*4.4. More Difficulties with Speech Fluency Not Related to Higher Level of Dissociation in Expressive and Receptive Language Skills*

The children with Down syndrome in this study had, on average, both a low language level and a dissociation between expressive and receptive domains. Nevertheless, the results do not indicate an association between a higher degree of difficulties with speech fluency and a larger gap between expressive and receptive language skills, with the only marginally significant finding actually going in the opposite direction. Contradictory to our findings, studies with typically developing children suggest that gaps in performance within or between linguistic subcomponents, such as between receptive and expressive vocabulary, are associated with stuttering [33,34,83,105]. Anderson et al. [34] concluded that their sample of 45 children who stutter (age 3–5.11 years) was three times more likely to have dissociations across speech-language domains than their sample of 45 children who do not stutter (age 3–5.11 years). Coulter et al. [83] replicated the paper from Anderson et al. [34], and their results showed that children who stutter were five times more likely to have dissociations than children who do not stutter. They suggested that the dissociations could be markers of speech and language production systems that are not congruent with each other [83]. However, we did not find a relationship between higher level of dissociation and more difficulties with speech fluency in children with Down syndrome. This may be due to a minimal impact of the gap between receptive and expressive skills on difficulties with speech fluency or to the coarse assessment of difficulties with fluency and the parent-reported nature of the variable.
