Down Syndrome Research and Practice 12(1)
Preventing challenging behaviours in children with Down syndrome: Attention to early developing repertoires
Kathleen Feeley, and Emily Jones
Several characteristics associated with the Down syndrome behavioural phenotype as well as biological factors are likely to increase the presence of challenging behaviour in individuals with Down syndrome. The application of evidenced based strategies assessing and addressing challenging behaviours in individuals with developmental disabilities can be systematically applied to address such behaviours in individuals with Down syndrome. Additionally, evidence based strategies can be systematically implemented by caregivers of very young children with Down syndrome to address early communication skills (requesting, vocal imitation), escape behaviours, and self stimulatory behaviour thus diminishing early developing behaviours likely to lead to more significant challenges as the child with Down syndrome matures.
Teeth grinding turns out to be no more common in children with Down syndrome than it is in other children and it reduces with age. These are reassuring findings as teeth grinding can be quite an annoying problem at home and at school.
Understanding number concepts and basic mathematical skills is important for many everyday activities in modern societies. Little is understood about the numeracy abilities of people with Down syndrome. At present, it appears that numeracy is an area of relative difficulty and that progress with more complex mathematical understanding is slow. However, some teaching approaches that seek to utilise certain relative strengths to communicate number concepts seem to be useful in practice. Further research is needed to define the precise difficulties experienced by children with Down syndrome and to evaluate teaching strategies.
Clear speech can often be challenging for people with Down syndrome. The shape of the hard palate in the top of the mouth influences speech production. A new paper reports detailed measures of the shape and size of the hard palate among children with Down syndrome.
Sam is 18 years old and has Down syndrome. He achieved a grade in the standard assessment of mathematics (GCSE) at 16 years of age. This paper describes the part played in his success in school by the Kumon method of teaching mathematics, identifies the benefits of the small steps and lots of practice built in to the method and illustrates the way Sam applied his Kumon learning in school.
Sue Buckley, and Ben Sacks
There is a higher incidence of oral health problems among individuals with Down syndrome, particulary after 10 years of age, indicating a need for better teaching of teeth brushing and more regular visits to the dentist. Do these oral health problems affect their quality of life?
Objective: This study was carried out to determine the oral health condition and treatment needs of a group of individuals with Down syndrome in Nigeria. Method: Participants were examined for oral hygiene status, dental caries, malocclusion, hypoplasia, missing teeth, crowding and treatment needs. Findings were compared with controls across age group, sex and educational background of parents. Result: Participants with Down syndrome had poorer oral hygiene than controls, with no significant sex difference. Oral hygiene was similar in the lower age groups but deteriorated with age in the Down syndrome group. Conclusion: Individuals with Down syndrome in Nigeria have poorer oral health and more treatment needs than controls. They would benefit from frequent oral health assessment.
Improved social and educational opportunities and access to informed healthcare are helping today’s generations of people with Down syndrome to achieve more and live longer. This progress is bringing new challenges. Scientific research is steadily improving our understanding of the condition. Future improvements in the lives of people with Down syndrome will require multidisciplinary efforts and more applied or translational research with practical outcomes. In this context, this journal has reviewed the roles it plays in communicating research to specialists and non-specialists, families, practitioners and researchers alike.
Jan McConnochie, and Greg Sneath
Katrina is 10 years old and has Down syndrome. She is making good progress with learning and numbers and mathematics. We describe how Katrina has learned number concepts and arithmetic skills over several years. We highlight the influence of early learning habits, visual supports, motivation and practice, and the uses made of different number teaching schemes.
Being physically active can have a number of benefits - having fun, meeting with friends, keeping healthy and experiencing success. For children with Down syndrome the foundations need to be laid early if they are to keep active in school, teenage and adult years and parents ask for more help in this area from professionals.
This essay describes the setting up of early intervention services in Vietnam. From the outset, there was a focus on developing staff training programmes alongside establishing model early intervention programmes to ensure that the work would be sustained at the end of the project funding and spread throughout the country. The success of this work has now led to the government of Vietnam wanting to move to the next stage and to begin to develop training for full inclusion of children with disabilities in the school system.
Frank Buckley, and Ben Sacks
Mice that carry additional copies of genes comparable to those present on human chromosome 21 have been shown to perform better on memory tests when treated with drugs that target brain function. Could this be an important break-through in the search for pharmacological therapies to assist people with Down syndrome?
This paper presents a review of all patients with Down syndrome seen over a 5-year period by one consultant neurologist in general outpatient and specialist cognitive function clinics. It revealed only 7 cases in > 4500 general referrals (= 0.2%), all referred with suspected seizure disorders. The diagnosis of epilepsy was confirmed in 6 patients. Only one new, comorbid, diagnosis was made. Neurologists have little exposure to, and hence little chance to develop expertise in, the neurological complications of Down syndrome. It is suggested that closer liaison between neurologists and psychiatrists with an interest in learning disability might improve the management of neurological problems in patients with Down syndrome.
A new film offers practical advice and guidance for teachers, classroom assistants and families. Available on DVD, it presents views on classroom practice and effective inclusion, with examples of children at work and at play in UK schools.
The Challenge Me! Mobility Activity Cards address mobility, balance coordination, spatial awareness, trunk control, transferring skills, gross motor skills, flexibility, adaptability, safety awareness, and independence.
This paper discusses the use of Stern teaching materials with children with Down syndrome. The theory underlying the design of the materials is discussed, the teaching approach and methodology are described and evidence supporting effectiveness is outlined.
Tony Wing, and Romey Tacon
This paper discusses the use of Numicon number teaching materials with children with Down syndrome. The theory underlying the design of the materials is discussed, the teaching approach and methodology are described and evidence supporting effectiveness is outlined.
Rubén López-Pérez, Patricia López-Morales, Borges-Yáñez, Gerardo Maupomé, and Gustavo Parés-Vidrio
This study sought to determine the prevalence of bruxism in a Mexican community of children with Down syndrome, and to evaluate bruxism’s relationship with age, sex, intellectual disability level, and type of chromosomal abnormality of trisomy 21. Using a cross-sectional design, 57 boys and girls (3 to 14 years old) were examined. Three approaches to establish presence or absence of bruxism were employed: parental questionnaire, clinical examination, and dental study casts. Data were analysed using bivariate analyses and conditional logistic regression. We found that the overall prevalence of bruxism was 42%. No statistically significant associations between bruxism and age, sex, or intellectual disability level were found. There was, however, a significant association between bruxism and type of chromosomal abnormality, with mosaicism being more frequently associated with bruxism.
Individuals with Down syndrome typically have low fitness levels and obesity despite data that indicate physiological gains from physical activity and exercise interventions. Low fitness levels and obesity in individuals with Down syndrome may be related to sedentary lifestyles, social and recreational opportunities, or low motivation to be physically active. These causal influences on the overall health of individuals with Down syndrome may be related to parental or caregiver support. Through this study, parents of children with Down syndrome from preschool to adolescent ages were interviewed about their perceptions of the health and physical activity needs of their children. Data from four focus groups indicated the following most salient themes: (1) all parents believed participation in physical activity has immediate and long-term positive health impacts on their child with Down syndrome, and most of the parents thought their child would benefit from being more physically active, (2) most parents observed that their child participated in physical activities primarily for social reasons, most notably to be with their peers with or without Down syndrome or to be with their sibling(s), and that without such motivation their child would choose sedentary activities, (3) parents of teenagers identified a need for their child to learn an individual sport to have sporting opportunities that do not require ability-matched teammates and opponents, and (4) parents recognised their need for help from physical activity specialists through either parent education regarding home-based physical activity programmes or an increase in appropriate community-based physical activity programmes for their child with Down syndrome. The interview data suggest future research should evaluate the outcomes of long-term individualised home-based physical activity interventions for children with Down syndrome. Additionally, educators, recreation specialists, and therapists should assist children and youth with their acquisition of skills used in individual and dual sports.
Gopalan Bhagyalakshmi, Annappa Renukarya, and Sayee Rajangam
The hard palate is viewed as playing an important role in the passive articulation of speech. Its probable role in the defective articulation of speech in individuals with Down syndrome has been examined in the present study. In individuals with Down syndrome, the hard palate is highly arched, constricted, and narrow and stair type with malformed misaligned teeth and a large and fissured tongue. As a result good palato-lingual contact is not achieved, with resulting defective articulation. Using orthodontic and prosthodontic principles could modify this situation, i.e. the anatomy of the hard palate. The altered palatal contour may give better placing to the tongue, leading to improved palato-lingual contact and articulation. The dimensional parameters measured were: average linear width (AVL), average curvilinear width (AVCL), average height (AVH) at different planes; average antero-posterior length (AAP), average volume (V), palatal arch length (PAL), and palatal index (PI). The findings were compared with those of controls of the same age and sex. The AVL, AVCL, AAP, PAL, V and PI values of patients with Down syndrome were found to be less than the corresponding values of controls and the average height values of patients with Down syndrome were greater than the corresponding values of controls. Statistical significance was observed in all measurements between the controls and the patients with Down syndrome, especially in those concerning the height and the volume of the oral cavity. Observations from this study have suggested that prostheses might be designed to modify the palatal anatomy and produce better articulation in people with Down syndrome.
Ana Loureiro, Fernando Costa, and José da Costa
Objective: This study aimed to determine the prevalence of periodontal disease among children and adolescents with Down syndrome and the possible repercussions of such pathology in the quality of life of the group in question. Method: The sample consists of 93 individuals with Down syndrome 6 - 20 years old, living in Brazil (Minas Gerais). Periodontal probing was carried out on every site of each tooth. The Plaque Index and periodontal clinical parameters were recorded. A broad interview was carried out with the mothers, consisted of an adaptation of the Oral Health Impact File OHIP-14 that was used to measure the negative repercussions of periodontal disease in the daily lives of these individuals. Results: The prevalence of gingivitis was 91%, whereas periodontitis was found in 33% of the individuals. When the impact of periodontal disease on the quality of life was correlated with the clinical periodontal parameters, it was observed that there are significant statistical differences among them: bleeding on probing, probing depth and attachment loss. These same results, correlated with all the different groups that are categorised according to the diagnosis of periodontal disease, also show significant differences. Conclusions: Periodontal disease can be considered as a condition with high prevalence within the group in question, which has negative effects on the quality of life of the subjects. These effects are aggravated by the seriousness of the disease.