despite this difference in the recall of stories, the findings demonstrated that comprehension skills in children with Down syndrome generalize across media. Children recalled similar proportions of events across different media, and there were significant correlations among comprehension measures within the same medium as well as between comprehension measures across different media. This is consistent with recent findings that comprehension skills in young children without disabilities are not limited or specific to the medium in which the narrative is presented (Kendeou et al. 2006, 2007; van den Broek et al. 2005). This conclusion has important implication for comprehension assessment and instruction in children with Down syndrome. First, it suggests that comprehension skills required for reading comprehension can be taught outside of the reading context and later may transfer to reading. Although this is speculative with respect to children with Down syndrome, the well-established predictive relation between early narrative comprehension and later reading comprehension in typical development (Kendeou et al. 2007; Paris and Paris 2001, 2003; van Kraayenoord and Paris 1996) adds credence to this possibility. Another implication of current findings is that it may be beneficial to teach comprehension skills to children with Down syndrome, particularly those skills that emphasize the causal structure of texts, using highly motivating and available media (e.g., television; see van den Broek et al. 2005, for details on this methodology).

Finally, our results indicate that narrative comprehension skills develop relatively independently from basic language skills (i.e., letter naming, phonological awareness, and vocabulary) in young children with Down syndrome. Indeed, there were no significant correlations between comprehension measures in both media and measures of basic language skills. This finding is consistent with the results by van den Broek and colleagues (Kendeou et al. 2007; Lynch et al. 2008; van den Broek et al. 2005) with typically developing 4- and 6-year old children, and with models of reading development that posit (narrative) comprehension processes are independent from word decoding skills and make independent contribution to reading (e.g., Gough and Tunmer 1986; Snow 1983; Whitehurst and Lonigan 1998). These findings suggest that instruction and training in comprehension skills can be conducted concurrently with and, perhaps, separately from training in these important basic skills.

The current study had a relatively small number of children and, therefore, relatively low statistical power. The fact that, despite such low power, consistent and significant patterns were observed indicate the strength and reliability of these patterns. Additionally, it would be worthwhile to replicate the current study with measures that are less demanding in terms of expressive language skills. The current materials and procedures were used successfully to induce comprehension recalls from the typically developing 4-year old children in previous studies (Kendeou et al. 2007; Lynch et al. 2008; van den Broek et al. 2005). The children with Down syndrome seemed to find the current study procedures difficult especially after the aural story, as shown in the smaller number of available aural recall data. The reported difficulty of children with Down syndrome in expressive language (Miles and Chapman 2002) may be related to this pattern. We did however consider both gestural responses and oral responses from the children as measures of their recall. Replication of this study with a larger sample size or other response modalities would provide further evidence concerning the observed patterns and, in addition, may provide evidence for additional patterns (such as the generalization of sensitivity to causal connectivity across media and across narratives of differential complexity).

The major aim of the present study was to gain a deeper understanding of the nature of narrative comprehension skills in children with Down syndrome. Findings of this study provide answers but also raise interesting questions. One question concerns the boundary conditions in which children with Down syndrome can maintain sensitivity to the semantic structure of information. For instance, would their causal sensitivity change if stories that are either more or less complex or difficult (e.g., ability-matched stories) or expository materials (e.g., news story) are used? Conversely, how can teachers and parents create optimal circumstances for children with Down syndrome to apply and possibly extend their abilities to identify semantic and thematic structures? A second question pertains to the extent of similarity with respect to causal sensitivity between children with and without Down syndrome. Our findings show that children with Down syndrome are indeed sensitive to the semantic structure of information and in that sense they are similar to their peers without disabilities, but that does not mean there are no differences in this sensitivity. To understand the unique circumstances of comprehension in children with Down syndrome it would be important to determine their differences and similarities in comprehension with children without Down syndrome in direct comparisons. By raising these questions, we hope that our findings stimulate further in-depth investigations of comprehension abilities in children with Down syndrome as well as development of instructional activities that foster and take advantage of these abilities.