Unique Intervention Strategies for Down's Syndrome Children to Progress in Education and Socially - Research Paper Example

 Introduction Down syndrome or trisomy 21 is a serious neurobiological disorder whose complete consequences are still incompletely understood. The disease of genetic origin results from the existence of an extra chromosome and can cause various limitations and abnormalities in affected children. The disorder manifest themselves in both neuro-developmental and neuro-psychological arenas but the simplest observation remains that it causes developmental delays which can range from mild to moderate learning disability to severe mental disability. [Abb08] Down syndrome is a chromosomal disorder which occurs in approximately 1 in 1000 births. Chromosome 21's presence in the affected, which contains 225 genes which contribute to the phenotype and pathogenesis of Down syndrome is referred to as the main cause of this distinct neurobiological, genetic, psychological, developmental and medical disorder.[Hat00] It is recognized that a very high proportion of brain anatomy and verbal intelligence is governed by genetic control. These findings greatly influence the study of Down Syndrome patients, their genes and their resulting speech, memory, language and other cognitive functions. [Geo04]. Research has also shown that children affected by Down syndrome have declining Developmental and Intellectual quotients and thus have deficits in verbal and linguistic skills. Patients may also possess weak sequential auditory memory skills but they remain more adept at visual-spatial based memory tasks[Var87] . Researchers have concluded that early intervention programmes benefit the socially adaptive function but do little to improve the cognitive function or IQ.[Gib88]. There is no uniform cognitive benefit of early intervention if specific learning and intervention strategies are not used. There are multiple reasons provided for these findings. They include complex neuro-behavourial syndromes which often means that the intervention method chosen for learning is not working at its prime and increasing the frequency or the intensity of the same method will not provide results. Rather there is a need for different intervention strategies specific to their needs.[Gib91] This means that early intervention of the right kind at the right time is required for a positive cognitive difference. A common example of this phenomenon can be observed when a child does not achieve spoken language skills and phonological competence despite attaining cognitive skills and other language comprehension skills which support complex skills.[Kum00]These are a sign the verbal intervention means have failed and calls for intervention strategies based on vision-based communication. This vision based communication uses signs and pictures to lead to symbol-based language development. It should however be remembered that increasing the intensity of phonology based therapies is also frequently met with poor results. Another visible delayed or aberrant function in Down syndrome is the pervasive developmental disorder. Children might suffer from developmental regression or social, communication or behavourial impairment. These children then require prompt referrals for medical and neuro-developmental assessment leading to the establishment of a vision based system of communication. The normal assumption regarding early intervention plans for Down syndrome children is that they are extremely beneficial. In fact most of these early intervention programs are mandated by the state and are provided free of cost. This directly results in a Down syndrome child receiving physical therapy and early education in the first year of his life. [Geo04] Occupational and speech therapy often follow the course in the second year of life. Parents and therapists often assume that the purpose of this early intervention is to speed the pace of development and the role of this early intervention is somewhat different in reality. The most important purpose of this programme is to support development by the use of specific strategies, to guide and train parents and to immediately recognize the need for medical referrals. Early intervention programmes for Down syndrome were initially generic in nature, being similar to those of children with mental retardation. But now considerable progress has been achieved by defining the unique strengths and weaknesses possessed by a Down syndrome child. Specific guidelines for acquisition of skill acquisition during primary years are also emerging. Thus different strategies to teach gross and fine motor skills, speech and language skills, reading and writing skills are emerging. These strategies are mostly based on expert opinions and best-practice guidelines rather than being evidence-based therapies. Thus learning strategies for all Down syndrome patients should be cleverly crafted keeping the individual and his unique competence in mind. However there are a few guidelines and research findings which must be kept in mind when developing a support and developmental learning programme for these students. Intervention: an overview and critical analysis Early intervention as stated before has been a source of great debate. Though the general assumption is that early intervention is always helpful, but the eventual retardation stage of Down syndrome questions the benefits of early intervention. There is a whole body of research which suggests that early intervention programmes have led to improved developmental functioning. [Sim82]. Simeonson, Cooper and Scheiner[Sim82] have also concluded that early intervention is effective though the analysis lacked the rigorourous statistical methodology which would have made the study effectively convincing. Cicchetti [Dan90]has adopted a liberal developmental perspective for children with Down syndrome and also drew a definitional framework for intervention strategies. Multiple social, political and other factors related to a child's development have influenced the emergence of these intervention programmes. According to Cicchetti[Dan90], the intervention programmes should have some major focuses such as promoting optimal functioning in areas of development. Attention also be paid to the time and the context of the training and both social and physical activities should be included. Another assumption that should be made when treating children with Down syndrome is the fact that the existence of significant relationships between different developmental areas must be recognized. For example a child's slow motor development and hence low locomotor ability maybe hindering growth in other developmental areas. Similarly speech and intelligence problems may laos lead to self esteem and confidence issues. Cicchetti[Dan90] has also suggested that an organizational approach be taken towards treating children with Down syndrome and intervention strategies to revolve around it. Stoel-Gammon [Car11]had provided a similar approach to phonological intervention for Down syndrome children which was the assessment and formation of clear goals. Thus a common consensus among these two scholars is reached when it comes to the ways in which intervention should be directed. In regard to play development, Esenther[SEs84] has described an early intervention programme designed to improve the motor and sensory skills of infants with Down syndrome. The assumption here is again the relevance of different developmental areas that the improvement of fine motor skills will lead to improved attention and fine exploration in children. Another reported suggestion for strategies for early intervention in Down syndrome children is the creation of an individualized and structured environment. This is also suggested by many researchers that intervention strategies for all Down syndrome children should be custom made since their competencies and weaknesses are different from each other and unique to them only. Another weakness that is frequently faced by Down syndrome children is the processing of incoming information. Research indicated that children with Down syndrome have more difficulty in processing information and guidance that is auditory rather than visual.[Mar82]. Thus it should be clear that these information processing difficulties interfere with the learning and acquisition of other developmental skills. Thus one of the basic early intervention strategies should focus around how to improve these information processing abilities to minimize their impact on contemporary and future development.[Dan90] When it comes to defining the earliest intervention programmes for Down syndrome children, they revolved around improving the child's intellectual development and slowly an awareness of the linkage between intellectual and language development arose. Thus early intervention programmes revolved solely around these two areas that is language and intellectual development.[SMP82] There is also a question of how relationship focussed intervention promote developmental learning in Down syndrome patients. Mahoney and Perales[htt] have furthered the discussion on this model of intervention which defines parental involvement in highly responsive interactions with their child. Relationship focussed intervention was based on two basic concepts which were supported by the child developmental theory and other researches. The first was that parents have a greater impact on the development of their child as they have more opportunities to contribute towards their development. Secondly they can promote their child's development by engaging in highly responsive actions. [htt]. More than 20 RFI studies have been published which indicate that this intervention is quite effective at promoting the development in Down syndrome children. [htt]"Furthermore, research reported by Mahoney and Perales indicated that RFI resulted in a 50% improvement in children's rate of cognitive development and 150% improvement in their rate of communication development, point to RFI as a promising method for realizing the promise of early intervention"[htt] For the last 20 years, early intervention was dominated behavorial instructional techniques which encouraged the child to learn but in contrast Relationship Focussed intervention deemphasized this and encouraged parents to respond to and support the actions that the child was already doing instead of teaching higher developmental actions. The result of research on Relationship focussed intervention resulted in reaching the conclusion that it enhances the child's development less by teaching skills and behaviour and more by the encouragement of the assimilative learning process of both repetition and practice. [htt] Language skills Acquisition of language skills in Down syndrome children is a slower replica of normal children. The language structure and formation in not remarkably different from other children, besides the fact that they are slow and can be painfully delayed. Evans and Hampson[Eva68] have noted that the worst area of development in individuals with Down syndrome is language and they might lag behind controls by up to 50%. Observation of Down syndrome patients has strongly suggested that the productive and the receptive language function is nearly normal in language and grammar but is considerably weak in lexical, semantic and pragmatic functions.[Jea95] Thus Down syndrome patients are weak in all learning functions which are related to cognition. The first and the foremost step for making unique language based intervention effective is to include active participation of family, school and the rest of the community. The merits of any intervention strategy are limited in furthering development if inclusion is inappropriate. [Jea07] The diverse modalities of language functioning are also to be considered and spoken language to be undoubtedly being given the most importance. Language can also be developed using non-verbal means of communication such as manual signs. It should be remembered that the strength of a Down syndrome patient remains in his strength as a visual learner and thus when this perspective is put to use it results in a greater manifestation of positive outcomes. Alternative and augmentative system of communication may have benefits in the development of language skills which have to be appraised individually and can create a pathway for speech in children with severe language defects. Language intervention should also be planned in an age related manner. According to Rondal [Jea07]early intervention from birth is an absolute necessity. Continued intervention during school years should also be organized in coordination with the school. Girolametto[Gir98] has reported an encouraging level of success in the fostering of an expressive vocabulary in young Down syndrome children. This has been achieved by reliance on parental involvement which resulted in a promotion of interaction and an encouragement for imitation. Speech and verbal skills Motor components of speech are also expected to be problematic in patients of Down syndrome. A degree of generalized hypotonia should be expected and to deal with this. This techniques particularly those reducing the buccal hypotonia are useful in order to permit a child to speak clearly and audibly. Stoel-Gammon [Car11] has noted that phonological intervention for Down syndrome patients has to be done in 3 basic steps. These are 1) assessing the child's phonological system, 2) setting intervention goals and 3) determining the most appropriate method for achieving these goals. Another phonological therapy centres around the word variability in Down syndrome children. Here words are units of treatments and parents normally serve as the as the agents of therapy. Only one set of pronunciation is acceptable and other variants are accepted as long as they are developmental and not deviant. Since expressive oral language is considerably delayed in Down syndrome children, it is essential that other means of communication are also used. Lexical training to carefully choose labels for objects is highly encouraged. These exemplars or labels should be carefully labelled for example for a bird, robin is a better archetype than a penguin to lay a firm foundation in the child's mind. [Jea07] Sue Buckley[Sue11] in her extensive research on developing skills in Down syndrome children and teenagers has noted that language learning ends at about 7 years and reaches a syntactic ceiling. Thus intervention before that is helpful in developing appropriate language skills before then. After that age intervention can improve more complex grammar and syntax but intervention and teaching efforts before that produce more meaningful results. A cause for impaired language and speech skills is the weak memory of Down syndrome children. Language is always learnt from listening and poor auditory short-term memory skills have a detrimental effect on acquisition of language structure and vocabulary acquisition. [Sue11]Thus intervention strategies which revolve around repetition and rehearsal, thus aiding both memory and language are particularly helpful in teaching Down syndrome children. Memory and learning skills Literacy skills and memory of Down syndrome children are weaker as said before. Researchers have also defined intervention methods to improve these skills in an early stage before mental retardation, stagnancy and a fall in IQ begins to take place. An investigation into literacy, language and memory skills of Down syndrome individuals by Bryne, Buckley, MacDonald and Bird tested these experimentally to reach conclusions and derive theoretical results supported by evidence. Data revealed that children with Down syndrome had uneven cognitive profiles but possessed reading skills which were quite advanced when compared to their other skills. [Byr95] The Down syndrome children under experiment were compared in their language and memory skills with mainstream class mates. Interrelationships between literacy, language and memory skills were investigated and a look was taken at the cognitive strategies which are employed when teaching such children to read[Byr95]. The comparision of these 24 Down syndrome children with their reading matches revealed that there were significant differences in memory but the mean reading scores were not significantly different. Children with Down syndrome were weaker in language, spelling and number skills than their matches. Short term memory is also associated with learning disorders and language defects. It is an important aspect of cognitive functioning. In normal children short term memory capacity increases rapidly but children and adults with Down syndrome have a short term memory delay which has to be overcome so that it does not affect other aspects of developmental growth. Teaching these short term memory skills to children with Down syndrome has also been investigated. In a study by Broadley and MacDonald[Bro93], 63 children were assessed. One half was given rehearsal training and the other organization based training. The results depicted that each training method was effective in improving the memory skills which were addressed by that specific training thus reinforcing our belief that early and meaningful intervention is effective and necessary. The cause of this delay is the memory problem and not lack of attention and concentration which is often deduced from observations. Since verbal encoding of the stimulus is often restricted intervention strategies are focussed around visual memory enhancing techniques. Children with Down syndrome do not recall things the way other individuals recall from their short term memories and thus techniques often employed to facilitate learning are rehearsal and organization. Rehearsal involves silently repeating information and organization involves categorizing and grouping similar items together. [Bro93] Herriot and Cox [Her71]allocated 24 Down syndrome children and 24 children with learning difficulties to different group material and found that memory strategies of clustering and subjective organization markedly improved their ability to recall information. Broadley's[Bro93] study of the visual and auditory memory of children with Down syndrome revealed that greater gains can be achieved with younger children. Rehearsal and organization both had their individual effects with children who were exposed to rehearsal showed sign of that training whereas the others improved in organizational recollection with no change in rehearsal measures. This research also demonstrated the importance of starting the intervention as early as possible as the results were remarkable when done in children as compared to adolescents in previous studies. Reading skills It was initially assumed that children with Down syndrome will not be able to read and thus their literacy training came much later. But surprisingly studies revealed that Down syndrome children are not that slow in reading as compared to other developmental measures. Now many children with Down syndrome are learning to read and their reading ages are considerably far ahead their other chronological ages. Sue Buckley and Gillian Bird have done extensive research and experimentation about teaching Down syndrome children to read.[Buc93]. There are various principles around which these teaching methods are centred. By their experiments and observations they learnt that reading improves language, phonology and speech and has a long lasting impact. It also greatly improves articulation. They also found that Down syndrome children can read at very early ages with few being able to read as early as 2 years 6 months. [Buc93] These children might have language and speech problems due to other congenital defects such as hearing loss, auditory short term memory and a high visual memory. But simultaneously the stronger visual memory serves as a strength for the ability to read. A stronger visual memory is also the reason why children with Down syndrome like learning with the computer which presents information visually. Thus Sue and Buckley have reached a conclusion that the earlier a child learns to read, the greater will be the benefit for their speech and language skills. Class room intervention strategies Pupils with Down syndrome find it difficult to cope with some class room practices. They might be unable to learn through listening alone and whole class teaching. Intervention strategies have been designed keeping this in mind and teachers are trained to provide modifications. These modifications include visual reinforcement of the text and worksheets which involve cloze methods. But it is again necessary to realize that these techniques should not be restricted to keeping the diverse range of competencies of Down syndrome children. Children may also benefit from individual teaching and one to one training sessions, in fact short and focussed sessions of well managed individual teaching enable pupils to gain skills which can allow them to be easily integrated into the mainstream learning. [htt1] Peer tutoring is another intervention strategy which is often used in class rooms. However care must be taken that one peer does not have dominating effect over the other. Down syndrome students may initially be needing the help of an assistant to aid and facilitate their work. Research has consistently shown that peer tutoring benefits both the tutor and the tutee[htt1] Social progress Social progress comes with independence and high self esteem. Thus early intervention measures in Down syndrome children should relate to boosting their morale and confidence and guiding them towards complete independence. Again early intervention with appropriate strategies would ensure that the child achieves these milestones of confidence and independence at the proper time and even if they are delayed, they are achieved as soon as possible. Full inclusion in mainstream schools and acceptance there also provides significant gains for Down syndrome children. But this is only in the case if their special education needs are appropriately met. [Buc01]. It has also been noted that the goals set for these children should be age appropriate and the barriers targeted should be achievable for children. Social development includes social interactive skills, understanding, empathy and an ability o develop friendship. Social understanding is a strength for Down syndrome children who take cues from non-verbal behaviour even when they don not understand verbal messages. Influences on social development start as early as the earliest days of the babies' life and thus early intervention is encouraged. Down syndrome children are greatly influenced by the experiences of their parents and care givers and thus it should be acknowledged that development of Down syndrome children like other children is a dynamic and interactive process where the behaviours of the parents and children affect each other. Children's behaviour will also be an outcome of his temperament and personality and thus his social skills and social progress will largely be dependent upon their basic behavioural style. When it comes to social issue, another important aspect to remember is that physical limitations such a hearing loss or poor motor skills might also result in social ineptness. Low cognitive and communication skills are also directly linked to lack of socialisation and friends. Thus early intervention efforts which work towards easing the limitations and social intervention efforts such as stressing the need to make similar friends are also greatly emphasized. [Sue111] A child's social development is also a result of his understanding of the world around him and thus children with delayed cognitive development are likely to face difficulties in becoming socially competent. As their language and communication skills will develop, their frustration resulting from an inability to communicate will decrease and they will become more adept at socially acceptable behaviour. [Sue111]. Thus children who progress more slowly at language and cognitive development are more likely to face social difficulties. For these intervention strategies relate to language should be used. Educational progress for Down syndrome children has been a cause for debate initially but now studies indicate that education provided appropriately in inclusive settings provides the best opportunity for children with Down syndrome. Inclusion not only provides gains in expressive language skills and literacy achievements but also enhances social behaviour. [Buc93] Since the basic goal of education is to equip children for adult life, thus it is only inclusive education which will provide the child enough exposure and opportunities to enter adult, responsible life. Both social and academic learning achieved in schools are equally important and the earliest possible intervention is the most likely to modify the child's behaviour and stream it towards a more acceptable one. Conclusion Early intervention is the name of the game for Down syndrome children as is proved by various researchers. It is known that Down syndrome patients reach a developmental ceiling at an early age and thus the earliest possible intervention is bound to give the greatest rewards. However early intervention is not the key to all problems. The success and the developmental and social progress largely depend upon the methods used. These methods have to be specific. It should be realized that each Down syndrome child is unique and has a different level of competencies. Thus programmes and strategies which are custom made for the child should be used. The programmes should draw upon the strengths of Down syndrome children like the strength of their visual memory and modifications be made in intervention programmes. Similarly short and focussed individual study methods should be used. The child should be assessed before directing any strategy towards him and different areas of weaknesses should be analysed. It should also be remembered that different limitations in Down syndrome children are linked to each other and thus working on one might help in other areas. Similarly some areas of weaknesses cannot be improved until others are addressed. Some interventions which produce the greatest gains in Down syndrome children are awareness and treatment of hearing loss, appropriate remedial language teaching from the first year of life, normal classroom experience by being taught in mainstream environment, learning reading and writing in preschool years and teaching methods which keep short term auditory memory in mind. Specific techniques to target oral motor skills, speech sound production and specific language skills should be used to enhance development in Down syndrome children. Lastly but not the least, the importance of inclusive education in a main stream system can never be emphasized enough. It helps the child gain both academically and socially thus leading to great educational and social progress. Early intervention does not accelerate the pace of development but it helps support development. It prevents maladaptive patterns from happening before neuro-maturation and also prevents secondary handicaps from emerging. Group therapy is also highly recommended for Down syndrome children from as early as the 18th month of life. Interventions produce the optimal results when they are done at the right time in the right way and thus a coupling of them that is using the most advanced mind growth stage with proper techniques will allow Down syndrome children to progress both educationally and socially. References Abb08: , (Deliz, 2008), Hat00: , (Hattori, 2000), Geo04: , (Capone, 2004), Var87: , (Varnhagen, 1987), Gib88: , (Gibson, 1988), Gib91: , (Gibson D. , 1991), Kum00: , (Kumin, 2000), Sim82: , (Simeonson, 1982), Sim82: , (Simeonson, 1982), Dan90: , (Cicchetti, 1990), Dan90: , (Cicchetti, 1990), Car11: , (Stoel-Gammon), SEs84: , (Esenther, 1984), Mar82: , (Marcell, 1982), SMP82: , (Rynders, 1982), htt: , (Gerald Mahoney), htt: , (Gerald Mahoney), Eva68: , (Evans, 1968), Jea95: , (Rondal, 1995), Jea07: , (Jean-Adolphe Rondal, 2007), Gir98: , (Girolametto, 1998), Sue11: , (Buckley), Sue11: , (Buckley), Byr95: , (Byrne A, 1995), Byr95: , (Byrne A, 1995), Bro93: , (Broadley I, 1993), Bro93: , (Broadley I, 1993), Her71: , (Herriot, 1971), Buc93: , (Buckley SJ, 1993), Buc93: , (Buckley SJ, 1993), htt1: , (Accessing the curriculum - Strategies for differentiation for pupils with Down syndrome), htt1: , (Accessing the curriculum - Strategies for differentiation for pupils with Down syndrome), Buc01: , (Buckley SJ S. B., 2001), Sue111: , (Sue Buckley), Buc93: , (Buckley SJ B. G., 1993), Read More