Evaluating the BabblePlay app intervention to encourage vocalising in infants with Down Syndrome

Approximately one baby out of 893 live births in the UK is born with Down syndrome (Public Health England, 2019). Babies with Down syndrome don't use their voice to make sounds as much as typically developing babies (Parikh & Mastergeorge, 2018; Thiemann-Bourque et al., 2014). Therefore their language development is delayed from the outset, and continues to develop more slowly than for typically developing children. Language learning problems in childhood are associated with worse mental health and a lower rate of employability later in life (Law et al., 2009). This project aims to tackle this particular issue and through it a wider societal challenge. We propose a method to encourage babies with Down syndrome to make more sounds with their voice (that is, to vocalise), to support early language development. Improved language proficiency for people with Down syndrome will benefit not only them and their families, but also society more broadly, by helping individuals lead a mentally healthier life and improve their employability.

Our team designed the BabblePlay app. The app encourages babies to vocalise by responding to the babies' vocalisations with colourful moving shapes on an iPad screen (Daffern et al., 2020). Results of a one-week preliminary (pilot) study demonstrated that babies with Down syndrome made more sounds when playing with BabblePlay than when playing with a mirror, and increased the number of sounds they made throughout the week of playing with the app. BabblePlay is an easily accessible, parent/carer led intervention tool for babies with Down syndrome, which makes it feasible as an intensive daily intervention.

This project will conduct a trial of the BabblePlay intervention with babies with Down syndrome. The trial will evaluate the feasibility of engaging children and families over 3-6 weeks, the recruitment and randomisation procedures, and the suitability of the assessment measures. This work will provide critical knowledge about the feasibility of a Definitive Trial of BabblePlay with this population, and represents a significant advance in early spoken language intervention for this group.

The study is led by an interdisciplinary academic team in collaboration with the Down Syndrome Education International (DSEI) charity. The study design was co-created with parents who participated in the preliminary study. Clinicians, parents/carers of children with Down syndrome and adults with Down syndrome are already engaged to form a Trial Management Group which will be involved in shaping the procedures, creating ties with the community, evaluating the running of the study, and disseminating its findings to users and policy makers.

If BabblePlay proves beneficial for advancing the language of children with Down syndrome, it will generate significant positive impacts for the children and their families and for Speech and Language Therapists. Speech and Language Therapy services are often poorly resourced and prohibitively expensive; BabblePlay, which is implemented by parents/carers, could offer an accessible and cost-effective support for families and is intended for use during the baby's first year of life, when most babies with Down syndrome do not currently receive Speech and Language Therapy. Following the trials we will make BabblePlay available for free to families with children at risk for language delay and to early years professionals. This will give families, anywhere in the UK, access to easy-to-implement early speech and language intervention for their children and thus help overcome place inequalities.