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Year : 2012  |  Volume : 28  |  Issue : 2  |  Page : 136-141

Assessment of nonsymbolic communication skills in children with Down syndrome and autism

1 Unit of Phoniatrics, Otorhinolaryngology Department, Ain-Shams University, Egypt
2 Clinical Genetics Department, National Research Center, Cairo, Egypt

Correspondence Address:
Samira Ismail
Department of Clinical Genetics, National Research Center, Behoth Street, Dokki, 11769 Cairo
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Source of Support: None, Conflict of Interest: None

DOI: 10.7123/01.EJO.0000413586.50968.a4

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Communication is among the most basic of human needs. Verbal communication is the highest level of communication, whereas nonverbal (nonsymbolic) communication may remain the only mode of communication in individuals with significant cognitive limitation. Assessment of nonsymbolic skills of two categories of patients with limited verbal output, namely, those with autism [autistic disorder (AD)] and those with Down syndrome (DS), is our main aim. We used the Dynamic Assessment of Nonsymbolic Communication (DANC) test to achieve our aim, because most traditional language tests underestimate this type of communication. Insight into the nonverbal communication abilities of AD and DS patients helps to maintain the communication between them and their caregivers.

Participants and methods

The current study recruited 20 patients with DS, 20 patients with AD, and 20 normal children as controls. The age of the AD and DS patients ranged from 2 to 5 years, whereas the age of controls ranged from 1 to 2 years. All participants were subjected to detailed personal, family, medical, and developmental history taking. Full clinical examination, hearing tests, and assessment of mental ability (intelligence quotient) were performed. The Childhood Autism Rating Scale was provided to evaluate the severity of autism. The DANC test was administered to evaluate the nonsymbolic skills of all participants.


The control group achieved the highest score in all parts of the DANC test, followed by the DS group and the AD group, respectively. There was no significant difference between the DS group and normal group (P>0.05), whereas the autistic group showed highly significantly lower scores compared with both the normal and DS groups (P<0.001). There was also a highly significant difference in scores on the DANC test among the patients in the autistic group in terms of its severity.


Application of the DANC test reflected a specific pattern of nonsymbolic skills of AD and DS patients with respect to their relative strengths and weakness. Such patterns should be considered while designing their intervention program aiming either at developing verbal communication or at enhancing the nonverbal skills. Maintaining communication with such patients helps to fulfill their simple needs and prevents frustration among their caregivers caused by lack of communication.

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