INT J LANG COMMUN DISORD, MAYJUNE

VOL.

2013,

48, NO. 3, 343349

Short Report
Can individuals with Down syndrome improve their grammar?
Esther Moraleda Sepulveda, Miguel Lazaro Lopez-Villasenor and Elena Garayzabal Heinze
Education Department, Camilo Jose Cela University, Villanueva de la Canada, Madrid, Spain
Psychology Department, Castilla-La Mancha University, Talavera de la Reina, Spain
Linguistic Department, Autonoma University, Madrid, Spain

(Received March 2012; accepted November 2012)

Abstract
Morphosyntax constitutes one of the most complex areas of language. It takes into account the structure of the
word and that of the sentence, and its development allows one to establish adequately agreements both within
the nominal phrase and in the rest of the sentence. Morphosyntax is particularly impaired in individuals with
Down syndrome. To improve their morphosyntactic skills, an intervention programme was designed and carried
out with a total of 20 Spanish-speaking children with Down syndrome; half of them composed the experimental
group and the other half the control group. The results obtained show that the children in the experimental group
improved more than the children in the control group in the areas of syntax, morphology and semantics, but
not in pragmatics, where both groups improved to the same extent. Overall, the results obtained support the
effectiveness of the programme implemented as a clinical and educational tool for intervention in individuals with
Down syndrome.
Keywords: Down syndrome, morphosyntax, semantic, speech and language therapy programme.

What this paper adds

What is already known on the subject?
Earlier research has shown that language is one of the most affected cognitive abilities in people with Down syndrome
and specifically the acquisition and development of morphosyntactic skills.
What this study adds
Despite scientific evidence that shows that individuals with Down syndrome have difficulties with morphosyntactic
production, it is difficult to find specific programmes focused in language intervention for this population. We
have designed and carried out an intervention programme to improve morphosyntactic abilities in Spanish-speaking
children with Down syndrome, and have tested its effectiveness comparing the results obtained with those of another
group of individuals with Down syndrome attending language rehabilitation without this specific programme. The
results confirm the better progression of the experimental group. This study provides a new alternative for the
enrichment of morphosyntax and communication in people with Down syndrome.

Introduction
Down syndrome is one of the most common genetic
neurodevelopmental disorders (e.g. Rondal and Perera
2006), occurring in approximately one in 700 new
births. It is produced by the presence of an extra chromosome or part chromosome, chromosomal translocation (a chromosomal fragment changing position) or

mosaicism (the coexistence of two or more cell populations with different genetic composition) on chromosome 21. People with Down syndrome have moderate to severe levels of intellectual disability and a
range of associated physical and medical conditions (as
heart diseases or visual problems), including language
impairment.

Address correspondence to: Esther Moraleda Sepulveda, Camilo Jose Cela University, C/ Castillo de Alarcon, 49, CP. 28692, Villanueva de la
Canada, Madrid, Spain; e-mail: emoraleda@ucjc.edu
International Journal of Language & Communication Disorders
C 2013 Royal College of Speech and Language Therapists
ISSN 1368-2822 print/ISSN 1460-6984 online 
DOI: 10.1111/1460-6984.12002

344

Esther Moraleda Sepulveda et al.

Table 1. Expressive language acquisition for Spanish-speaking

children
Language
development
Eye contact
Syllabic reduplication
First words
Word combination
Simple sentence
production
Production of subordinate
sentences

Typical
development

Down
syndrome

1 month
610 months
1012 months
19 months
22.5 years

2 months
1215 months
1924 months
3140 months
34 years

34 years

67 years

Source: Adapted from Arregi (1997).

Even though individuals with Down syndrome constitute a very heterogeneous collective, they present a
common profile of difficulties and skills conserved in
certain areas. Among the best developed capacities, one
finds vocabulary (frequently richly developed and varied in the early stages of language development; e.g.
Cardoso-Martins et al. 1985, Chapman et al. 1991,
Fowler 1990, Vicari et al. 2000, Rodrguez and Olmo
2010). Fowler (1990) states that lexical skills in children with Down syndrome are completely preserved
in relation to their mental age. However, although the
first words of children with Down syndrome are generally understood and produced in a manner appropriate to their mental age, some studies have shown that
as they develop their lexical skills improve at a slower
pace, which would be more evident in expressive than in
comprehensive language (Cardoso-Martins et al. 1985,
Galeote et al. 2012).
In contrast with lexical skills, the level of grammar
seems to be particularly affected in Down syndrome.
Morphosyntax is an area where major impairment is
very commonly observed (e.g. Moraleda 2011, Zampini
and DOdorico 2011) and there is a considerable delay
compared with their peers (table 1).
The development of morphosyntax in children with
Down syndrome has been studied exhaustively using
different techniques and experimental procedures, such
as the analysis of mean length of utterance (MLU). This
parameter measures the average number of morphemes,
whether grammatical or lexical, in a sentence spoken in
a natural context. This technique allows one to carry
out subsequently very rich quantitative and qualitative
analyses. The results obtained from examining MLU of
children with Down syndrome and subsequent analyses of transcriptions have revealed deficiencies in their
usage of auxiliary verbs, articles, prepositions and verb
inflections (e.g. Chapman et al. 1998, Eadie et al. 2002).
Children with Down syndrome produced few subordinate sentences and showed poor organization of agreements, with problems making logical connections between statements (e.g. Rondal and Perera 2006).

Chapman et al. (1991) studied a group of children

and adolescents with Down syndrome aged between
five and 20 years. Verbal production was evaluated using qualitative analysis of samples of narration and conversations between participants and the researcher. The
results confirmed specific difficulties in productive syntax compared with a control group with the same mental
age. Other studies carried out confirmed that children
with Down syndrome also uttered fewer verbs than
the control children matched for MLU (Hesketh and
Chapman 1998) and tend to use simple sentences in
which they also omit function words. These results have
also been confirmed with languages other than English.
Fabbretti et al. (1997) used a story description task to
compare the narrations of ten children with Down syndrome and ten children with typical development (TD).
These authors showed that the productive language skills
of Italian adolescents with Down syndrome were best
characterized by deficiencies in some morphological aspects, mainly the omission of free morphemes. Similarly,
Bol and Kuiken (1990), using qualitative and quantitative analysis of spontaneous speech samples, pointed
out certain difficulties in the morphological area for German children with Down syndrome. The participants
in their study used fewer pronouns and made more verb
agreement errors than 14-year-old TD children.
It should be remembered that much of the scientific
literature on Down syndrome has been obtained in studies carried out with native English-speaking children,
and it also happens when one considers studies reporting
results of morphosyntactic interventions. For example,
Buckley (1995) carried out an intervention programme
for six English-speaking children with Down syndrome.
During the training session, the examiner pointed at
different pictures and asked the student to repeat the
utterance previously given orally. The results showed,
except for one participant, that children used longer
and more complex sentences in their conversation after
training. However, it is notable that the progress and
improvements were closely linked to the speech production ability and comprehension of grammar before the
training programme began.
Studies using Spanish individuals with Down syndrome are of particular interest; like Italian, it has an
inflectional system which is considerably more complex
than English. According to Vicari et al. (2000), research
in other languages with different morphosyntactic complexity is needed in order to understand the influence of
certain language features in generating specific developmental profiles.
As speech and language therapists, our greater interest lies in helping individuals to overcome, or at
least to lessen, their language difficulties. In the case
of Down syndrome, it is of key interest to facilitate
an improvement in the morphosyntactic (and therefore

Can individuals with Down syndrome improve their grammar?

communicative) abilities. To the best of our knowledge, in Spanish there is currently no intervention programmes for Down syndrome in the area of morphosyntax, and therefore Spanish therapists have no tested
interventions on which to base their work with these
children. We considerer that this is an important lack for
our community and, with the aim of bridging this gap,
we have designed a morphosyntactic intervention programme for children with Down syndrome. This study,
therefore, examines the effectiveness of the morphosyntactic intervention programme we have conceived for
children with Down syndrome.
Method
Participants
A total of 20 individuals with Down syndrome took
part in the study, with ages between six and 14 years
belonging to the Toledo Down Syndrome Association.
They were all native Spanish speakers, as well as their
parents, and did not have any hearing impairment. Of
these individuals, ten were assigned randomly to the
experimental group (four girls and six boys) and the
other ten to the control group (five girls and five boys).
The mean age of the experimental group was 10 years 5
months (SD = 1 year 11 months) while the mean age of
the control group was 10 years 9 month (SD = 2 years
5 months).
Given that the intellectual capacity of children with
Down syndrome is highly variable, and this capacity
might explain differences in performance after applying
the programmes, this was evaluated using the WISC-IV
intelligence scales (Wechsler 2003). This test was administered after the children were randomly assigned to
the experimental groups. The results for both groups
were similar in terms of the intelligence quotient (IQ).
The mean IQ of the experimental group was 45.5
(4.9), whilst that of the control group was 44.1 (3.1).
The differences in IQ are not significant (t(9) = 0.07,
p = 0.9), nor were other aspects measured by the test;
Verbal Comprehension (t(9) = 1.2, p = 0.2); Working
memory (t(9) = 1.3, p > 0.2); Processing Speed (t(9) =
0.7, p = 0.4). The only significant difference observed
in this test is found in the Perceptual Reasoning index
(t(9) = 2.5, p < 0.05) where the control group scores
were significantly greater than those of the experimental
group. The possible role of this result will be considered
in the Discussion section.
Informed consent was obtained from the parents before carrying out the study. The control group continued receiving their habitual speech and language treatment for the duration of the intervention programme
with the experimental group, such that the number of
speech and language therapy sessions received was the

345
same for both groups of children during the research
period.
Instruments and materials
We used the full version of the Batera de Lenguaje Objetiva Criterial (BLOC-C; Puyuelo et al. 1998) for the
evaluation of language, both before and after the intervention. This test evaluates four different components
of language: morphology, syntax, semantics and pragmatics, and it is validated for Spanish-speaking children
between five and 14 years. It is composed of 190 items
to assess morphology, 180 items to assess syntax, 80
items to assess semantics and 130 items to assess pragmatic development. This test provides raw scores for
each module. The results of children can be interpreted
by therapists by comparing them with those of other
children with the same chronological or mental age.
This survey employed the raw data to perform statistics.
Procedure
Each participant was evaluated individually in the room
where speech and language therapy is carried out, and
therefore in a place the children already knew. In order to
control better for attention, we took care that there were
no toys or other objects in sight of the children. Because
the administration of the test allows for pauses after each
module, tasks were ended when some tiredness in the
children was noted. Two sessions were required for each
child in order to complete the evaluations.
Before embarking on the training programme, two
preparatory sessions were carried out with the three
speech and language therapists to implement the programme. These therapists were the childrens habitual
therapists. The programme ran for 30 sessions of 30
min duration for each participant, twice weekly over
3.5 months.
The training activities were structured such that two
sessions were set aside for each of the following aspects:
inflection for the number in nouns, inflection for gender in nouns, inflection of articles for both gender and
number, correct usage of pronouns, use of interrogative
particles, use of adverbs, and use of morphosyntactically
correct adjectives. Four sessions were used to work on
verb tenses; two sessions for the present, one for the past
and one for the future. A total of five sessions were dedicated to work on sentence structures and another five
sessions on dialogues see breakdown and examples of
intervention in appendix A.
Results
All statistics performed used a significant alpha level
of p 0.05. Comparing the results of both groups of

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Esther Moraleda Sepulveda et al.

Table 2. Differences in the scores before and after treatment
Experimental

Morphology
Syntax
Semantics
Pragmatics

Control

Pre-

Post-

Difference

Pre-

Post-

Difference

12.9 (7.2)
5.5 (3.5)
23.5 (10.1)
1.0 (1.24)

28.6 (10)
20 (10.19)
47.80 (12)
4.4 (3.09)

15.7
14.5
24.3
3.4

11.9 (6.72)
8.9 (10.3)
33.5 (20.4)
2.0 (4.72)

17.4 (9.98)
11 (12.3)
34.9 (23.2)
2.8 (4.94)

5.5
2.1
1.4
0.8

Note: Standard deviations are given in parentheses.

children in the BLOC-C test before the administration

of the test, we observed no differences in Morphology;
(t(9) = 0.4, p = 0.6); in Syntax (t(9) = 1.7, p = 0.1);
and in Pragmatic development (t(9) = 1.5, p = 0.1).
However, in the semantics section there were differences
(F(18) = 5.78, p < 0.05), where the control group
scored significantly higher than the experimental group.
Once the programme had been implemented, we
proceeded with the statistical analysis using a repeated
measures ANOVA with the within-subjects factor of
language components and the between-subjects factor
of participants (experimental control). The dependent
variable is the difference between the scores obtained
before and after the treatment.
The analysis showed a significant main effect of participants (F(1,18) = 18.05 MSe = 180.01, p < 0.001).
Children in the experimental group showed better results than children in the control group. The effect of
language components reached a marginal signification
(F(1,18) = 4.3 MSe = 75.51, p = 0.053). More importantly, the interaction between these factor reached
significance (F(1,18) = 7.4 MSe = 75.5, p < 0.001). A
planned comparison carried out showed that there are
differences between groups in the case of morphology
(p = 0.002), semantic (p = 0.008) and syntax (p =
0.001). The difference between groups did not reach
significance in the case of pragmatic development (p =
0.2). As can be seen in table 2, the significant differences
are in favour of the experimental group.
Discussion
The results obtained indicate that the morphosyntactic programme administered was efficient in improving
scores on morphology, syntax and semantics, but not in
pragmatics in children with Down syndrome. This is
what follows from the main significant effect found for
participants; the difference between the scores obtained
before and after the administration of the programme
was significantly higher for children in the experimental
group than for children in the control group.
Results in the Semantics area were unexpected. We
can just make the assumption that results reflect the
fact that morphosyntax implies lexicon and semantics,

and that this programme seems to be more effective

in this area when children have low skills, but more
research on this matter is required to establish a reasonable hypothesis. These results support, nevertheless,
previous studies that observe a high positive correlation
between lexical development (size of the vocabulary) and
morphosyntactic development (e.g. Bates and Goodman
1997, Serrat et al. 2010). In fact, this positive correlation
between vocabulary and morphosyntactic has also been
found in children with different disorders and delays,
and with atypical development (early and late speakers,
with brain injuries, with Williams syndrome, etc.; DazItza and Miranda 2007). However, it is important to
take into account that the results suggest that improvements in morphosyntactic aspects bring improvements
in lexical aspects, but an increase in vocabulary does not
lead to improved morphosyntactic skills. The data obtained cannot shed light on the profound relationship
that exists between the two levels, or present statistics in
favour of some possible hypothesis or another; but the
results seem to support the close relationship between
morphosyntax and the lexicon, such that modifications
at the morphosyntactic level affect the lexical level.
It is important to remember that improvements observed cannot be explained by the greater number of
speech and language therapy sessions received by the experimental group compared with the control, given that
both groups received the same number; the experimental group received the sessions of the programme and
the control group received the regular sessions.
Other point to be considered, in this case as a limitation of the study, is the low number of participants
involved in the survey. With a total number of 20 participants, and in order to match the number of children
per group, the programme was carried out with ten participants. Statistically, the low number of participants
makes it more difficult to find differences between conditions, so we believe that the data are strong and allow
a conclusion to be made that differences between the
experimental and control groups indeed existed. However, we think that it is necessary to be cautious if one
wants to generalize the results. One has to be cautious
because the external validity is threaded as a consequence of the low number of participants. However, we

Can individuals with Down syndrome improve their grammar?

consider that this study provides relevant information
and draws important clues about how an efficient intervention with children with Downs syndrome can be. We
also consider that the results support the systematic implementation of the intervention programme with the
Spanish-speaking Down syndrome population. It offers
substantial benefits, mainly to individuals with Down
syndrome, but also to the professionals who work in the
language area with this population.
Acknowledgements
The second author acknowledges support from the Ministerio de
Economa y Competitividad de Espana FFI2012-39325-C03-01.
Declaration of interest: The authors report no conflicts of interest.
The authors alone are responsible for the content and writing of the
paper.

References
ARREGI, A., 1997, Sndrome de Down: Necesidades educativas y desarrollo del lenguaje. Vitoria: Departamento de Educacion,
Universidad e Innovacion del Gobierno Vasco.
BATES, E. and GOODMAN, J., 1997, On the inseparability of grammar
and the lexicon: Evidence from acquisition, aphasia and realtime processing. Language and Cognitive Processes, 12, 507
586.
BOL, G. and KUIKEN, F., 1990, Grammatical analysis of developmental language disorders: a study of the morphosyntax of
children with specific language disorders, with hearing impairment and with Downs syndrome. Clinical Linguistics and
Phonetics, 4, 7786.
BUCKLEY, S., 1995, Improving the expressive language skills of
teenagers with Down syndrome. Down Syndrome Research
and Practice, 3, 110115.
CARDOSO-MARTINS, C., MERVIS, C. B. and MERVIS, C. A., 1985,
Early vocabulary acquisition by children with Down syndrome. American Journal of Mental Deficiency, 90, 177
184.
CHAPMAN, R. S., SCHWARTZ, S. E. and KAY-RAINING, E., 1991,
Language skills of children and adolescents with Down syndrome. Journal of Speech and Hearing Research, 34, 1106
1120.
CHAPMAN, R. S., SEUNG, H., SCHWARTZ, S. E. and KAY-RAINING,
E., 1998, Language skills of children and adolescents with
Down syndrome: II. Production deficits. Journal of Speech,
Language and Hearing Research, 41, 861873.
DIEZ- ITZA, E., MIRANDA, M., 2007, Perfiles gramaticales especficos
en el sndrome de Down. Revista de Logopedia, Foniatra y
Fonoaudiologa, 27, 161172.
EADIE, P. A., FEY, M. E., DOUGLAS, J. M. and PARSONS, C. L., 2002,
Profiles of grammatical morphology and sentence imitation
in children with specific language impairment and Down
syndrome. Journal of Speech, Language and Hearing Research,
45, 720732.
FABBRETTI, D., PIZZUTO, E., VICARI, S. and VOLTERRA, V., 1997,
A story description task in children with Down syndrome:
lexical and morphosyntactic abilities. Journal of Intellectual
Disability Research, 41, 165179.
FOWLER, A., 1990, Language abilities in children with Down syndrome: evidence for a specific syntactic delay. In D. Cicchetti
and M. Beeghly (eds), Children with Down syndrome: A Developmental Perspective. Cambridge: Cambridge University Press,
pp. 302328.

347
GALEOTE, M., SOTO, P., SEBASTIA N, E., REY, R. and CHECA, E.,
2012, Vocabulary acquisition in children with Down syndrome: normative data and developmental trends. Infancia y
Aprendizaje, 35, 111122.
HESKETH, L. and CHAPMAN, R. S., 1998, Verb use by individuals
with Down syndrome. American Journal of Mental Retardation, 103, 288304.
MORALEDA, E., 2011, Analisis del desarrollo morfosintactico en
personas con Sndrome de Down en el periodo infantil y
adolescente. Revista de Investigacion en Logopedia, 1, 121
129.
PUYUELO, M., WIIG, E. H., RENOM, J. and SOLANAS, A., 1998,
Batera de Lenguaje Objetiva y Criterial (BLOC). Barcelona:
Masson.
RODRIGUEZ, L. and OLMO, L., 2010, Aportaciones para la intervencion psicologica y educativa en ninos con sndrome
de Down. Revista Docencia e Investigacion, 20, 307
227.
RONDAL, J. A. and PERERA, J., 2006, Down Syndrome. Neurobehavioural Specificity. Chichester: Wiley.
SERRAT, E., SANZ, M., BADIA, I., AGUILAR, E., OLMO, R. and LARA,
F., 2010, La relacion entre el aprendizaje lexico y el desarrollo
gramatical. Infancia y Aprendizaje, 33, 435448.
VICARI, S., CASELLI, M. C. and TONUCCI, F., 2000, Early language
development in Italian children with Down syndrome: asynchrony of lexical and morphosyntactic abilities. Neuropsychologia, 38, 634644.
WECHSLER, D., 2003, WISC-IV: Technical and Interpretive Manual.
San Antonio, TX: Psychological Corporation.
ZAMPINI, L. and DODORICO, L., 2011, Lexical and syntactic development in Italian children with Downs syndrome. International Journal of Language and Communication Disorders, 46,
386396.

Appendix A: Intervention programme

The intervention programme establishes a main aim for
each of the sessions. Depending on the aim, two or more
sessions are used to achieve it. The aims are structured
in order of complexity, from less to more complex. To
work on each aim, at least two activities are offered.
Prior to carrying out the activity, the therapist explains
it to the child and then shows them what they have
to do, giving several examples. Each session is accompanied by its corresponding material, and an attempt
is always made to offer visual support. Whenever more
than three consecutive errors are made in any of the activities, the therapist will repeat the instructions for the
activity to guarantee that the participant has understood
the procedure for the activities.
Example for session 1: Working on the number
morphemes in nouns (singular and plural)
Main aim
The main aim is the correct use of number inflections in
nouns, and its generalization to spontaneous language.
In Spanish there are two plural noun markers: -s and
-es. As a rule, -s is added to nouns that end in a vowel
(except i/u) and the ending -es for nouns that end in a

348
consonant. All words used in this activity follow these
rules, avoiding irregular plurals.
Materials
Picture cards showing an object. These pictures are not
specific to any given published material. Any visually
clear image can be used, from those already published
to ad-hoc designs, catalogues, etc.
Activities
1. Activity 1: Focuses on the forming the plural using
singular nouns. We used 20 pictures for naming in
this activity. The steps to be followed in this part of
the treatment were:
1.1. Naming the object presented. The therapist asks: What is this? A response is
obtained.
1.2. Introducing the required morpheme. Using the
response given in 1.1. the therapist continues:
Good. Here we have a car. And if there were
lots? Then we would have some . . . . The target
response is obtained. If the response is not the
expected one or is wrong the therapist provides
the correct response and repeats the sentence
so that the child ends the structure correctly.
Repeat as many times as necessary.
1.3. Generalization. We attempt to generalize the
structure worked on with the same pictures put
into different context situations, even carrying
out role play.
(1) Activity 2: This task is considerably more difficult
than activity 1, given that we use the determiner
itself to evoke the corresponding noun which coincides in gender and number. The activity is presented as a game. The therapist says to the child:
Now Im going to say a word and you have that
say another word that might go with the one I said.
Shall we try an example? If I say the . . . you
can say . . . ? If the child cant think of anything,
we offer examples to help: The (masculine) . . .
tree or the (masculine) . . . pencil. Now its your
turn.
Thirty determiners were used to form the structures.
This task becomes particularly attractive if it is made
into a race. Thus, we can give an incentive for responses,
saying that the child who says more words with the
correctly matched determiner will win. We draw smiley
faces when the responses are correct.
If incorrect responses are given we draw sad faces,
which often lead to self-correction. If this does not happen, we give them the correct response without asking

Esther Moraleda Sepulveda et al.

for repetition. Only when they finish the race will we tell
them what they did wrong and ask them to repeat the
structure correctly, beginning the generalization phase
as above in 1.3.
Whenever the child carries out the model activities
correctly, he or she receives positive verbal reinforcement
such as: Good, Well done, Keep it up, etc.
Example for session 2. Working on complex sentences
and their generalization
Main aim
The main aim is the correct formation and generalization of complex sentences composed by subject + verb
+ complement which is the regular word order in
Spanish. All examples follow this order.
Materials
For the first task 20 picture cards showing different
activities are required (someone buyingselling, singing,
etc.). For the second task they are required also 20 picture
cards showing known objects (a tree, a house, a car, etc.).
Pictures are not specific to any given published materials.
Activities
1. Activity 1: Sentence formation following the correct word order. The therapist asks the child: What
does the child? The child answers the question. In
case of success the therapist reinforces well done,
great and repeats the sentence correctly. In case of
an incorrect response, the therapist says the child
the subject; in this case the child and waits until
the child continues the sentence. If the child completes the sentence correctly, the same reinforcement is carried out. If the response is still incorrect
or the child does not try again, the therapist says
the subject (again) and the verb the child takes,
and waits until the child completes the sentence. If
the child completes the sentence correctly, the same
reinforcement as said before is carried out. If the
response is still incorrect, the therapist says entirely
the sentence and the child has to repeat it. After the
repetition of the child the therapist repeat again the
sentence.
2. Activity 2: Sentence formation from a single word.
The therapist asks the child what is shown in the
picture. The child has to answer. If the child answers correctly, the therapist reinforces the child as
explained in the previous activity. If the child does
not repeat correctly or says that she/he does not
know, the therapist says the word and the child
has to repeat it. After this repetition, the therapist

Can individuals with Down syndrome improve their grammar?

repeats it again. Once the word is known, the therapist says to the child that he/she has to make a
sentence with that word following the previous examples. If the child says a sentence correctly (subject
+ verb + object), the therapist reinforces the child.
If the child is not capable, the therapist starts the
sentence by saying the subject (which includes the

349
noun and the article). As in the previous tasks, if
the child says a sentence correctly, the therapist reinforces, and if the child is still not able to say a
complex sentence, the therapist continues by saying
the object plus a verb. In the last case, the therapist
says a full sentence and the child repeats it. The
therapist also repeats the sentence.