Including A Child With Down Syndrome In Your Group
Children with Down syndrome are like all children in their need to make friends, to explore their environments, to gain confidence and self esteem, and to learn.
In recognition of these needs, opportunities are provided for children with Down syndrome now that are very different to those available to their counterparts of 15 to 20 years ago.. Along with other children in their neighbourhood, they are encouraged to join in the full range of activities within the community – preschool, school, dance, gymnastics, music, team sports and so on.
Preschool and other community activities are excellent preparation for the integration of children with Down syndrome into their local school whether in a regular class or in a special class attached to a regular school – which for most children is a realistic goal.
The majority of teachers in the early childhood field, unless they have specialised in teaching children with special needs, will have met few children with Down syndrome in the course of their work, and may hence have questions about what to expect when such a child joins their group.
These guidelines have been compiled by the Down Syndrome Association of NSW for preschool teachers, childcare workers and community workers. While the preschool situation is emphasised, it is emphasised that others involved in community activities ( such as dance, music, swimming and gymnastics will be able to adapt what they read here to their own needs.
This booklet has been based on booklets developed by the Down Syndrome Association in England, and we are indebted to their support in allowing us to adapt their material to the Australian context.
What is Down syndrome?
Children with Down syndrome have a genetic condition which affects about one in every 860 babies born each year.
This syndrome is created by the presence of an extra chromosome in every cell of the body – in most cases an extra chromosome 21. (This is why Down syndrome is often referred to as Trisomy 21). Chromosomes are, in simple terms, the building blocks which give us our individual characteristics – eye colou, hair colour and so on. The presence of an extra chromosome in people with Down syndrome gives rise to certain physical characteristics and some degree of intellectual disability. The extent to which a child shows the physical characteristics of the syndrome is no indication of his or her intellectual capacity.
However similar children with Down syndrome may look at first glance, they carry family likenesses which become obvious very quickly. These likenesses are not just physical – children also reflect the personalities and talents of their families. Each child is more like his or her family than like other children with Down syndrome.
Some Characteristics of Down syndrome
There are areas in which some children with Down syndrome may have difficulties.
We have outlined these areas here because it is important that you as a teacher or community worker be aware if them in case problems arise.
It must be stressed that all children do not have difficulties in all areas.
Many children who have Down syndrome have small nasal cavities, which make it harder for them to fight off colds and infections. This in turn can affect hearing which will obviously, if left untreated, lead to problems with learning.
Some children have additional hearing loss, often as a result of a condition known as glue ear. Treatment can include insertion of grommets or hearing aids. It is advisable to check that children can hear after having a cold. Children with hearing aids need to be helped to use and control them and their effectiveness should be checked from time to time.
It is vital to ensure that instructions are given clearly, simply and face to face. Backgroung noise and multiple instructions can confuse a child with a hearing loss or hearing aids and sound location can be difficult.
Communication, Speech and Language
Expressive language is of vital importance to any child and no less so to a child with Down syndrome. Nothing is more frustrating for a child than not being able to put his or her ideas and point of view to other people.
The communication skills of children with Down syndrome ca be affected in two ways. Firstly, there may be a problem with articulation or pronunciation. There are physical factors which can contribute to this. The nasal passages an sinuses are smaller and the roof of the mouth is small and high which reduces the mouth cavity. The tongue is often thicker which can result in the child having difficulty keeping it inside the mouth, though most children manage this with reminders. Many children receive speech therapy to remediate problems with articulation and most speech pathologists are happy to report to teachers on the child’s current goals, strategies for teaching and progress.
Children with Down syndrome are also likely to be delayed in the development of their communication skills. In practice, this means they have smaller vocabularies, and/or speak in shorter phrases than their peers. They may also have problems in using their communication skills to meet all their needs, for instance, they may find it hard to use language to initiate conversations with friends, to indicate toilet needs, or to gain attention, and may use non-verbal means of meeting these needs.
Teachers need to be alert to children’s attempts to communicate, and to ensure that the environment of the centre provides opportunities for the child to practise communication with adults and peers. Look for activities which include turn-taking and sharing, such as structured activities in the sand pit, doll corner, block area or dough table. Encourage the child to communicate at routine times such as greeting time, toileting and meal times. For example, the child could ask to have fruit cut up, ask for help in doing up a button, or offer fruit to others at morning tea.
Guide the other children to wait for the child with Down syndrome to participate verbally, rather than talking for him or her.
A sign or symbol system can be very helpful to a child with delayed language. Such a system should be seen as a way to augment verbal communication, rather than as a substitute. Consultation with the child’s parents, speech pathologist and early intervention teacher is essential.
Because of a greater than average incidence of impaired vision, many children with Down syndrome wear glasses. A child with a small nasal bridge may find it difficult to keep their glasses on – if this problem arises, an optician may be able to assist with a different bridge piece and longer earpieces. Another point to watch is that the child’s eyes may not adapt quickly from bright light to shadow or vice versa. This can lead to tripping up or down steps, not necessarily to be seen as clumsiness on the child’s part.
While the child with Down syndrome may be a little late in walking, mobility is not generally a problem unless the child has multiple handicaps. However, the muscle tone is often looser than other children’s and this can lead to difficulties with co-ordination and gait. The child with Down syndrome should be encouraged to join in the full range of physical activities available in the preschool or centre, including running, skipping, climbing, bike riding and ball games.
You should be aware that there can be a looseness of the ligaments at the top of the spine in Down syndrome. This is called Atlanto-Axial Instability. This condition can be diagnosed through x-rays and many parents are choosing to have their children tested before they start preschool.
Ordinary preschool games do not aggravate this condition, and indeed, should be encouraged. However this condition can be aggravated by a fall on the head or neck, or by jerking or compression of the neck. Trampolining is one avtivity enjoyed by preschoolers which should be closely supervised. A child with Down syndrome experiencing neck pain, limitation of movement or change of gait should receive urgent medical attention.
Fine Motor Skills and Dexterity
Because their fingers are shorter and perhaps a little weaker, some children may need extra practice with fine motor skills. This can apply to cutting, drawing and other manipulative activities. The child may need to be reminded which is his dominant hand. Games requiring the child to pick up small objects using finger and thumb, or playing with tongs and tweezers to pick up objects, will improve manual dexterity.
The child may need to be reminded to hold the pencil correctly – a triangular grip guide may help. Scissors may be better controlled if held with the forefinger along the shaft and the second and third fingers in the finger holes. It is important to ensure that equipment is readily available and works well. It is often the less able child who is left with the least effective apparatus.
Children need to be physically stable when carrying out manipulative activities. Feet should be firmly on the floor, and the table should be at the correct height for the child. If the child is too small for the centre’s furniture, consider placing a box under her feet.
Diet, Toileting and General Health
A good diet should be encouraged, together with plenty of exercise, to offset the tendency to put on weight. Some children may have difficulty with chewing food and may need extra time to finish their meals.
If toilet training has not yet been fully achieved, it is likely the child’s parents are working towards this goal and will be very glad to have you working with them. The child who can use the toilet independently may still need reminders, and, as with all children, it is helpful to associate a visit to the toilet with other events in the daily routine, such as after a snack, or before going outside.
Children may need help with temperature control (advice to put on or take off a coat, for instance) and protection for dry and sun-sensitive skin. But it should be stressed that most children with Down syndrome are capable of learning to make these judgements by themselves, and should be encouraged to take increasing responsibilty for their own physical wellbeing.
This may not be as well developed as in children who do not have Down syndrome. Children with Down syndrome may be more susceptible to illness, especially in their early years.
Some children with Down syndrome have heart problems of varying severity. Many are successfully operated on when babies or infants. Others require medication and careful observation. Consult the parents as to the most appropriate ways of handling the child who has a heart problem.
It must be explained that although the list of physical needs may seem daunting at first glance, not all children with Down syndrome have all the problems at once, if at all! Many will have learned to deal with the problems in their own way. Learn from the child by being able to help bring out the best. Obvious benefits will accrue from centre and family keeping one another informed of general health conditions.
Social Skills and Behaviour
One of the most difficult misconceptions to live down for any child with Down syndrome is that they are always loving and affectionate. Some are, some definitely not! As with all children, children with Down syndrome can have annoying or irritating habits, and be disobedient or easily distracted at times. Behaviour can vary between situations, according to management style and expectations of the adults involved. Children with Down syndrome, like all children, benefit from a consistent approach, which includes emphasis on teaching constructive behaviour.
Another characteristic that is often attributed to children with Down syndrome is ‘stubbornness’ – a term used to describe withdrawn or silent refusal to comply with directions. This behaviour may be the child’s way of conveying that a task is too hard for her, or that she does not understand what is required. A more verbal child can argue, complain or seek help when she find herself in this situation, but the child with Down syndrome may find it very difficult to verbally communicate her feelings. Try to look at ‘stubbornness’ or other changes in behaviour, within the total context – what happened beforehand, what else is going on in the environment, and so on – to try to pinpoint the issue that is concerning the child. As well as providing the right teaching steps for the child, and avoiding frustration, it is important to teach the child strategies for indicating to a peer or teacher that she needs help.
Some children with Down syndrome can be taken over by other members of the group and ‘mothered’. The teacher should demonstrate to the whole group, through his or her own behaviour and attitudes, that the child with Down syndrome is expected to behave in the same way as everyone else, and to act independently wherever possible.
Many children are affected by alteration to routine, particularly if sudden or unexplained. This can often considerably affect children with Down syndrome. Care should be taken to explain changes in activity, routines or staffing.
Parents are generally well aware of the necessity of appropriate social behaviour, and discourage their child from kissing and other effusive greetings once they grow past the age where these are appropriate. Other adults are not always so aware, and may ‘baby’ the child with cuddles and so on regardless of the child’s age. It is important that all adults involved treat the child with Down syndrome as they would the other members of the group.
It cannot be emphasised enough that it is more important to praise good behaviour frequently than to give attention for misbehaviour. This approach shows the child what is expected of her, and encourages her to live up to those expectations, while helping her to learn that misbehaviour is neither effective or necessary as a way to gain attention.
The Child in the Centre
Here are some practical suggestions for helping the child with Down syndrome to make the most of the opportunities for learning within your centre.
Communication between home and school is vital and valued by parents and teachers alike. The child’s parents are likely to be spending a great deal of time following through programs such as speech therapy, physiotherapy and early education, and will probably wish you to follow up what is happening in your centre. Parents play a very significant role in helping to reinforce and practise new skills being learned by their child. It is worth keeping in mind that parents are an important source of information about their child, and can put their teacher in contact with others who may be working with the child. Some teachers and parents find a home/preschool communication book helpful. This communication book should, of course, be used in conjunction with personal contact – it is not sufficient on its own.
Starting Preschool or Day Care
While it is helpful if a new child can recognise her peg, cope with removing and putting on her clothes, go to the toilet independently and so on, insisting on these skills could make parents, and indeed the child, overanxious. The child will probably learn these skills quickly from observing the other children.
Strategies for Learning
During group activities, ensure the child with Down syndrome is sitting where she can see and hear, perhaps towards the front of the group, and with her back to any bright windows.
Check that she is attending to you before you give any directions – including whole group directions. If you always repeat directions for her afterwards, she will come to rely on this and will see no need to listen the first time. It is best to give her prior notice that she needs to listen. Of course, many children need such reminders!
Some tasks need to be broken down into small steps. It often works well to teach the last step first – for example sliding the last piece of a jigsaw into place or pulling pants up from hip to waist.
Consider whether the height of activities such as sand or water trays need adjusting if the child is very small, or raise the child on a low platform.
Peers are importan models to the child. Make sure that the child with Down syndrome is in play situations with other children who play appropriately and handle materials constructively.
The teacher needs to be aware of the child’s level of attainment in all developmental areas. Assessment tools can be administered fairly quickly at the beginning of the year, so that realistic goals can be set. To ensure a consistent approach, these goals must be discussed with parents and other professionals involved.
The child with Down syndrome will usually be able to do the same activity as the rest of the group. In some cases the child may be able to do the same activity, but at a simpler level. There may be areas where separate programming and/or brief one-to-one teaching sessions are required.
The way in which the preschool or centre works with the child will depend on the number of days per week the child attends, the resources available at the centre, whether or not the child receives one-to-one teaching elsewhere, and what other opportunities the child has for peer interaction. For example, if two mornings a week at preschool provide the child’s only contact with other children, encouraging the child to interact will have a higher priority than withdrawing the child for one-to-one instruction. On the other hand, if the child attends your centre for long day care several days a week, her experience with you will be critical not only for her social interaction, but also for the development of her cognitive and motor skills.
Down Syndrome WA
The DSWA welcomes contact with teachers and group leaders who are working with children with Down syndrome, and will endeavour to assist with any enquiries. We can be contacted on (08) 9368 4002.