Free-play Interactions Research Articles

Adult recasts as fluency-facilitators in preschoolers who stutter: Evidence from FluencyBank

Adult conversational recasts are based on child platform utterances that contain errors (e.g., Child: “Me going.” Adult: “Yes, you are going”), and recasts are effective in the child language literature. For many years, adult recasts of preschoolers’ stuttered utterances were surmised as fluency-facilitating, but to date, no evidence has been reported to support their efficacy. The purpose was to investigate the natural occurrence of, and the fluency-facilitating potential of, recasts produced by caregivers and clinicians/examiners in free-play interactions transcribed from audio or video recordings on FluencyBank. Forty-three participants with a median age of 38 mo (3;2) (Range=28–73 mo), including 32 boys and 11 girls were selected from five databases, and recasts which were near-imitations and simple recasts as per Weiss (2002) were identified. One database chosen was the Illinois project, to include a subgroup of persistent (n = 9) and recovered children (n = 9). In the 43 participants, significantly (p < 0.0001) fewer stutters and lower percent syllables stuttered (%SS) were observed in post-recast utterances (4%SS) as compared to post-nonrecast utterances (12.5%SS). The CWS-persistent subgroup (n = 9) did not fit the group trend of the 34 others who significantly differed in stuttering frequency post-nonrecast versus postrecast. Findings are taken to mean that adult conversational recasts of preschoolers’ stuttered utterances are fluency-facilitating, and interpretations are addressed.

Sentence Diversity in Spanish-English Bilingual Toddlers.

There remain few available tools to assess language development in Spanish-English dual language learner (DLL) toddlers in the United States. Of interest is the development of early sentences as children move from producing single words to producing multiword utterances. This study is the first to extend sentence diversity to the context of Spanish-English DLLs by describing development from 24 to 30 months of age in children with and without language delays (LDs). Spontaneous language samples were collected from Spanish-dominant DLL children and their mothers as they were observed during a free-play interaction. Existing sentence diversity protocols were adapted for the DLL context to describe children's flexibility in combining subjects and verbs to form utterances in Spanish and English. Children maintained an accurate separation in their grammars for subject-verb combinations in Spanish versus English. There was an overwhelming preference for Spanish subject-verb combinations with null subjects. The emergence of sentence diversity distinguished children with and without early LD unlike the emergence of word combinations. Consistent with prior research, findings showed that DLLs did not confuse grammatical structures across languages. Instead, they showed a differential pattern of results in each language, such that the strongest grammatical skills were evinced first in the dominant language. Sentence diversity shows promise for assessment and progress monitoring in Spanish-English DLLs in the United States.

Caregiver sensitivity predicts infant language use, and infant language complexity predicts caregiver language complexity, in the context of possible emerging autism.

While theory supports bidirectional effects between caregiver sensitivity and language use, and infant language acquisition-both caregiver-to-infant and also infant-to-caregiver effects-empirical research has chiefly explored the former unidirectional path. In the context of infants showing early signs of autism, we investigated prospective bidirectional associations with 6-min free-play interaction samples collected for 103 caregivers and their infants (mean age 12-months; and followed up 6-months later). We anticipated that measures of caregiver sensitivity/language input and infant language would show within-domain temporal stability/continuity, but also that there would be predictive associations from earlier caregiver input to subsequent child language, and vice versa. Caregiver sensitive responsiveness (from the Manchester Assessment of Caregiver-Infant interaction [MACI]) predicted subsequent infant word tokens (i.e., amount of language, coded following the Systematic Analysis of Language Transcripts [SALT]). Further, earlier infant Mean Length of Utterance (MLU; reflecting language complexity, also derived from SALT coding) predicted later caregiver MLU, even when controlling for variability in infant ages and clear within-domain temporal stability/continuity in key measures (i.e., caregiver sensitive responsiveness and infant word tokens; and infant and caregiver MLU). These data add empirical support to theorization on how caregiver input can be both supportive of, and potentially influenced by, infant capacities, when infants have social-communication differences and/or communication/language delays suggestive of possible emerging autism.

Infant vocalizations elicit simplified speech in childcare.

Infant babbling has an important social function in promoting early language development by attracting caregiver attention and prompting parents' contingent, simplified speech, which is more learnable for infants. Here, we demonstrate that prelinguistic infant vocalizations also create learning opportunities for infants in childcare settings by eliciting simplified and more learnable linguistic information during teacher-infant interactions. We compared the rates and complexity of contingent and non-contingent verbal interactions of 34 childcare teachers during a one-on-one free play interaction with a familiar infant under their care (M=12.6months old). As compared to non-contingent utterances, teachers' contingent utterances included fewer unique words, a higher proportion of single-word responses, and a shorter mean length of utterances. Teachers did not change their response length based on infants' syllable type and were equally likely to respond to vowels and consonant-vowel vocalizations. Sources of individual differences in the simplification effect related to infant behaviors and teacher characteristics are discussed. The results parallel previous findings demonstrating the simplification effect in parent-infant interactions. That teachers also show this simplification effect when responding to infant vocalizations suggests the power of infant prelinguistic vocalizations for organizing caregiver attention in various settings to elicit simplified, learnable language.

Communication Breakdowns and Repairs of Children with Autism Spectrum Disorder with Fathers and Mothers

ABSTRACT The ability to repair breakdowns in communication is a critical pragmatic language skill. To date however, studies of repairs have been conducted with mothers or examiners. Little is known about repairs children with autism spectrum disorder (ASD) use in interactions with fathers. Expanding our understanding of communication repairs used with fathers, and how these compare with mothers, may have clinical implications for improving social communication skills for children with ASD. This descriptive study investigated communication breakdowns and repairs of 16 children with ASD and fathers and mothers, during unscripted 15-min parent-child play sessions. Analysis of breakdowns and repairs was compared across parent gender. Findings provide early evidence of differences in breakdowns experienced and communication repairs used by children with ASD in interactions with their mothers and fathers. In parent-child free-play interactions, children with ASD had significantly fewer initiations, more breakdowns, and lower rates of repairs, with fathers than with mothers. Results suggest that including fathers in parent coaching aimed at increasing initiations, reducing breakdowns, and enhancing repair strategies may be a valuable component of parent-implemented social communication interventions for children with ASD.

Joint attention episodes during interactions with fathers but not mothers at age 2 years is associated with expressive language at 3 years

Joint Attention (JA) in parent–infant interaction has been demonstrated to contribute to infants’ language outcomes. A limited number of studies have investigated the characteristics of JA episodes during parent–toddler interaction in relation to toddlers’ language development. The majority of these studies were conducted with mothers, whereas JA with fathers remains understudied. The current study investigated JA episodes during interactions with mothers and fathers separately as well as longitudinal associations with child language outcomes. A total of 31 toddlers (18 girls) and their mothers and fathers participated in the study at ages 2 years (M = 24.07 months, SD = 1.45) and 3 years (M = 37.44 months, SD = 1.72). JA episodes were observed during free play interactions at age 2 and were coded microanalytically; receptive and expressive language skills were assessed by Bayley Scales of Infant and Toddler Development–Third Edition at ages 2 and 3. No significant differences in JA episodes were found between mother–toddler and father–toddler dyads. Whereas JA characteristics with mothers were not found to be significantly associated with toddlers’ language outcomes, multiple linear regression analyses showed that paternal education and parent-followed JA episodes during father–toddler interaction at age 2 explained a significant amount of variance in toddlers’ expressive language skills at age 3. Findings suggest that JA episodes during interactions with fathers might benefit toddlers’ expressive language development.

Mothers’ and fathers’ bimodal communication in dyadic and triadic interaction with their infants

Parents play an important role in children’s language development. To our knowledge, no studies have compared fathers’ and mothers’ use of gestural and verbal communication in dyadic versus triadic contexts. This study aimed at analyzing similarities and differences in the bimodal communication of parents when they play alone with their infant and when all three play together. Twelve Italian-speaking families with infants aged 16 months took part in the study. Dyadic and triadic free-play interactions of mothers and fathers with their infants were videotaped. Mothers’ and fathers’ communicative acts (i.e., ‘only speech’, ‘only gesture’, ‘speech + gesture’), and types of gestures (i.e., deictic, representational, and emphatic) were coded. Results showed that infants experience mothers’ and fathers’ bimodal communication when interacting with both parents. In the dyadic context, mothers produced more communicative acts and more verbal communication than fathers who in turn used more gestures and ‘speech + gesture’ communicative acts than mothers. Both parents used gestures to clarify and reinforce their verbal communication in dyadic and triadic contexts. With respect to the triadic context, no differences between mothers’ and fathers’ verbal and non-verbal communication emerged. Comparing each parent across the two contexts, findings showed that in the triadic context, mothers increased their use of gestural communicative acts and decreased their use of mixed acts, whereas fathers increased their verbal component while decreasing their ‘speech + gesture’ communicative acts. It seems that in the triadic context there is a coordination between parents that leads them to align with the kind of communication provided to the infant. Thus, the input experienced by infants in the triadic context is still equally composed of both verbal and non-verbal communication. Results are discussed considering the role of parents’ bimodal communication within several daily interactional contexts.

Maternal sensitivity at the age of 8 months associates with local connectivity of the medial prefrontal cortex in children at 5 years of age.

The quality of mother–child interaction, especially maternal sensitivity in caregiving behavior, plays an important role in a child’s later socioemotional development. Numerous studies have indicated associations between poor mother–child interaction and offspring brain structure and function, but more knowledge on how variation in the characteristics of early caregiving is associated with children’s brain structure and function is needed. We investigated whether maternal sensitivity at 8 or 30 months is associated with functional connectivity in a child’s brain at 5 years of age based on the FinnBrain Birth Cohort Study (17 and 39 mother–child dyads at 8 and 30 months, respectively, with an overlap of 13 dyads). Maternal sensitivity was assessed during a free play interaction using the Emotional Availability Scales at 8 and 30 months of the children’s age. Task-free functional magnetic resonance imaging (fMRI) was acquired at the age of 5 years in 7-min scans while watching the Inscapes movie. Regional homogeneity (ReHo) maps were created from the fMRI data, and multiple regression analysis was performed to assess the relation between maternal sensitivity and ReHo. Maternal sensitivity at the age of 8 months was positively associated with children’s ReHo values within the medial prefrontal cortex. Distal connectivity of this region showed no significant association with maternal sensitivity in a seed-based connectivity analysis. No associations were found between maternal sensitivity during toddlerhood and brain functional connectivity. Together, these results suggest that maternal sensitivity, especially in infancy, may influence offspring brain functional connectivity. However, studies with larger sample sizes are warranted.

Child language and autism diagnosis impact hierarchical temporal structure of parent-child vocal interactions in early childhood.

Timing is critical to successful social interactions. The temporal structure of dyadic vocal interactions emerges from the rhythm, timing, and frequency of each individuals' vocalizations and reflects how the dyad dynamically organizes and adapts during an interaction. This study investigated the temporal structure of vocal interactions longitudinally in parent-child dyads of typically developing (TD) infants (n=49; 9-18 months; 48% male) and toddlers with ASD (n=23; 27.2 ± 5.0months; 91.3% male) to identify how developing language and social skills impact the temporal dynamics of the interaction. Acoustic hierarchical temporal structure (HTS), a measure of the nested clustering of acoustic events across multiple timescales, was measured in free play interactions using Allan Factor. HTS reflects a signal's temporal complexity and variability, with greater HTS indicating reduced flexibility of the dyadic system. Child expressive language significantly predicted HTS (ß=-0.2) longitudinally across TD infants, with greater dyadic HTS associated with lower child language skills. ASD dyads exhibited greater HTS (i.e., more rigid temporal structure) than nonverbal matched (d=0.41) and expressive language matched TD dyads (d=0.28). Increased HTS in ASD dyads occurred at timescales >1s, suggesting greater structuring of pragmatic aspects of interaction. Results provide a new window into how language development and social reciprocity serve as constraints to shape parent-child interaction dynamics and showcase a novel automated approach to characterizing vocal interactions across multiple timescales during early childhood.

Applicability of a Novel Attunement Instrument and Its Relationship to Parental Sensitivity in Infants With and Without Visual Impairments

This study investigated the applicability of a novel instrument to assess parent–child attunement in free play interactions, in dyads with an infant with and without visual impairments (VI). We here report the findings on the reliability and applicability of the newly developed Attune & Stimulate Mother–Infant 56-items Instrument (A&S M-I) in two separate samples: one with infants with VI (N = 20) and one with typically sighted infants (N = 24). In addition, we assessed the contribution of parental sensitivity to attunement in dyadic interactions. The A&S M-I is an observational comprehensive instrument of behaviors that captures different body parts and their motility (i.e., finger movements, arm waving, and foot kicking), and different senses (i.e., audio, tactile, and visual). The appropriate responding of a parent to the child’s signal (i.e., matching and containing) reflects the ability to attune in the dyad as well as parent’s ability to stimulate the child to become engaged in the contact or activity. Consistency assessments revealed good reliability for maternal and infant behaviors, acceptable internal consistency and good test–retest reliability. Furthermore, both samples scored significantly above chance level on attunement, suggesting that the instrument captures parent–infant behavioral coordination, and VI was not related to parent–infant attunement. Lastly, a relation between parental sensitivity and attunement was found only in the TS sample. Altogether, these findings provide promising initial evidence of the applicability of the A&S M-I instrument for assessing dyadic attunement across different populations and ages. Having assessed the applicability of this observational instrument, future work should corroborate these findings in larger samples.

Effect of the START-Play Physical Therapy Intervention on Cognitive Skills Depends on Caregiver-Provided Learning Opportunities

Aims This study evaluated whether caregiver-provided learning opportunities moderated the effect of START-Play physical therapy intervention on the cognitive skills of young children with neuromotor delays, and whether START-Play impacted caregiver-provided learning opportunities over time. Methods One hundred and twelve children with neuromotor delays (7–16 months) participated in a multisite randomized clinical trial evaluating the efficacy of START-Play. Children were assessed at baseline and 3 (post intervention), 6, and 12 months post baseline. Cognition was scored from the Bayley Scales of Infant & Toddler Development, Third Edition, cognitive scale. The proportion of time caregivers spent providing learning opportunities was coded from a 5-minute caregiver-child free play interaction. Results Baseline caregiver-provided learning opportunities moderated the 3- and 12-month effects of START-Play on cognition. Cognitive gains due to START-Play were more pronounced for children whose caregivers provided more learning opportunities. START-Play did not impact caregiver-provided learning opportunities over time. Conclusions START-Play may have a lasting effect on children’s cognition, but this effect is contingent on caregivers providing their child with ample opportunities to practice cognitive skills. Strategies for improving caregivers’ uptake and transfer of START-Play principles to their daily routines should be evaluated. Trial Registration ClinicalTrials.gov NCT02593825

Prosocial Behavior in Preschoolers: Effects of Early Socialization Experiences With Peers.

Over the last decades, many studies had focused on the psychological outcomes of children who have received early socialization outside of the family context, highlighting that the daycare experience can both positively and negatively influence the child’s social-emotional development. Despite the number of studies conducted, there is a lack of observational research on this topic. The purpose of this study is to investigate whether the early daycare experience can influence the prosocial behaviors that children exhibit during free-play social interactions with peers, focusing on their quantity and quality. In addition, the associations between the enactment of prosocial behaviors and social-emotional and behavioral competence were investigated. 160 preschoolers, 77 of whom had previously attended daycare, participated in the study and were focally observed during two free play sessions with peers. Each prosocial behavior was identified and subsequently classified using a coding scheme designed to consider the self-initiated or required origin of prosocial actions and their underlying motive. Emotion comprehension was measured using a standardized test, while social-emotional and behavioral competence was assessed using a questionnaire filled out by teachers. The main findings showed that children who had attended daycare had higher anger and aggression scores than those who had not, who, in turn, were rated by their teachers as having more internalizing behaviors. These characteristics seemed to account for the differences found in the tendency to act prosocial acts in response to a peer’s request, which was lower in children who had a previous daycare experience. Moreover, early socialization outside of the family context appeared to foster the comprehension of others’ intent to achieve emotional or instrumental personal goals and, at the same time, to reduce conventional/affiliative prosocial acts. Overall, this study suggested that the incidental effects of daycare on prosocial behavior might be canceled due to the peculiar social-emotional and behavioral characteristics of the two groups of children.

Turn-Taking in Free-Play Interactions: A Cross-Sectional Study from 3 to 5 Years

Turn-Taking in Free-Play Interactions: A Cross-Sectional Study from 3 to 5 Years

Mother–Child Language Style Predicts Internalizing Behaviors in Children Exposed to Intimate Partner Violence

Exposure to intimate partner violence (IPV) is associated with children's internalizing and externalizing problems. IPV is thought to impair mothers' ability to scaffold young children's emotion regulation through coregulated interactions. Mother–child language style matching (LSM) is an index of coregulation that has yet to be examined in IPV-exposed samples. We hypothesized that LSM would mediate the association between IPV and children's behavioral problems. Participants were 194 mother–child dyads. IPV was assessed annually when children were ages 1–4. LSM was derived from speech during a free-play interaction at age 4, and children's behavior problems were assessed concurrently and again at age 10. Chronic IPV exposure in early life was associated with lower levels of mother–child LSM. LSM also mediated the association between IPV and later internalizing problems. These findings provide evidence that mother–child LSM may be a useful index of parent–child interaction quality in the context of IPV.

Differential At-Risk Pediatric Outcomes of Parental Sensitivity Based on Hearing Status.

Purpose The aim of this study was to investigate the role of parental sensitivity in language and neurocognitive outcomes in children who are deaf and/or hard of hearing (DHH). Method Sixty-two parent-child dyads of children with normal hearing (NH) and 64 of children who are DHH (3-8 years) completed parent and child measures of inhibitory control/executive functioning and child measures of sentence comprehension and vocabulary. The dyads also participated in a video-recorded, free-play interaction that was coded for parental sensitivity. Results There was no evidence of associations between parental sensitivity and inhibitory control or receptive language in children with NH. In contrast, parental sensitivity was related to children's inhibitory control and all language measures in children who are DHH. Moreover, inhibitory control significantly mediated the association between parental sensitivity and child language on the Clinical Evaluation of Language Fundamentals-Fifth Edition Following Directions subscale (6-8 years)/Clinical Evaluation of Language Fundamentals Preschool-Second Edition Concepts and Following Directions subscale (3-5 years). Follow-up analyses comparing subgroups of children who used hearing aids (n = 29) or cochlear implants (CIs; n = 35) revealed similar correlational trends, with the exception that parental sensitivity showed little relation to inhibitory control in the group of CI users. Conclusions Parental sensitivity is associated with at-risk language outcomes and disturbances in inhibitory control in young children who are DHH. Compared to children with NH, children who are DHH may be more sensitive to parental behaviors and their effects on emerging inhibitory control and spoken language. Specifically, inhibitory control, when scaffolded by positive parental behaviors, may be critically important for robust language development in children who are DHH.

Nine-month old infants' hand preference shows no link to concurrent or later vocabulary.

Previous studies have shown a link between language abilities and right hand preference (RHP) for both object manipulation and pointing between 10 and 18 months of age. For infants, RHP can still be unstable. The purpose of the present study was to test whether the link between vocabulary and RHP exists among 9-month-old infants. The study included 88 infants who were observed in videotaped free-play interactions with their mothers at 9 months of age. The infants' hand preference was coded for touching objects and pointing. The children's vocabulary was measured at 9, 12, and 18 months of age. The results showed a small and significant RHP for touching objects and no significant RHP for pointing. The degree of RHP was not correlated with vocabulary scores at any age. One interpretation of these results is that, for the infants in this study, the lateralization for motor abilities was still stabilizing and therefore showed no relationship with their vocabulary. If so, this result is consistent with the argument that language lateralization builds on the lateralization for skilled and/or communicative movement.

Infants Oscillatory Frequencies change during Free-Play

Social interactions are known to be an essential component of infant development. For this reason, exploring functional neural activity while infants are engaged in social interactions will enable a better understanding of the infant social brain. This in turn, will enable the beginning of disentangling the neural basis of social and non-social interactions as well as the influence that maternal engagement has on infant brain function. Maternal sensitivity serves as a model for socio-emotional development during infancy, which poses the question: do interactions between parents and their offspring present altered electrophysiological responses in comparison to the general population if said parents are at risk of mental health disorders? The current research aimed to observe the oscillatory activity of 6-month-old infants during spontaneous free-play interactions with their mother. A 5-minute unconstrained free-play session was recorded between infant-mother dyads with EEG recordings taken from the 6-month-old infants (n = 64). During the recording, social and non-social behaviours were coded and EEG assessed with these epochs.Results showed an increase in oscillatory activity both when an infant played independently or interacted with their mother and oscillatory power was greatest in the alpha and theta bands. In the present 6-month-old cohort, no hemispheric power differences were observed as oscillatory power in the corresponding neural regions (i.e. left and right temporal regions) appeared to mirror each other. Instead, temporal estimates were larger and different from all other regions, whilst the frontal and parietal regions bihemispherically displayed similar estimates, which were larger than those observed centrally, but smaller than those displayed in the temporal locations. The interactions observed between the behavioural events and frequency bands demonstrated a significant reduction in power comparative to the power observed in the gamma band during the baseline event.The present research sought to explore the obstacle of artificial play paradigms for neuroscience research, whereby researchers question how much these paradigms relate to reality. The present manuscript will discuss the strengths and limitations of taking an unconstrained free-play approach.

Physical touch during father-infant interactions is associated with paternal oxytocin levels

IntroductionPhysical connection, particularly parent-to-infant touch, is critical for the well-being of infants and may support the development of the parent-infant bond. Physical touch has also been found to stimulate oxytocin levels. This study tested whether fathers' micro-coded touch behaviors during parent-child interaction predicted their subsequent oxytocin levels. We also compared two widely-used methods of oxytocin immunoassay that have been found to yield discrepant results in past studies. MethodsAmong 45 fathers and their six-month-old infants, we micro-coded paternal physical touch at 1/10 s intervals during a laboratory-based free-play interaction. Paternal oxytocin was measured via blood plasma and was processed both with and without the extraction step prior to immunoassay so that results from the two methods could be compared. ResultsUnextracted and extracted oxytocin were moderately correlated within our sample. Fathers who engaged in more playful proprioceptive touch showed higher levels of both unextracted and extracted oxytocin. Gentle affectionate touch and functional proprioceptive touch predicted higher unextracted but not extracted oxytocin levels. Fathers who did not engage in physical touch showed lower levels of both unextracted and extracted oxytocin. ConclusionResults are consistent with previous work showing that physical touch, particularly playful proprioceptive touch, is associated with higher oxytocin levels in fathers. These results replicate previous research using unextracted oxytocin measurement, and extend this work, showing that many but not all associations hold when using the more rigorous method of extraction when measuring oxytocin.

Pregnancy-specific stress and sensitive caregiving during the transition to motherhood in adolescents

BackgroundMaternal prenatal stress is associated with worse socio-emotional outcomes in offspring throughout childhood. However, the association between prenatal stress and later caregiving sensitivity is not well understood, despite the significant role that caregiving quality plays in child socio-emotional development. The goal of this study was to examine whether dimensions of pregnancy-specific stress are correlated with observer-based postnatal maternal caregiving sensitivity in pregnant adolescents.MethodsHealthy, nulliparous pregnant adolescents (n = 244; 90 % LatinX) reported on their pregnancy-specific stress using the Revised Prenatal Distress Questionnaire (NuPDQ). Of these 244, 71 participated in a follow-up visit at 14 months postpartum. Videotaped observations of mother-child free play interactions at 14 months postpartum were coded for maternal warmth and contingent responsiveness. Confirmatory factor analysis of the NuPDQ supported a three-factor model of pregnancy-specific stress, with factors including stress about the social and economic context, baby’s health, and physical symptoms of pregnancy.ResultsGreater pregnancy-specific stress about social and economic context and physical symptoms of pregnancy was associated with reduced maternal warmth but not contingent responsiveness.ConclusionsHeightened maternal stress about the social and economic context of the perinatal period and physical symptoms of pregnancy may already signal future difficulties in caregiving and provide an optimal opening for early parenting interventions.

Parent Command Use and Child Compliance During Parent-Child Interactions Including Children With Down Syndrome.

Purpose This study investigated maternal and paternal command use and child compliance in children with Down syndrome during mother-child and father-child free-play interactions. We also examined child compliance to direct versus indirect commands, and the relationships between maternal command use, paternal command use, child compliance, and child speech and language abilities. Method Fifteen families including a mother, father, and child with Down syndrome participated. Mother-child and father-child dyads participated in free-play interactions. We coded overall parent command use, command type (direct or indirect), and child compliance with the commands. Child language abilities were measured using a standardized assessment as well as during free-play. Results Mothers and fathers of children with Down syndrome used a similar number of commands, and children complied similarly across interactions. Children were more likely to comply with direct versus indirect commands. Parent command use was related to child language abilities in different ways for mothers and fathers. Child compliance was not related to receptive or expressive language abilities. Conclusions Mothers and fathers of children with Down syndrome use commands in similar ways but may base their command use on different child factors. Using direct commands with children with Down syndrome may be beneficial when increasing compliance during early interactions.