Psychological support provided to families of young children with Down syndrome

In this article we are presenting an outline of the experience of the Moscow Downside Up Early Intervention Center and our focus in our early support service.

Zhiyanova, P. (2005) Psychological support provided to families of young children with Down syndrome. Down Syndrome News and Update, 5(1), 17-19. doi:10.3104/practice.354

Psychological model of family support

Mother-child interaction and, thus, child development are influenced by various factors, which have been described in Russian and international literature. In particular, it was shown that stress factors affecting the family make it difficult to develop positive parent-child interaction, which in its turn affects the child's overall development and hinders social adaptation. In addition to the well-known stress factors, typical to situations when babies with disabilities are born, in Russia there are some more stress factors present that we will indicate below.

Our own experience proves the idea that support provided to the whole family (rather than to the child only) should be the primary focus of the work of an early intervention service. According to this principle, we have arranged our work so that each of its aspects (educational, social, etc.) as well as the work as a whole includes a psychological component in addition to a direct support provided by a professional psychologist. It means that the support system we have built might be considered a psychological model of family support.

In order for this model to be effective the following requirements must be fulfilled:

How are these requirements fulfilled at our Center?

Downside Up was established in 1996. Downside Up runs an Early Intervention Center helping over 500 families from Moscow, other Russian regions and the Commonwealth of Independent States (CIS). The Center is the only place in Moscow where direct services to children with Down syndrome are provided on a daily basis. In addition to home and center-based learning support for children from birth to seven years old the staff publishes books describing their experience, translates and distributes literature to increase awareness of Down syndrome and provides vital information to parents. The Center also organizes training and seminars for staff of maternity hospitals, kindergartens, babyhouses and rehabilitation centers.

Downside Up is the operating name of Downside Up Limited, a registered UK charity no. 1055087, registered UK address as below, registered company no. 3026295, and of Russian Charitable Fund no. 67698.

UK: 28 Mysore Road, London SW11 5SB, Tel/Fax: +44 (0) 20 7223-1013, e-mail: v.garrett@btopenworld.com

Russia: 115184, Moscow, Ozerkovsky pereulok, 15.

Tel/Fax +7 (095) 951-0079

Tel. +7 (095) 959-4979

e-mail: downsideup@dowsideup.org

website: www.downsideup.org

First of all we should emphasize that there is a well thought-out system of stages in our work with the family. In our Center families are offered professional advice and support from birth to the time when they go to school (in Russia children start school at the age of seven). So there are two stages in the work of the Downside Up Center, and correspondingly, two types of program: Early Intervention Programmes and Pre-school Programmes. Among the Early Intervention Programmes there is a maternity hospital program, a home visit program and an adaptation group program, while the pre-school programs include individual and group session programs. It is important to note that on each stage psychological, pedagogical, social and informational support is provided to the families. A system like this allows us to work with the family for a long period of time gradually reducing the support, and helping parents of children with special needs to rely, more and more on their own resources.

A multidisciplinary team

One more essential factor in achieving success is the presence of a multidisciplinary team which consists of experts in various subjects related to the development of children with special needs, in our case, - with Down syndrome. Whatever work the team members do in our family-centerd model, they always consider the family as a system. Each team member gradually accumulates and begins to use expertise in closely related subjects. This allows us to arrange the work so that one professional having a wide range of knowledge and skills can be a home visitor capable to take a comprehensive approach to every child and her family. It allows the family to avoid multiple contacts with specialists, which is especially important in the early stages of the work with the family.

The first stage: How to work with a "mother-child" dyad

When a home visitor plans her work with the family she takes into account the mother's state and infant's individual characteristics.

The mother's state

We should note that in spite of all individual differences there are many similarities in mothers' state, which might be explained by similar circumstances under which the doctors in maternity hospitals in Russia break the news. Down syndrome is usually identified immediately after birth, and the mother is usually told of it before the genetic analysis is made. The news is often broken during the first hours of the baby's life. At this time, the mother is usually alone, lacking support from her family. Besides, she knows that she has to tell the news to her relatives. As a rule, the maternity hospital staff try to persuade the mother to give up the baby, and the mother can be prevented from breastfeeding. (In most Russian maternity hospitals, an old-fashioned system still exists when newborn babies are kept in a separate ward and are brought to their mothers only for feeding.) Nurses often do not bring the mother her baby with Down syndrome. Sometimes special medicines are used to stop lactation. Many mothers remember for a long time the attitude of others towards her and her baby, as full of contempt or disgust. It happens mainly because neither the mother nor the people around her have correct and up-to-date information about the causes of Down syndrome, abilities of children with this chromosomal abnormality and their developmental perspectives. For these reasons, many mothers of children with Down syndrome are deeply depressed.

Characteristics of the child

Infants with Down syndrome like other infants are ready to establish a primary interaction, however, their reactions and behavior have some specific differences. Many of them have sucking problems which can interfere with the interaction during feeding; eye contact can appear a little later, and in some cases be shorter; their smile can be less expressive and appears later, vocalization is not as active as in most other babies. In addition, infants with Down syndrome can have some sensory disorders.

Mother's responses to infant's behaviors

The infant's development can also be affected by a secondary issue relating to the mother's responsiveness . Sometimes the mother's perception of her infants responses can be delayed; she may not notice behaviors as easily and therefore they go unnoticed and not be responded to. This affects the development of mother-infant interactions. The most typical mother's behaviors are described below.

In both cases, mothers who cannot "read" their infants' signals treat their peculiar behaviors as a lack of signals and do not respond to their initiatives. Instead, they guide them in all their activities. Therefore, the home visitor's role is to attract the mother's attention to her infant's signals and help to her learn to interact with the child and build relationships of cooperation.

What might happen later?

Observing further development of mother-child interaction, we sometimes notice the following things:

Children at Downside Up's Early Intervention Center

At this stage, so called adaptation groups play an invaluable role. At these group sessions, all the above-mentioned characteristics of the mother-child relationship become noticeable because of the presence of others. In a desire to show her infant to the best advantage the mother often tries to repress any manifestation of her independence, she restricts her natural behavior and uses a directive style when she talks to her. Sometimes the mother interrupts the child's play, diverting her from one toy and giving another, even without using a verbal instruction.

When parents, especially mothers, attend adaptation group sessions together with their children in most cases we observe positive changes due to following reasons:

In our Center parent support groups work permanently. A professional psychologist leads them. Recently a group of parents, whose children attend the Center regularly, set up a Family Club, and unexpectedly most parents took up this initiative. It was especially remarkable that mothers of very young children who do not attend group sessions yet joined the Club too.

Conclusion

We are far from considering the model described above a miracle cure solving all the problems families of children with special needs face. At the same time, we find it important to regard Early Intervention Centers not only as organizations promoting early development of children with disabilities, but also as Centers providing social and psychological family support.

Bibliography

  1. Bowlby, J. (1989, 1973). Attachment and loss. V. 1,2. N.Y.
  2. Guralnick, Michael J. (1997). Second-Generation Research in the Field of Early Intervention. In The Effectiveness of Early Intervention. Edited by Michael J. Guralnick (pp. 3-20). Baltimore: Paul Brookes Publishing Co.
  3. Yurtaikin, V. and Zhiyanova, P. (2000). Family Teacher and His Role. Doshkolnoe obrasovanie (Pre-school Education), 3, 91-103 (in Russian).
  4. Zhiyanova, P. (2005). Family-Centerd Model of Early Intervention. Moscow: Monolit (in Russian) (in press)
  5. Zhiyanova, P. and Ghimadeeva, M. (2002). Social Adaptation of Young Children with Down Syndrome. Moscow: Monolit. (in Russian)
  6. Promoting Complex Development of Children with Down Syndrome: Individual and Group Sessions / Edited by Elena Pole. Moscow: Monolit. (in Russian)
  7. Cicchetti, D. (1990). (Ed.) Children with Down Syndrome. A developmental perspective. Cambridge University Press.
  8. Mukhamedrakhimov, R. (1999). Mother and Infant: Psychological Interaction. St. Petersburg: St. Petersburg University Publishing. (in Russian)

Editor's Glossary

Dyad - a social unit made up of two people, e.g. mother-child, client-therapist, doctor-patient.

Pedagogical - relating to educational issues

Symbiotic - describing a mutually beneficial relationship