Developing a screening instrument for underlying core domains of communicative competence in children with communication support needs

Figures & data

Table 1. Core domains and underlying constructs of communicative competence.

Core domains and definitions (ICF-CY)	Underlying constructs
Attention Specific mental functions of focusing on an external stimulus or internal experience for the required period of time.	Focused attention
	Shifted attention
	Sustained attention
	Joint attention
Perception Specific mental functions of recognizing and interpreting sensory stimuli.	Auditory perception
	Visual perception
	Olfactory perception
	Gustatory perception
	Tactile perception
	Visuospatial perception
Memory Specific mental functions of registering and storing information and retrieving it as needed.	Working memory (WM)
	Phonological loop
	Visuo-spatial sketchpad
	Episodic buffer
	Long term memory (LTM)
	Semantic memory
	Episodic memory
	Procedural memory
Cognition General mental functions, required to understand and constructively integrate the various mental functions including all cognitive functions and their development over the life span.	Problem solving skills
	Cause-effect Object permanence
	Pairwise comparison
	Ordering relationships
	Pattern recognition
	Puzzling
	Sizes & quantities and numbers & calculation
	Concept formulation
	Reasoning skills
	Cognitive play
Orientation General mental functions of knowing and ascertaining one’s relation to object, to self, to others, to time and to one’s surroundings and space.	Orientation in space
	Orientation in time
	Orientation in person
Social-emotional development Specific mental functions related to the feeling and affective components of the processes of the mind and general mental functions, as they develop over the life span, required to understand and constructively integrate the mental functions that lead to the formation of the personal and interpersonal skills needed to establish reciprocal social interactions, in terms of both meaning and purpose.	Emotional regulation
	Social cognition
	Self-consciousness
	Imitation
	Interpersonal attention
	Social referencing
	False belief understanding
	Theory of mind
	Social play
Motor skills Functions associated with control over and coordination of voluntary movements.	Fine motor skills
	Movement and gross motor skills
	Balance/stability
	Object control
	Locomotor

Table 2. Characteristics of the participants.

	Study 1		Study 2	Study 3
	TD (n = 295) n (%)	DS (n = 133) n (%)	TD (n = 232) n (%)	CSN (n = 85) n (%)
Age
12–23 months	84 (28.5)	29 (21.8)	72 (31.0)	–
24–35 months	107 (36.3)	37 (27.8)	69 (29.7)	3 (3.5)
36–47 months	104 (35.2)	32 (24.1)	91 (39.2)	4 (4.7)
48–59 months	–	13 (9.8)	–	17 (20.0)
60–71 months	–	14 (10.5)	–	17 (20.0)
72–84 months	–	8 (6.0)	–	16 (18.8)
85–144 months	–	–	–	28 (32.9)
Maternal education
Low	8 (2.7)	8 (6.0)	0 (0)	NA
Medium	85 (28.8)	45 (33.8)	34 (14.7)	NA
High	201 (68.1)	80 (60.2)	198 (85.3)	NA
Missing	1 (0.3)	–

Note. TD = children with typical development; DS = Down syndrome; CSN = communication support needs; NA = not available.

Table 3. Total test statistics per core domain in study 1.

		Typical development				Down syndrome
Core domain	Items	N	mean P	alpha	Rage	N	mean P	alpha
Attention	11	295	0.60	0.79	0.64	133	0.45	0.74
Perception	9	187	0.75	0.81	0.63	0
Memory	7	295	0.62	0.82	0.80	133	0.32	0.72
Cognition	20	295	0.48	0.93	0.87	133	0.19	0.92
Orientation	6	295	0.64	0.81	0.78	133	0.39	0.79
Social-emotional development	13	295	0.67	0.85	0.76	133	0.44	0.86
Fine motor skills	12	295	0.59	0.89	0.79	133	0.32	0.86
Gross motor skills	17	295	0.62	0.90	0.80	133	0.32	0.89
Total screening instrument	95	187	0.62	0.98	0.88

Table 4. Mokken scale statistics per core domain.

Core domain	Items	H	Minimum Hi
Attention	11	0.38	0.11
Perception	9	0.43	0.33
Memory	7	0.63	0.54
Cognition	20	0.67	0.47
Orientation	6	0.78	0.76
Social-emotional development	13	0.54	0.40
Fine motor skills	12	0.60	0.43
Gross motor skills	17	0.57	0.24

Table 5. Latent correlations between the subscales in children with typical development (above diagonal) and Down syndrome (below diagonal) groups.

Core domain	1	2	3	4	5	6	7	8
1. Attention	1	0.81	0.79	0.83	0.80	0.87	0.66	0.66
2. Perception	na	1	0.83	0.86	0.85	0.77	0.81	0.75
3. Memory	0.84	na	1	0.96	0.86	0.86	0.89	0.84
4. Cognition	0.88	na	0.98	1	0.95	0.90	0.92	0.85
5. Orientation	0.74	na	0.95	0.95	1	0.84	0.83	0.83
6. Social-emotional dev.	0.85	na	0.97	0.99	0.93	1	0.87	0.90
7. Fine motor skills	0.65	na	0.88	0.90	0.92	0.92	1	0.87
8. Gross motor skills	0.51	na	0.79	0.82	0.83	0.86	0.95	1

Table 6. Total test statistics per core domain in study 2 and 3.

	TD (N = 232)			CSN (N = 85)
Core domain	mean P	alpha	Rage	mean P	alpha
Attention	0.75	0.75	0.72	0.39	0.75
Perception	0.86	0.76	0.52	0.63	0.81
Memory	0.74	0.72	0.76	0.34	0.69
Cognition	0.58	0.95	0.89	0.21	0.92
Orientation	0.73	0.73	0.75	0.45	0.68
Social-emotional development	0.75	0.86	0.83	0.29	0.81
Fine motor skills	0.63	0.90	0.86	0.39	0.91
Gross motor skills	0.61	0.90	0.87	0.39	0.94
Total screening instrument	0.68	0.98	0.90	0.36	0.97
Language (ELS)	0.72	0.96	0.87	0.26	0.93

Figure 1. Mean scores, divided by the subscale maximum, by age for each of the core domains, in the typical development (TD) and Down-syndrome (DS) groups.

Note. Thin grey lines indicate 25^th and 75^th percentile in the sample of children with typical development.

Table 7. Latent correlations with the ELS in study 2 and 3, and observed correlation with CM in study 3.

Core domain	Latent RELS TD (N = 232)	Latent RELS CNN (N = 85)	Observed RCM CNN (N = 77)
Attention	0.89	0.70	0.47
Perception	0.69	0.58	0.36
Memory	0.95	0.88	0.64
Cognition	0.98	0.93	0.75
Orientation	0.94	0.93	0.63
Social-emotional development	0.96	0.87	0.71
Fine motor skills	0.93	0.78	0.69
Gross motor skills	0.89	0.60	0.54
Total screening instrument	0.96	0.90	0.74
Language (ELS)			0.82

Note. TD = children with typical development; CCN = complex communication needs. All correlations are significant at p < 0.001 level, except for Rcm Perception (p < .01).

Table 8. AAC strategies connected to underlying domains of communicative competence.

Core domain	Examples of AAC strategies, communication modes, AAC devices
Attention	Tactile manual signs; signing together; movement, touch; 4-hand signing; reducing or increasing stimuli; tactile stimulation; following interest; standing table; visual of auditory cues on AAC device; tactile symbols; movement in images/videos, moving symbols
Perception	Multimodal forms of AAC; manual signing; tactile signing; sensory input; rythm; exploring objects, symbols (or the world) together; using contrasts; heightened auditory input
Memory	Referential objects (for person, day, moment, activity; also including smell); repetitions; imitation games; aided AAC; rythm; anchored approaches; adaptations in language input; using film and pictures (f.e., Film as Observable Communication, FaOC, Legel et al., in review); Visual Scene Displays; scripts; interactive storybook reading
Cognition	Matching and puzzling in (of referential objects, day schedule); rythm, music; scripts; offering more time; adaptations in input (quality and quantity); imitation and repetitions; exploration; action-reaction (f.e. with switches or eye-gaze), cause-and-effect with switches and toys; categorization, building semantic networks based on direct experiences (anchored approach)
Orientation	(Estafette) Planning; referential objects; picto-agenda; scripts; working on rituals and routines; referential songs; visualize what is going to happen; explore environments and put objects on a determined spot; movement and motor practices (Floorplay, Sherborne, for body image and orientation in space)
Socio-emotional and adaptation	Social scripts; turn taking with switches; imitation games; role play; scripts for recognizing and dealing with own emotions; rythm, music; offering closeness; attachment strategies; stimulating initiatives (incl. use of video interaction counseling); body contact; offering choices
Motor skills and mobility	Direct vs indirect selection; head balance; hand and arm functions; eye and head movements; resilience; moving together; 4-hand signing; working on motor patterns and motor memory; dance
Language	Adaptations in language input; VSD; self-made films; aided AAC; manual signing; anchored approaches; interactive storytelling; core and fringe vocabulary; exploring familiar and unfamiliar objects