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20 April 2026

16 Pages

Sensory-Rich Play and Language Development in Children with Down Syndrome and Intellectual Disabilities: A Quasi-Experimental Study

,
and
1
Department of Preschool Education Science and Educational Design, University of the Aegean, 85131 Rhodes, Greece
2
Department of Special Education, University of Thessaly, 38446 Volos, Greece
3
Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece
*
Author to whom correspondence should be addressed.
Educ. Sci.2026, 16(4), 650;https://doi.org/10.3390/educsci16040650
This article belongs to the Special Issue Innovations and Evidence-Based Approaches in Early Intervention and Early Childhood Special Education
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Abstract

This study examined the association between sensory-rich messy play and language development in children with Down syndrome (DS) and children with intellectual disabilities of unknown etiology (IDUE). Drawing on Vygotsky’s sociocultural theory and the framework of embodied cognition, the study investigated whether different play contexts are differentially associated with expressive and receptive language outcomes across developmental populations. A 2 × 2 quasi-experimental pretest–posttest design was employed. Forty children aged 4 to 6 years were assigned to one of four conditions based on diagnostic group (DS vs. IDUE) and intervention type (sensory-rich messy play vs. structured non-sensory play). Language development was assessed before and after a 12-week intervention using the LaTo standardized test. Mixed-design analyses of variance revealed significant improvements in language performance over time, as well as significant effects of intervention type and diagnostic group. Children who participated in sensory-rich messy play demonstrated greater gains in expressive and receptive language compared to those engaged in structured play. A significant interaction between diagnostic group and intervention type was also observed, indicating that the association between play context and language development differed across groups. In particular, children with DS in the messy play condition showed the most pronounced improvements, especially in expressive language. These findings suggest that sensory-rich play contexts are associated with enhanced language outcomes, particularly for children with DS. However, due to the quasi-experimental design, causal interpretations should be made with caution. These findings suggest that sensory-rich play contexts are associated with enhanced short-term language outcomes, particularly for children with DS. However, due to the quasi-experimental design and the absence of follow-up assessment, conclusions regarding long-term or causal effects should be made with caution.

1. Introduction

Messy play, defined as engagement with tactile and sensory-rich materials such as sand, water, and paint, constitutes a widely recognized component of early childhood experiences (Ayres, 2005). Through open-ended exploration, children interact with textures, manipulate materials, and engage in activities that can support multiple domains of development. Previous research suggests that sensory-based play environments may facilitate neural integration, promote fine motor coordination, and support exploratory and symbolic thinking (Rushton et al., 2010). In addition, messy play often occurs in socially interactive contexts, encouraging cooperation, shared attention, and turn-taking, which are closely linked to early communicative development (Gascoyne, 2016).
From a language development perspective, sensory-rich play contexts may provide meaningful opportunities for verbal interaction. Children are often prompted to describe their actions, express preferences, and negotiate with peers and adults during play (Hallahan et al., 2020). Empirical evidence suggests that such environments can increase both the frequency and complexity of verbal exchanges (Patimah & Nurhayati, 2023). However, it is important to acknowledge that the effectiveness of messy play is not uniform across populations. Its impact may depend on individual cognitive and linguistic profiles, as well as the degree of scaffolding and environmental support provided. Therefore, while messy play represents a promising approach, it should not be considered universally beneficial without empirical validation across different developmental groups.
The present study is theoretically grounded in Vygotsky’s sociocultural theory, which emphasizes the fundamental role of social interaction and culturally mediated activities in cognitive and language development (Vygotsky, 1978). According to this framework, learning occurs within the Zone of Proximal Development (ZPD), where children acquire new skills through guided participation and interaction with more knowledgeable others. Sensory-rich play environments, such as messy play, may provide an optimal context for such processes, as they naturally encourage collaborative engagement and scaffolded communication.
In addition, the framework of embodied cognition provides a complementary perspective on the role of sensory experiences in learning. According to Barsalou (2008), cognitive processes are grounded in bodily interactions with the environment. Engaging with tactile materials may support the formation of mental representations that underpin both conceptual understanding and language acquisition. Through the integration of sensory and motor experiences, children can associate linguistic labels with concrete experiences, potentially facilitating vocabulary development and semantic processing (Yin et al., 2014, 2015, 2017).
Taken together, Vygotsky’s sociocultural theory and the framework of embodied cognition provide a complementary account of how sensory-rich environments may support language development. While sociocultural theory emphasizes the role of scaffolded interaction within the Zone of Proximal Development, embodied cognition highlights the contribution of sensorimotor experience to the formation of linguistic representations. In the context of messy play, these frameworks converge in suggesting that language learning may be facilitated through the interaction between social engagement and multisensory experience.
Language development in children with Down syndrome (DS) is characterized by a distinct and well-documented profile (Karmiloff-Smith et al., 2012; Kumin, 2012; Miller, 1999). Research consistently indicates that receptive language abilities tend to be relatively stronger than expressive language skills, with particular difficulties observed in syntax and morphology (Abbeduto et al., 2007; Chapman, 1997; Cuskelly et al., 2016; Deckers et al., 2019; Katsarou & Andreou, 2022a; Loveall et al., 2016; Næss et al., 2021). Deficits in phonological memory further constrain vocabulary acquisition and sentence processing (Katsarou & Andreou, 2022b; Jarrold & Baddeley, 2001; Laws et al., 2015; Næss et al., 2015; Smith et al., 2020). At the same time, children with DS often demonstrate relative strengths in social communication, including the use of gestures and nonverbal cues, which can support interaction and compensate for expressive language difficulties (Fidler et al., 2005; Dimitrova et al., 2016; te Kaat-van den Os et al., 2015; Romano et al., 2020). These characteristics suggest that interventions incorporating social interaction and multimodal input may be particularly promising for this population (Brady et al., 2014; Esbensen et al., 2017; Gallegos et al., 2024; Landa, 2018; Quinn et al., 2024; Roberts et al., 2008; Yoder & Warren, 2001).
In contrast, children with intellectual disabilities of unknown etiology (IDUE) present more heterogeneous developmental profiles, reflecting variability in underlying cognitive, neurological, and environmental factors (Matson & Shoemaker, 2009). Language development in this population is often characterized by delays in both receptive and expressive domains, with expressive language typically more affected (Abbeduto et al., 2016; Thurm et al., 2015). Vocabulary acquisition may be slower, and syntactic and morphological development is often limited, resulting in less complex linguistic productions (McDuffie et al., 2017). Phonological memory deficits, commonly observed in children with intellectual disabilities, can further impede language learning (Gathercole & Baddeley, 1990; Lifshitz et al., 2016; Saeed & Tahir, 2016; Sermier Dessemontet et al., 2017). Pragmatic language abilities vary considerably, with some children demonstrating relative strengths and others experiencing significant challenges (Kim et al., 2018; Martin et al., 2018; Smith et al., 2017; Tager-Flusberg & Sullivan, 2000). Given this heterogeneity, responses to intervention are likely to differ across individuals, underscoring the importance of examining how specific approaches, such as sensory-based play, function within this group (Von Tetzchner, 2022; van Wingerden et al., 2014).
Despite the growing interest in sensory-based interventions, the existing literature remains limited in its comparative scope. While previous studies have examined the benefits of messy play in early childhood and in general developmental contexts (Gascoyne, 2019, 2020; Patimah & Nurhayati, 2023), there is a lack of research investigating its differential effects across distinct developmental populations. In particular, to our knowledge, few studies have directly compared the effects of sensory-rich play across distinct developmental populations such as children with Down syndrome and children with heterogeneous intellectual disabilities of unknown etiology. This gap is critical, as these populations differ not only in their cognitive and linguistic profiles but also in their potential responsiveness to specific types of intervention.
In the present study, sensory-rich messy play is operationalized as engagement with open-ended, tactile, and multisensory materials (e.g., sand, water, clay, paint) that encourage exploratory manipulation, variability of sensory input, and spontaneous communicative interaction, in contrast to structured play activities that are goal-directed and involve limited sensory variability.
The present study aims to address this gap by examining the association between messy play and language development in children with DS, in comparison to children with IDUE who participate in structured play activities without sensory enrichment. By adopting a comparative approach, the study seeks to contribute to a more nuanced understanding of how sensory-rich environments may differentially support language development across populations with distinct developmental characteristics.
Based on these theoretical and empirical considerations, the study proposes the following hypotheses:
Hypothesis 1. 
There will be a significant overall improvement in language performance (expressive and receptive) from pre-intervention to post-intervention across participants, reflecting general developmental progression and the effects of structured engagement in play-based activities.
Hypothesis 2. 
Children participating in sensory-rich messy play will demonstrate greater improvements in language outcomes compared to those engaged in structured non-sensory play, indicating an association between sensory-rich environments and enhanced language development.
Hypothesis 3. 
Differences in language development will be observed between diagnostic groups, with children with Down syndrome and children with intellectual disabilities of unknown etiology showing distinct patterns of language performance over time.
Hypothesis 4. 
There will be a significant interaction between intervention type and diagnostic group, such that the association between messy play and language development will differ across groups. Specifically, it is expected that children with Down syndrome will show greater gains in expressive language in the messy play condition, reflecting their relative strengths in social communication and responsiveness to interactive, multimodal environments.
Hypothesis 5. 
A three-way interaction between time, intervention type, and diagnostic group is expected, indicating that changes in language performance over time will vary as a function of both the type of play context and the developmental profile of the participants.

2. Materials and Methods

2.1. Research Design

The present study employed a 2 × 2 quasi-experimental pretest–posttest design to investigate the relationship between play context and language development in children with developmental disabilities. The design incorporated two independent variables: diagnostic group (Down syndrome [DS] vs. intellectual disabilities of unknown etiology [IDUE]) and type of play intervention (sensory-rich messy play vs. structured non-sensory play). This factorial structure resulted in four experimental conditions: children with DS engaging in messy play, children with DS engaging in structured play, children with IDUE engaging in messy play, and children with IDUE engaging in structured play. Such a design allows for the examination of the main effects of diagnostic group and intervention type, as well as their interaction, thereby enabling a more precise interpretation of whether sensory-rich play is differentially associated with language development across populations.
Participants were assigned to intervention conditions within each diagnostic group using stratified allocation procedures, ensuring balanced representation across conditions and reducing potential selection bias. Allocation was not randomized; rather, participants were assigned using a stratified matching procedure based on age and nonverbal ability in order to achieve balanced group composition. Although the design strengthens internal validity relative to non-comparative approaches, it is acknowledged that it remains quasi-experimental, and therefore, causal inferences should be drawn with appropriate caution.

2.2. Participants

The sample consisted of between 40 children (n = 10 per condition), diagnosed either with Down syndrome or intellectual disabilities of unknown etiology. Participants were distributed across the four experimental conditions described above. To enhance comparability between groups, participants were matched on chronological age and nonverbal cognitive ability. Nonverbal reasoning was assessed using Raven’s Progressive Matrices, allowing for the control of cognitive differences that are independent of language ability. Additional demographic variables, including gender and socioeconomic status, were recorded and examined to ensure equivalence across groups.
It is important to note that children with intellectual disabilities of unknown etiology (IDUE) constitute a highly heterogeneous population, encompassing a broad range of cognitive, linguistic, and developmental profiles. To provide a more detailed characterization of this group, additional descriptive information was examined. Children in the IDUE group demonstrated nonverbal reasoning scores ranging from 19 to 31 on Raven’s Progressive Matrices, with a mean of approximately 25, indicating variability within the mild to moderate range of intellectual functioning. In addition, variability was observed in baseline language performance, with differences in both expressive and receptive language levels across participants. Informal observational data from educational records indicated differences in communicative abilities, attention regulation, and engagement with sensory stimuli, further supporting the heterogeneous nature of this group. No participant in the IDUE group had a confirmed genetic syndrome or neurological diagnosis at the time of recruitment. Such variability is likely to influence individual responsiveness to intervention and should therefore be carefully considered when interpreting the findings. In this context, all reported values reflect observed sample data.
The total sample size (n = 40) was determined by the availability of eligible participants within the collaborating settings. Although sufficient to detect medium to large effects, this sample size should be considered modest for a factorial mixed-design analysis, particularly with respect to higher-order interaction effects.
Inclusion criteria for participation included: (a) a confirmed diagnosis of Down syndrome or intellectual disability of unknown etiology, (b) age between 4 and 6 years, and (c) the ability to participate in structured play-based activities. Exclusion criteria included: (a) severe sensory or motor impairments that would prevent participation in play activities, and (b) uncorrected hearing or visual impairments that could affect language assessment. Diagnostic status was verified through clinical and educational records provided by the participating institutions. Demographic Characteristics of Participants by Diagnostic Group and Intervention Condition are presented in Table 1.
Table 1. Demographic Characteristics of Participants by Diagnostic Group and Intervention Condition.

2.3. Measures

Language development was assessed using the LaTo standardized test, which provides quantitative measures of both expressive and receptive language abilities. The expressive language scale has a maximum score of 58, while the receptive language scale has a maximum score of 69. Assessments were administered at two time points: prior to the intervention (pretest) and immediately following the intervention period (posttest), allowing for the evaluation of changes over time.
Nonverbal cognitive ability was assessed using Raven’s Progressive Matrices, a widely used instrument that evaluates abstract reasoning independently of language skills. This ensured that any observed differences in language outcomes were not attributable to baseline differences in general cognitive functioning (Table 2).
Table 2. Nonverbal Reasoning Scores (Raven’s Progressive Matrices) by Group.
The LaTo assessment was administered by two trained assessors with experience in language assessment in children with developmental disabilities. Both assessors followed the standardized administration procedures of the instrument. Assessors were blind to participants’ intervention condition and diagnostic group at the time of assessment. Formal double-scoring procedures were not implemented in the present study; therefore, inter-rater reliability was not estimated from the current sample. This should be taken into account when interpreting the findings. However, both assessors were experienced in administering standardized language assessments and followed strict administration protocols as defined by the test manual. This standardized administration procedure is expected to reduce variability in scoring, although the absence of formal inter-rater reliability estimates remains a limitation.
Descriptive statistics for language performance at pre- and post-intervention are presented in Table 3 and Table 4. At baseline, expressive and receptive language scores were comparable across all groups, indicating no substantial initial differences in language performance.
Table 3. Pre-Intervention Language Scores (LaTo).
Table 4. Post-Intervention Language Scores (LaTo).

2.4. Procedure

Each session lasted approximately 40 min and was conducted twice per week over the 12-week period. The intervention was implemented over a period of 12 weeks, during which all participants engaged in play-based sessions that were matched in terms of duration, frequency, and level of adult support. Children in the sensory-rich messy play condition participated in activities involving tactile and multisensory materials such as sand, water, clay, and paint. These activities were designed to promote exploration, shared attention, and spontaneous communicative interaction within a rich sensory environment.
In contrast, children in the structured non-sensory play condition participated in goal-directed activities such as puzzles, construction tasks, and rule-based games. These activities were designed to involve comparable levels of social interaction and adult scaffolding but did not include sensory-rich materials. In this way, the two intervention conditions were equivalent in terms of social and instructional context, differing only in the presence or absence of sensory stimulation.
To ensure consistency across conditions, the interventions were carefully standardized with respect to session duration and frequency, group size, adult-to-child ratio, and the level of linguistic input and scaffolding provided by facilitators. This standardization was intended to isolate the sensory component of the intervention as the primary variable of interest.
All intervention sessions were delivered individually on a one-to-one basis between each child and the facilitator. No participants were treated simultaneously within the same session, and children did not interact with peers during intervention activities. Therefore, each participant constituted an independent observational unit, and no clustering effects due to shared intervention contexts were present.
Intervention fidelity was monitored using structured observation protocols and session checklists to ensure that activities were delivered as intended and that procedures were applied consistently across groups.
To reduce assessment bias, pre- and post-intervention language assessments were conducted by two evaluators who were blind to participants’ diagnostic group and intervention condition. The assessors were not involved in intervention delivery. Although standardized administration procedures were followed, no double-scoring or re-scoring procedures were conducted; therefore, formal inter-rater and intra-rater reliability indices were not available for the present study.
Intervention fidelity was quantified using structured observation checklists completed by independent observers in a random subset of sessions (approximately 25%). Fidelity scores indicated high adherence to the intervention protocol, with implementation accuracy ranging between 85% and 95% across conditions.

3. Results

Prior to conducting the analyses, data were screened for completeness, outliers, and distributional assumptions. The assumptions of normality and homogeneity of variance were examined, and no substantial violations were identified.
Data were analyzed using SPSS 25.0. Because the intervention was delivered individually, observations were treated as statistically independent for the purposes of the mixed-design ANOVA, and no adjustment for clustering was required. Two separate mixed-design analyses of variance (ANOVAs) were conducted to examine the effects of time (pretest vs. posttest), diagnostic group (DS vs. IDUE), and intervention type (messy play vs. structured play) on expressive and receptive language outcomes, respectively. This approach was adopted in order to reflect the distinct developmental profiles of expressive and receptive language, particularly in children with Down syndrome, where expressive language is typically more impaired than receptive language.
Effect sizes, including partial eta squared and Cohen’s d, were calculated to assess the magnitude of observed effects. Statistical significance was set at p < 0.05. Given the quasi-experimental nature of the design, results were interpreted with appropriate caution, particularly with regard to causal inference.
Descriptive statistics for language performance at pre- and post-intervention are presented in Table 3 and Table 4. At baseline, expressive and receptive language scores were comparable across all groups, indicating no substantial initial differences in language performance. Independent samples t-tests confirmed that there were no statistically significant differences between groups at baseline for either expressive or receptive language (p > 0.05).
A mixed-design analysis of variance (ANOVA) was conducted to examine the effects of time (pretest vs. posttest), diagnostic group (DS vs. IDUE), and intervention type (messy play vs. structured play) on language outcomes. The results of the analyses for expressive and receptive language are presented in Table 5.
Table 5. Results of Mixed-Design ANOVAs for Expressive and Receptive Language Outcomes.
The analysis revealed a significant main effect of time, F(1, 36) = 32.45, p < 0.001, partial η2 = 0.47, indicating that participants demonstrated overall improvement in language performance from pre- to post-intervention. This finding supports Hypothesis 1. A significant main effect of intervention type was also observed, F(1, 36) = 14.87, p < 0.001, partial η2 = 0.29, suggesting that children who participated in sensory-rich messy play exhibited greater gains in language outcomes compared to those engaged in structured non-sensory play. In addition, a significant main effect of diagnostic group was found, F(1, 36) = 5.12, p = 0.03, partial η2 = 0.12, indicating differences in language performance between children with Down syndrome and those with intellectual disabilities of unknown etiology. Importantly, the interaction between time and intervention type was significant, F(1, 36) = 18.92, p < 0.001, partial η2 = 0.34, indicating that changes in language performance over time differed depending on the type of play activity. Similarly, a significant interaction between time and diagnostic group was observed, F(1, 36) = 6.35, p = 0.016, partial η2 = 0.15, suggesting that developmental trajectories varied between the two groups.
The observed effect sizes (partial η2 ranging from 0.10 to 0.47) indicate moderate to large effects according to conventional benchmarks, suggesting that the differences observed are not only statistically significant but also of practical relevance.
Separate mixed-design ANOVAs conducted for expressive and receptive language yielded largely comparable patterns of results, with significant main effects of time and intervention type observed in both domains, as well as significant interaction effects involving diagnostic group and intervention condition. However, effect sizes were generally larger for expressive language outcomes, particularly in the interaction effects involving the Down syndrome group, indicating a stronger sensitivity of expressive language to the intervention. In both domains, significant main effects of time and intervention type were observed, as well as significant interaction effects involving diagnostic group and intervention condition. Although some variation in effect magnitude was present between expressive and receptive language, the direction and interpretation of the findings remained consistent across the two domains.
The interaction between diagnostic group and intervention type was also statistically significant, F(1, 36) = 4.28, p = 0.045, partial η2 = 0.10. This finding indicates that the association between intervention type and language outcomes differed across diagnostic groups.
Finally, a significant three-way interaction between time, diagnostic group, and intervention type was observed, F(1, 36) = 7.11, p = 0.011, partial η2 = 0.17. This result suggests that the magnitude of change in language performance over time varied as a function of both group membership and intervention condition. Specifically, children with Down syndrome in the messy play condition demonstrated the greatest improvements, particularly in expressive language, whereas children with IDUE showed more modest and variable gains across conditions. No missing data or participant attrition were observed during the study period.
The factorial structure of the present study represents a methodological improvement over previous designs by allowing the differentiation between the effects of intervention type and diagnostic group. However, certain limitations remain. The quasi-experimental design does not fully eliminate potential sources of bias, and the heterogeneity of the IDUE group may introduce variability that is difficult to control. Consequently, findings should be interpreted as indicative of associations rather than definitive causal relationships. Future research employing randomized controlled designs and larger, more homogeneous samples is recommended to strengthen the validity and generalizability of the findings.
Given the relatively small sample size, the findings should be interpreted with caution. Although statistically significant main and interaction effects were observed, the study may have had limited statistical power to detect smaller effects reliably, particularly for higher-order interactions. Therefore, the results should be viewed as preliminary and in need of replication with larger samples.

4. Discussion

The present study examined the association between play context and language development in children with Down syndrome (DS) and children with intellectual disabilities of unknown etiology (IDUE), within a 2 × 2 quasi-experimental framework. By incorporating both sensory-rich and non-sensory play conditions across diagnostic groups, the study aimed to disentangle the relative contributions of intervention type and developmental profile to language outcomes.
Consistent with Hypothesis 1, the findings revealed a significant overall improvement in both expressive and receptive language from pre- to post-intervention across participants. The separate analysis of expressive and receptive language was considered particularly important given the well-documented dissociation between these domains in children with Down syndrome, where expressive language is typically more impaired than receptive language. This general effect aligns with previous research highlighting the role of structured interaction and enriched environments in supporting language development in children with developmental disabilities (Brady et al., 2014; Yoder & Warren, 2001). Repeated engagement in communicative contexts may facilitate language growth, irrespective of the specific type of play activity.
In line with Hypothesis 2, children who participated in sensory-rich messy play demonstrated relatively greater gains in language outcomes compared to those engaged in structured non-sensory play. This finding is consistent with previous studies suggesting that sensory-based play environments are associated with improvements in cognitive and linguistic processing by promoting active engagement and multimodal learning (Rushton et al., 2010; Patimah & Nurhayati, 2023). The integration of tactile, visual, and motor experiences may provide a meaningful context for language use, allowing children to associate sensory experiences with linguistic representations (Barsalou, 2008; Yin et al., 2014, 2015, 2017). However, these findings should be interpreted with caution, as the benefits of messy play may vary depending on individual developmental characteristics and contextual factors.
Regarding Hypothesis 3, differences in language development were observed between diagnostic groups, reflecting their distinct developmental profiles. Children with Down syndrome demonstrated patterns consistent with the literature, including relatively stronger receptive language and greater challenges in expressive language (Abbeduto et al., 2007; Chapman, 2006; Cuskelly et al., 2016; Deckers et al., 2019; Loveall et al., 2016; Næss et al., 2021). In contrast, children with IDUE exhibited greater variability in both expressive and receptive outcomes, which is consistent with the heterogeneous nature of this population (Abbeduto et al., 2016; McDuffie et al., 2017; Thurm et al., 2015). These findings highlight the importance of considering diagnostic characteristics when evaluating language development and intervention outcomes.
Importantly, the results supported Hypothesis 4, indicating a significant interaction between intervention type and diagnostic group. Children with Down syndrome appeared to benefit more from the messy play condition, particularly in expressive language. This finding may be explained by the relative strengths in social communication observed in this population, including the use of gestures, shared attention, and responsiveness to social interaction (Fidler et al., 2005; Dimitrova et al., 2016; Romano et al., 2020). Sensory-rich play contexts may provide a naturalistic environment that supports these strengths, encouraging verbal expression through interaction and shared engagement.
From a theoretical perspective, these findings are consistent with Vygotsky’s sociocultural theory, which emphasizes the role of social interaction and guided participation in language development (Vygotsky, 1978). Messy play may facilitate learning within the Zone of Proximal Development by providing opportunities for scaffolding through interaction with more knowledgeable others. Furthermore, the results align with the framework of embodied cognition, which posits that cognitive and linguistic processes are grounded in sensory and motor experiences (Barsalou, 2008). The tactile and exploratory nature of messy play may support the integration of sensory input with linguistic meaning, thereby facilitating language acquisition.
The presence of a significant three-way interaction (time × diagnostic group × intervention type), as proposed in Hypothesis 5, further underscores the complexity of the relationship between developmental profile and learning environment. Changes in language performance over time were not uniform but varied depending on both the characteristics of the participants and the type of play context. This finding suggests that intervention effectiveness is shaped by the interaction between individual differences and environmental affordances.
In contrast to the pattern observed in children with Down syndrome, children with intellectual disabilities of unknown etiology (IDUE) demonstrated more variable and less consistent gains across intervention conditions. Rather than suggesting that sensory-rich messy play is inherently less effective for this population, these findings should be interpreted in light of the considerable heterogeneity that characterizes the IDUE group. This population encompasses a wide range of cognitive, linguistic, and developmental profiles, which are likely to influence responsiveness to different forms of intervention (Abbeduto et al., 2016; McDuffie et al., 2017; Thurm et al., 2015; Von Tetzchner, 2022).
The variability observed in the IDUE group may reflect differential responsiveness among subgroups of children with distinct developmental characteristics. Some children may benefit from sensory-rich environments that promote engagement and multimodal learning, while others may require more structured and explicitly guided interventions targeting specific linguistic processes. In this sense, the effectiveness of messy play may depend not only on the properties of the intervention itself but also on the degree of alignment between the intervention context and the individual child’s cognitive and linguistic profile.
Furthermore, the comparatively smaller gains observed in the IDUE group may be associated with underlying processing constraints that affect language learning. Difficulties in phonological memory, working memory, and syntactic processing, which are commonly reported in children with intellectual disabilities, may limit the extent to which children can benefit from open-ended, multisensory environments without additional scaffolding (Gathercole & Baddeley, 1990; Lifshitz et al., 2016; Saeed & Tahir, 2016; Sermier Dessemontet et al., 2017). As a result, sensory-rich activities may need to be complemented by more structured and individualized supports in order to facilitate language development effectively within this population.
Taken together, these findings suggest that variability in outcomes within the IDUE group should not be interpreted as evidence of reduced intervention potential, but rather as an indication of the need for more differentiated and individualized approaches. Identifying meaningful subgroups within the IDUE population and examining how specific intervention components interact with distinct developmental profiles represent important directions for future research. It is also important to consider the potential influence of unmeasured confounding variables. Although participants were matched on age and nonverbal ability, other factors such as prior language intervention, home language environment, and individual differences in attention, motivation, or engagement may have influenced responsiveness to the intervention. These factors may partially account for the variability observed, particularly within the IDUE group.
The findings of the present study have important implications for practice. For children with Down syndrome, sensory-rich messy play appears to be a promising approach for supporting expressive language development within socially interactive contexts. For children with IDUE, the results highlight the need for more individualized and differentiated interventions that combine sensory engagement with structured support tailored to specific developmental needs. These conclusions are consistent with broader evidence emphasizing the role of responsive, enriched language environments and caregiver-mediated interaction in promoting language development (Brady et al., 2014; Yoder & Warren, 2001).

4.1. Implications for Practice

The observed differences between children with Down syndrome (DS) and those with intellectual disabilities of unknown etiology (IDUE) underscore the importance of adopting differentiated and developmentally responsive intervention approaches. The findings indicate that children with DS demonstrated greater responsiveness to sensory-rich messy play, suggesting that such environments may be particularly conducive to supporting language development in this population. This may be attributed to the interaction between their relative strengths in social engagement and the multimodal nature of sensory-based activities. In contrast, the more limited and variable progress observed in the IDUE group highlights the inherent challenges associated with designing interventions for heterogeneous populations characterized by diverse cognitive and linguistic profiles.
From a practical perspective, these findings suggest that educational and therapeutic programs should incorporate differentiated instruction, tailoring intervention strategies to the specific developmental characteristics of each group. For children with DS, the integration of sensory-rich activities—such as those involving tactile materials, including sand, water, and paint—may provide a promising approach for supporting both expressive and receptive language development. These activities offer meaningful opportunities for verbal interaction, joint attention, and experiential learning, thereby facilitating the connection between sensory experiences and linguistic expression.
In contrast, for children with IDUE, the variability in language development necessitates a more individualized and flexible intervention framework. While sensory-based activities may still hold potential benefits, their effectiveness is likely to depend on the alignment between the intervention and the child’s specific cognitive, linguistic, and sensory processing profile. Consequently, a combination of sensory-rich experiences and structured, targeted support may be required to optimize language outcomes within this population.
The findings of the present study can be interpreted within the framework of Vygotsky’s sociocultural theory, which emphasizes the central role of social interaction and guided participation in learning (Vygotsky, 1978). Sensory-rich play contexts, such as messy play, provide opportunities for scaffolded interaction within the Zone of Proximal Development, enabling children to engage in communicative exchanges with peers and caregivers in meaningful and contextually embedded ways. Such environments may not only support language development but also promote broader social competencies, including cooperation, turn-taking, and problem-solving, which are foundational to early childhood development.
Furthermore, the results are consistent with the principles of embodied cognition, which highlight the role of sensory and motor experiences in shaping cognitive and linguistic processes (Barsalou, 2008). Engagement in multisensory activities may facilitate the formation of mental representations that support conceptual understanding and language acquisition. Through interaction with physical materials, children can develop foundational schemas related to properties such as shape, texture, and volume, which are essential for later academic learning, including mathematics and scientific reasoning.
For children with intellectual disabilities of unknown etiology, the findings highlight the importance of adopting flexible and individualized intervention strategies that account for substantial variability in developmental profiles. While sensory-rich activities such as messy play may provide valuable opportunities for engagement and language use, their effectiveness is likely to vary depending on individual differences in cognitive functioning and language processing.
Accordingly, intervention approaches should not rely exclusively on a single type of activity but should instead integrate sensory-rich experiences with structured and targeted support. This may include the provision of explicit language modeling, increased scaffolding, and strategies designed to support attention and memory processes. Such an approach acknowledges the heterogeneity of the IDUE population and emphasizes the importance of aligning intervention strategies with the specific needs of each child.
In addition, the generalizability of the findings may be limited by the specific characteristics of the sample and the educational contexts in which the study was conducted. Replication across different settings, cultural contexts, and intervention formats is necessary to determine the broader applicability of the results.
Taken together, the findings underscore the value of sensory-rich play within inclusive educational contexts, particularly for children with Down syndrome. Such approaches may enhance participation in group activities and promote interaction with peers, thereby supporting both language development and social inclusion. At the same time, the variability observed in the IDUE group highlights the necessity of implementing individualized, flexible intervention strategies that account for the diverse needs of this population.
Finally, these results emphasize the importance of collaboration between educators and caregivers in creating language-rich, supportive environments across settings. The integration of sensory-based activities within both classroom and home contexts may contribute to more consistent and meaningful opportunities for language use, ultimately supporting the developmental trajectories of children with diverse learning needs.

4.2. Limitations and Future Directions

While the findings of the present study provide valuable insights, several limitations should be acknowledged. Although statistically significant effects were identified, the sample size was relatively modest for a 2 × 2 × 2 mixed-design ANOVA. This is particularly relevant for the detection and stability of higher-order interaction effects, such as the three-way interaction observed in the present study. Consequently, the study may have been underpowered to detect smaller effects, increasing the risk of Type II error and limiting the generalizability of the findings. Future research should aim to replicate these results with larger samples.
Second, language development was assessed using a single standardized instrument (LaTo), which primarily captures expressive and receptive language abilities. Given the multidimensional nature of language, including pragmatic, functional, and interactional components, reliance on a single measure may not fully reflect the complexity of language development in these populations. Future research would benefit from incorporating a broader range of assessment tools, including observational and discourse-based measures, in order to provide a more comprehensive evaluation of communicative competence.
Third, despite the factorial structure of the study, the quasi-experimental design does not fully eliminate potential sources of bias, and therefore, causal interpretations should be approached with caution. Although the inclusion of both intervention types across diagnostic groups represents a methodological improvement over previous designs, further research employing randomized controlled trials would strengthen the validity of the findings.
In addition, the study examined language outcomes over a relatively short intervention period. Longitudinal research is needed to determine whether the observed improvements—particularly among children with Down syndrome—are maintained over time. Such research would also allow for the investigation of developmental trajectories and the long-term impact of sensory-rich interventions.
Another limitation concerns the absence of formal inter-rater and intra-rater reliability estimates for the language assessments. Although two blinded assessors administered the instrument using standardized procedures, no double-scoring procedures were implemented. Future studies should include independent scoring checks in order to strengthen measurement reliability.
Finally, the variability observed within the IDUE group highlights the need for future studies to identify more homogeneous subgroups based on cognitive, linguistic, or sensory processing characteristics. A more fine-grained understanding of individual differences within this population may facilitate the development of more targeted and promising intervention approaches. Furthermore, future research should explore how sensory-rich interventions can be adapted or combined with structured instructional strategies to better meet the diverse needs of children with IDUE.
A further limitation of the present study is the absence of follow-up assessment beyond the immediate post-intervention period. As a result, it is not possible to determine whether the observed improvements reflect sustained developmental change or short-term responsiveness to the intervention context. Future studies should incorporate follow-up measurements (e.g., at 3- and 6-month intervals) to examine the maintenance and generalization of language gains over time.

5. Conclusions

The present study examined the association between play context and language development in children with Down syndrome (DS) and children with intellectual disabilities of unknown etiology (IDUE), within a 2 × 2 quasi-experimental framework. The findings indicate that participation in play-based interventions was associated with improvements in language performance over time, with differences observed as a function of both intervention type and diagnostic group.
In particular, children who engaged in sensory-rich messy play demonstrated greater gains in expressive and receptive language compared to those participating in structured non-sensory play. This pattern was especially evident among children with Down syndrome, who showed the most pronounced improvements, particularly in expressive language. These findings suggest that sensory-rich play contexts may provide a supportive environment for language development, potentially by facilitating engagement, social interaction, and multimodal learning.
At the same time, the results highlight that the effectiveness of such interventions is not uniform across populations. Children with intellectual disabilities of unknown etiology exhibited more variable outcomes, suggesting that sensory-rich play alone may not be sufficient to support language development in all cases. Instead, intervention approaches for this group may need to be more individualized, taking into account the diversity of cognitive and linguistic profiles.
Importantly, given the quasi-experimental nature of the study, the findings should be interpreted as indicative of associations rather than definitive causal effects. Nevertheless, the study contributes to the growing body of literature emphasizing the role of environmental context in shaping language development and underscores the importance of aligning intervention strategies with the developmental characteristics of specific populations.
Overall, the findings support the potential short-term value of incorporating sensory-rich play into language intervention programs, particularly for children with Down syndrome, while also highlighting the need for longer-term follow-up and more individualized approaches for children with IDUE.

Author Contributions

Conceptualization, D.V.K., G.A. and E.M.; methodology, D.V.K., G.A. and E.M.; software, D.V.K., G.A. and E.M.; validation, D.V.K., G.A. and E.M.; formal analysis, D.V.K., G.A. and E.M.; investigation, D.V.K., G.A. and E.M.; data curation D.V.K., G.A. and E.M.; writing—original draft preparation, D.V.K.; writing—review and editing, D.V.K., G.A. and E.M.; supervision, D.V.K. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by Institutional Review Board (IRB)/Ethics Committee of the University of the Aegean (Approval No.: 14, Date: 23 December 2024).

Data Availability Statement

Data is unavailable due to privacy or ethical restrictions.

Conflicts of Interest

The authors declare no conflicts of interest.

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