Developing the Educational and Social Needs of Children with Down Syndrome

Hertfordshire Grid for Learning

Reprinted with the permission of the Hertfordshire SEN Advisory Team

• Speech and language development: difficulties in understanding verbal instructions, abstract concepts and explaining how tasks have been carried out.
• Short term auditory memory: difficulties in retaining verbal instructions, remembering rules, rote learning.
• Generalisation and flexible thought.
• Auditory and visual impairment.
• Concentration span.
• Fine and gross motor skills: difficulties in recording tasks, handling small equipment, cutting out, construction.
• Sequencing events.
• Consolidation and retention of information.
• Motivation: may adopt behavioural strategies that enable them to avoid tasks seen as too difficult, easy/troublesome.

Inclusive Placement

• Place the child with his/her own age group/at most one year behind.
• Encourage the child to take part in most class activities alongside their peers; let them work with more able children in a pair/group and foster co-operative working.
• Ensure they take part in all school activities.
  e.g. assembly
  lining up at dinner time

• Make sure that everyone takes a consistent approach to managing the child.
• Teach basic class and school rules; don't give special treatment.

• As class teacher, try to build a relationship with the child; don't let the LSA monopolise the child; work directly with the child at least once weekly.
• Give children some time each day without close adult supervision to make friends and learn from making mistakes.
• encourage the child to become an independent learner.

• Ensure the class teacher is involved in planning the IEP so that it is related to the class programme.
• Plan for joint planning between the class teacher and the learning support assistant.
• Foster co-operation between home and school; get to know the child's parents and their philosophy.
• Keep expectations high but don't blame yourself if the child falls behind. They will. There is nothing you can do to make Down syndrome/its consequences go away.

Supporting The Teacher And Learning Support Assistant

• preparing resources
• modifying teaching materials
• constructing learning apparatus
• producing word banks of subject-specific words
• observing in-class behaviour
• liaising
• keeping records.

Effective Teaching Approaches

• to feel accepted, cared for and respected
• to experience success
• to have friends.

• instructions and explanations to be presented visually
• access to concrete and visual materials wherever possible
• language to be simple and short
• learning to be presented in small steps at a slower pace and consolidated by overlearning.

• basic literacy skills
• developing speech and language in accordance with specific activities recommended by a Speech and Language therapist
• improving fine-motor skills, keyboarding and IT
• improving short-term memory
• planning opportunities for skills to be reinforced and applied in a range of situations to encourage generalisation

Giving Curricular Support

• before the lesson
• before a new task

• Children with learning difficulties also benefit.
• Children with poor attention skills will benefit too.

• cartoons
• icons
• on a flip chart/whiteboard

• so the child knows exactly what you want them to do.
• Use volunteers from the class to model good practice.
• Children tutored by peers gain from individual instruction and positive, potent peer reinforcement.

• a deeper understanding of the material learned by having to teach it.
• increased maturity, sense of responsibility, sensitivity and empathy.
• better social skills.
• enhanced self-worth, confidence and levels of aspiration.

Giving Emotional Support

• Give reassurance, encouragement and praise.
• Encourage independent learning.
• Talk through worries and problems.
• Help to develop networks of support from peers.

Behaviour

• It causes harm to the child/to others.
• It upsets/annoys other people.
• It interferes with the learning of the child/other pupils.
• It disrupts the smooth running of the organisation.

Areas of difficulties

• Children may misbehave because they want adult attention.
• They know what they are doing is naughty.
  They have done it before and it works.
  They would rather be punished than ignored.
• Children may misbehave because they are angry/frustrated.
  Built up anger needs to be let out; they lash out at whoever is nearby.
• Children may misbehave because they are uncertain/confused.
  They don't know what's expected.
  They don't realise it's unacceptable.
  They've done it before and not been told off.
• Children may misbehave because it gives them pleasure.
  The rewards over ride the consequences.
  It helps them unwind/calm down.
  They don't notice people getting cross.

Strategies

• Explicitly teach the major routines of the day and the behaviour that accompanies them such as:
  • lining up.
  • sitting at carpet time and assembly.
  • self-help skills like putting on coats.
  • encourage the child to notice what other children are doing.
• Hold consistent expectations. Ensure all staff have appropriate and shared expectations of behaviour.
  Once a basic rule is established, no exceptions should be made.
  Don't excuse antisocial behaviour because s/he is at a particular developmental stage.
  Encourage staff to discuss problems with each other to arrive at explanations and solutions.
• Distinguish the 'can't do' from the 'won't do'.
  Investigate inappropriate behaviour by asking why the child is acting like this. Is the work suitably differentiated? Is the work too hard/easy/long?
  Discourage special favours/allowances.
  Remind the child about school and class rules.
• Ignore attention-seeking behaviour within reasonable limits.
• Work closely with parents.
  Ensure they support school and class rules.
  Draw on their expertise in collaboratively devising a programme.
  Keep parents informed, but not about every hiccup.
  A home-school record book with a photocopy of the best work can be sent home each week.
• Provide clear instructions.
  Use short sentences and clear body language.
  Ensure rules are understood.
  Check that rules are remembered.
  Provide good behaviour prompt pictures.
  Ensure the child is working with peers who are acting as good role models.
• Contingent and not didactic style of teaching avoids frustration.
  Demonstrate practically/visually exactly what you want the child to do.
  Use volunteers from the class to model good practice.
• Encourage peers to be supportive.
  Set up a student support team.
  The child chooses 3 peers who are friendly and helpful.
  Ask the child to say what is happening in the classroom and at playtime.
  Ask peers for their interpretation.
  Ask the child what they want their peers to do.
  Encourage peers to suggest and be responsible for enacting strategies.
• A visual timetable shows the child that enjoyable activities will become available at some point in the day; it may stop the child from constantly going to the activity/object s/he likes.
• A visual timetable will help them feel more secure and can lead to a vast improvement in their behaviour and attainment.
• Teach replacement skills.
  e.g. Teach the child to say 'I've had enough' or 'Help me'.
• If the child refuses to come in after play, give him/her some responsibility such as holding the door.
• Rewards can be anything; start with a wonderful reward and gradually reduce it.
• Don't reason; just say 'No ...'
• Don't show the child that their antisocial behaviour is important to you.
• If the child constantly says 'No', you say 'My turn' and do the activity. Then ensure that they can't fail at the activity.
• Be calm and positive.

Social And Emotional Development

Areas of Difficulty

• They are likely to become frustrated/anxious more easily.
• They do not learn well from incidental learning.
• They need additional support in learning rules for normal and appropriate social development.
• They have a shorter concentration span.
• They take longer to learn social rules such as turn-taking, sharing and co-operating with others.

Strengths

• socially responsive, sensitive
• interested in people

Strategies

• benefit from the stimulation and models provided by the peer group.
• learn to work co-operatively.
• learn to work independently.
• develop social relationships with their peers.

• learning to participate and respond appropriately.
• responding to verbal requests and instructions.
• learning to take turns and share.

• considering friendship rotas/buddy system.
• organising LSA support so structured play sessions are provided at playtimes/lunchtimes.
• encouraging independence skills.
• giving responsibilities.
• encouraging self-awareness and self-acceptance.

Concentration Span

Areas of Difficulty

• short concentration span
• easily distracted
• tire quickly

Strategies

• Build in changes of activities.
• Give the child a 'boundary' such as a carpet square to encourage them to remain in one place.
• Build up an activity box that contains purposeful but enjoyable activities that the child can do unsupported (see below).

Literacy Box

• inset alphabet puzzle
• lotto with letters and pictures
• alphabet scrap book
• pattern/handwriting practice using laminated sheet and dry marker, chalk and chalkboard
• plasticine for making snakes and then letters

Maths Box

• tangrams with textured pieces if possible
• selection of pattern activities such as peg boards, beads, coloured shapes
• matching/pairs
  laminate magazine picture; have two the same/cut in half
• magazines to cut out pictures of up to 10 things
• Russian dolls, stacking toys

Memory

Areas of Difficulty

• They are known to have a particularly poor short-term memory. Research confirms that they perform significantly better on tasks involving processing and recall of visually presented material than on listening tasks.

Strategies

• Develop and extend their reading skills.
• Teach them to categorise. This is an important language skill.
  • Choose pairs that go together.
  • Category sorting: judgement is required as to which items belong together. Start with a target object, picture/word and 1 then 2 further objects, pictures or words which may/may not link with the target object.
  • Category sorting: identifying group members for given criterion e.g. pick out the animals
  • Odd one out: judgement is required as to whether an item belongs to the same category as the other
  items. It involves first finding the items that go together and then deciding which item does not belong.
• Practise using rehearsal techniques.
  e.g. When giving a message to deliver, teach them to repeat words out loud until the message is delivered.
  Later this can be done 'in their heads'.
• Use memory training pockets.¹ Research shows they are an effective way to improve memory.
  • Stick 2-5 clear pockets in a row on a piece of card. Removable cards can be inserted into them. Cards can be picture and word flashcards or a sequence in pictorial form.² Attach a hinged flap above each clear pocket.
  • The child is required to open the flap, say the word/describe the picture whilst looking at it and then close the flap and repeat from memory. Then the child opens the second flap, says that word/describe that picture whilst looking at it, closes the flap and repeats from memory. Now they repeat first and then second word/description from memory before going on to open the third flap and repeating the above.

Language: Understanding and Speaking

Areas of Difficulty

• Vocabulary is slower to develop and abstract concepts are difficult. Consequently children with Down syndrome have greater problems in understanding specific curriculum language and in following instructions.
• Problems with controlling tongue and facial muscles can affect the intelligibility of speech so that children have difficulty with articulation, fluency and tone.
• Speaking and listening may be sources of frustration.
• Their auditory short-term memory span is smaller.
• A particular sticking point is development beyond the single word stage. Children with Down syndrome have difficulties in producing longer sequences of words.
• Mastering rules of grammar and syntax are difficult. This results in telegraphic speech; articles, auxillaries and prepositions are often omitted. Correct markers for tenses and plurals are often missing too.
• Children with Down syndrome have hearing losses. 20% develop defects in their ears and auditory nerves. 50% have conductive hearing losses that can fluctuate daily in severity. This affects their ability to hear consonants and similar sounding words, leading to confusion if not accompanied by contextual cues.

Strengths

• Their first vocabulary is the same as for ordinary children. It is acquired later.
• They are competent with the pragmatic/social use of language.
• Most children are eager to communicate and will support their efforts with gestures and physical expressions.

Strategies

• Get specialist and specific advice on hearing loss and advice about best listening environments. Even 15 decibel reductions in hearing will affect progress.
• Ask the Speech and Language therapist to use minimal pairs (similar sounding words) to highlight hearing difficulties. Speech and Language therapists will also use the Derbyshire Language Scheme to assess levels of comprehension of speech. Ask them to explain the implication of their findings.
• Use a digit span test to see how big their auditory memory is. A digit span of 2 items implies that they will be able to remember 2 units of information heard sequentially for a brief period of time.
• Use additional channels of information processing.
  Reinforce meanings of abstract words with pictures and symbols.
  Provide a word bank with pictures and arrange alphabetically/in categories.
  Provide visual representations; encourage the support assistant to draw key ideas on the whiteboard.
  Use concrete materials.
  Give lots of opportunities of handling objects.
• Improve their memories by:
  • rehearsing and repeating.
  • playing memory games.
  • teaching categorisation.
• Research shows that probably the most effective way to improve language acquisition, clarity of speech, memory skills, and the ability to think and reason is to teach children with Down syndrome to read by using visual whole word approaches.
  • Many children articulate words more clearly when they read them. Sometimes they learn to say the word after learning to read it.
  • Sharing a book gives us a shared context and this makes it easier to understand their speech.
  • Reading supports the expansion of utterances beyond the single word level.
  • Reading helps newly learned vocabulary and linguistic structures to generalise into spoken speech.
  • Reading exposes children to grammatically correct sentences.
• Research does not support the belief that just exposing children with Down syndrome to verbally fluent peers will enhance the acquisition of language skills. They need a structured programme.
• Teach words within their understanding. Encourage the child to speak the words.
  Start with words that are most familiar to them; their own name followed by the names of family members.
  These can be followed by words that describe objects from their direct experience.
• Practise new vocabulary in different situations and with different people to generalise language.
• Engineer situations where the child can take the lead.
  e.g. playing teaching
  instructing others
• Repeat individually to the child any information that has been given to a group of children.
• Check and ask for careful listening. Encourage children to look at faces, especially mouths. Sit them towards the front of the class or face to face. Use short sentences and simple, familiar language wherever possible. Support your speech with gestures, facial expressions, pictures and words.
• Avoid closed questions; they allow for 1 word responses.
• Give plenty of for processing and thinking about what has been said and for organising responses.
  Remember that they usually know much more than they are able to tell.
• Encourage parents to take their child to group activities.
  Swimming, gym and drama workshops improve self-confidence, independence and develop both motor co-ordination and the social use of language.

Playbox

• Make a scene within a box in 3D.
  The aim is to set up a scene that is relevant to the child.
  e.g. playground, park, classroom, swimming pool
• Use playmobile figures/equivalent to act as individuals who play in the scene you have created.
• In the first session, the child listens to the adult modelling both activities and language.
  e.g. 'Let's go and play on the swings, are you coming? (said to child)
  'Yes, I want to come.' (modelled for the child)
  'Shall we sit down?' (said to child)
  'Yes we will sit down.' (modelled for the child)
• Repeat until the language is built up and extended; 3 x 15 minutes sessions weekly would be the ideal.
• The next stage is to bring a supportive peer to join in.

Activities to Move onto Talking at the 2 Word Level

• Have a picture and word list of target words. Make up a book using these pictures and words and encourage your child to describe them using 2 word phrases.
  e.g. target word = dog
  with colour words: brown dog, black dog
  with size words: big dog, fat dog
  possession: Elle's dog, mum's dog
• Model and encourage the use of extended utterances in a game. In this way, the child gets to use the target word in a longer sentence without having to make up the talking themselves.
  e.g. fishing game: 'I caught a...'
  hiding game: 'I found a...'
  skittles game: 'I knocked down a...'
• Make up a scrapbook/home-school diary with the child. Then they are more likely to remember the word. Encourage extended utterances.
  e.g. target word = car
  extended utterances: 'My car is big.'
  'I like my car.'

Activities to Develop Listening and Understanding at 2 Word Level

• Keeps still
• Looks
• Listens
• Thinks about what is being said
• Asks when they don't understand something.
  
  
• Shopping game
  Provide a bag and 6 pretend food items.
  'Get the eggs.'
  
  
• Tea party
  Provide plates, dolls and soft toys.
  'Give dolly the cup.'
  
  
• Colouring game
  Provide some large pictures and a few colouring crayons.
  'Colour the rabbit.'
  
  
• Provide models of 3 animals together with pictures of food.
  'Throw bananas to the monkey.'
  
  
• Body parts and actions in a place
  Dolls and soft toys with easy-to-move parts and the child.
  'Show me teddy's eyes.'
  'Show me your eyes.'
  'Elle jump.'
  'Teddy run.'
  'Stand teddy on the floor.'
  'Elle sleep on the cushion.'
  
  
• Dressing up as a worker
  Provide cap, bike, paintbrush and sponge.
  'Wash the wheels'.
  'Paint the seat.'

Literacy

Areas of Difficulty

• Speech and language skills are delayed. Vocabulary is limited.
• sequencing words into a sentence
• sequencing events/information in correct order
• organising thoughts on paper

Strategies

• Teach using the whole word method.
  Children with Down syndrome do not begin to read by using letter to sound knowledge.
  Start with family names or interest words.
  Follow up with words that describe objects from their direct experience.
  Make flashcards with the picture and the word together initially, using a picture symbol system like Picture Communication Symbols.
• These flashcards can be used to build up a picture dictionary of their own. The flashcards can be organised in an index card box grouped under categories such as animals and people to aid categorisation and memory skills.
• Begin by teaching word matching skills.¹
  The initial tasks are to:
  • match a word on a flashcard to an identical word.
  • repeat the word aloud after the teacher.
  • indicate in some way —pointing to an illustration/photo— that they understand what the word means.
Once matching is understood, a second word can be introduced for matching.
• Errorless learning techniques such as physical and verbal prompting are important tools. For example, you can gently guide the child's hand towards the correct object. You can give an extra clue that makes the answer obvious. You can say, 'Find the ... for me.'
• Once the child is reading a few words, they can be combined to make sentences.
  Make simple sentences.
  e.g. Mummy sleeping.
  The 'Breakthrough Approach' is ideal, especially if using the new magnetic boards. They can be purchased from Smart Kids (UK) Limited and their phone number is 01635 44037.
• The 'Breakthrough' sentences can be made into their own books about aspects of their lives. Photographic accompaniment would be ideal.
• Use uncomplicated stories from published schemes such as Literacy Links. They are available from Kingscourt. Their phone number is 0800 317457. Their internet address is mcgraw-hill.co.uk/kingscourt. Check that they have a suitable comprehension level.
• Give jobs that incorporate reading.
  e.g. write message on a card
  practice reading the message
  practice saying the message from memory
  deliver the message
• When 50 words are known, then begin to teach phonic skills by looking at the beginning of words.
  It will take several years of phonic instruction before new words can be decoded using sounds and before phonically regular words are spelled.
• Teach spellings as visually as possible.²
  For example, colour code similar letter groups/patterns within words.
• Use multi-sensory methods of teaching spelling such as:
  • tracing letters.
  • verbal rehearsal of letter order.
  • writing on the table with fingers.
  • reading every letter aloud in sequence.
  • taking a 'photo of the word in your mind'.
Encourage cursive script.
• Provide alternative methods of recording:
  • picture card sequences
  • computer with specialist software
  • sentence card sequences
  • scribing
  • underlining/ringing/pointing to correct answer
  • cloze procedure

Motor Development

Areas of Difficulty

• poor muscle tone and loose joints (hypotonia)
• low levels of fitness
• difficulties with timing, balance and co-ordination of movements
• difficulties mastering handwriting and cutting out because of slack ligaments and short fingers
• Some children are clumsy and have hand-eye or feet-eye co-ordination difficulties.

Strategies

• hand exercises 10 minutes daily
  The emphasis is on both wrist strength and first finger and thumb co-ordination and strength.
  • squeezing a stress ball
  • putting together and taking apart lego/multilink bricks
  • pinching, rolling, squeezing and making things with plasticine
  • picking up progressively smaller items
  • putting these items into progressively smaller containers
  • threading
  • tracing
  • drawing
• Provide additional opportunities to practice motor skills; the only way to speed up improvements is through practice.
• Progression: straight lines, then curved and zigzagged lines, followed by individual letters
  A programme that used to be called the Teodorescu Perceptuo-Motor Programme is available from the LDA as Write From the Start. LDA's phone number is 01945 463441.
• Differentiation: only in size; start big and progressively get smaller
• Use multi-sensory materials and activities such as
  • writing in sand with stick
  • writing in rice, paint, air
  • tracing over on screen
  • writing with water in an empty washing up bottle on the playground
  • write a letter in chalk on the playground and ask the child to walk, run/hop around the shape.
• Model frequently.
• Brush pens and whiteboards may be better for children with weak hand muscles as they work with only a little pressure.
• Use alternative means of recording sometimes- word processing, scribing, highlighting, picture cards, magnetic words.
• Developing ICT skills is essential. Clicker 4 is recommended because it encourages reading skills and has a spell checker.
• Tape enlarged versions of problematic letters on the corner of their desk to remind them of correct formation.
• Teach the routine of:
  • writing a word
  • pretending to put a dot with the pointing finger
  • moving onto the next word.
• Use larger/easier to handle equipment
  e.g. adapted scissors
  fat crayons
  cubes rather than counters

Numeracy

Areas of Difficulty

• Abstract concepts and processes are difficult to understand and represent visually.
• Performance is restricted by poor auditory memory.
• The most able children will achieve working towards/just achieved Level 2 by the end of KS2.

Strategies

• Use numerals with dots that the children can count and touch.
• Give a container in which to place objects once they are counted.
• All instructions and explanations should be accompanied by a visual reminder.
  e.g. similar task completed successfully
  putting a prompt (say plastic 3) on the table to reinforce an oral instruction (say colour 3 frogs)
• Teach appropriate language before it is used to carry out maths processes.
  • Have photographs (for example LDA 'Talking Maths') labelled with key words to act as a flashcard/prompt.
• Newly acquired skills need to be practised regularly and applied in a range of situations.
• Ensure that the Key Stage 1 curriculum is thoroughly taught.
  Explicitly teach the following sub-skills:
  • counting aloud
  • counting objects
  • counting a specific number of objects from a quantity of objects
  • the cardinal rule; that the last number is the total for that set.
    Assess by covering up some objects. Ask how many there are.
  • subitizing/silently counting objects without counting one by one
  • finger representation; quickly holding up a specified number of fingers
  • equivalence/set matching

1. Children with Down's Syndrome: Stephanie Lorenz
2. Meeting the Educational Needs of Children with Down's Syndrome: Gillian Bird and Sue Buckley
3. Including Pupils with Down's Syndrome: Information for Teachers and Learning Support (Primary): The Down's Syndrome Association