Karaaslan 2013a.

Methods	Design: RCT
Participants	Location: Turkey Setting: participants were drawn from 2 special education rehabilitation centres Child participants Sample size: 15 children (intervention: 7, control: 8) with Down syndrome Mean age: intervention: 55.1 months, control: 44.1 months, range 2‐6 months across both groups IQ: the overall IQs of the children were not clear. Inclusion criteria: children had to be under 6 years of age, with a diagnosis of Down syndrome, and their mothers must not have been previously involved in a parenting intervention Comorbid conditions: not reported Number of children per family: not reported Parent participants Sample size: 15 mothers Mean age: intervention: 42.4 years, control: 42.4 years Education(mean level): intervention: 8.9 years, control: 9.6 years Marital status: all married Occupation: not reported Socioeconomic status: not reported but see 'education level' above
Interventions	The 15 participants were randomly assigned to 1 of 2 groups. Intervention group (n = 7): responsive teaching as well as standard early intervention services. The responsive teaching intervention consisted of weekly, individual parent‐child sessions conducted at either a centre‐based facility or in families' homes for 1.5 to 2 hours over a 6‐month period. The total intervention time was approximately 48 hours. The intervention trained parents to increase their responsivity while modelling communication matched to the child's level of functioning. Children continued to receive early intervention services at their local special education centres for 2 days per week during the intervention. Parents could observe but did not participate actively in their children's intervention. Control group (n = 6): standard early intervention services only. Children received the same 2‐day per week early intervention services as those described above for the intervention group.
Outcomes	The measures listed below were used to measure the outcomes, 2 months following the intervention. Turkish version of Denver Developmental Quotient ‐II, which assesses 4 domains (personal‐social, language, fine motor, and gross motor development) Ankara Developmental Screening Inventory, which assesses cognitive‐language, fine motor, gross motor, and social/emotional functioning Child Behavior Rating Scale to measure children's attention and initiation from a free‐play interaction with their mother Maternal Behavior Rating Scale to assess mothers' responsiveness, affect and achievement/directiveness, also from a videotape of free‐play interaction with their child The study measured adherence to the intervention by the clinician, although parental dosage (intervention fidelity) was not reported.
Notes	Study start and end dates: not reported Funding source: not reported Conflicts of interest: not reported, although the 2nd author was one of the authors of the intervention programme
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Comment: children were randomly assigned to the treatment or control group using a computer‐generated list of random numbers.
Allocation concealment (selection bias)	Unclear risk	Comment: did not report if this was conducted
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comment: not possible
Blinding of outcome assessment (detection bias) All outcomes	High risk	Comment: 2 of the assessments used were totally or partially based on parent report, and parents were not blind to the group assignment.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: seemed to be no missing outcome data
Selective reporting (reporting bias)	Low risk	Comment: reported all pre‐specified outcomes
Other bias	Low risk	Comment: appears to be free of other sources of bias

EMT: enhanced milieu teaching; IPSyn: Index of Productivity of Syntax; MLU: mean length of utterances; NDW: number of different words; RCT: randomised controlled trial; SICD: sequenced inventory of communication development.