Objective: Individuals with Down syndrome have impaired linguistic ability but relatively good visuospatial cognition. A verbal-with-visual presentation enhanced the semantic grouping in individuals with Down syndrome, whereas a verbal presentation did not have this effect. This study aims to examine the influence of visual presentation on semantic grouping in individuals with Down syndrome. Method: Pictures that depict backgrounds and targets as pairs were shown to participants who were asked to make judgments according to semantic appropriateness. Targets in the same category were matched to the background in congruent and incongruent conditions. Results: Unlike two groups of typical developers, the studied group failed to display the congruency effect. They responded slowest to congruent conditions and had the lowest accuracy rates. Error patterns revealed that they exhibited coarse semantic classification. Conclusions: Through a visual presentation that provided contexts, an atypical contextual effect on semantic grouping was revealed in individuals with Down syndrome.