Student number: 0373390
SO2008 Assessed Task
Scenario One: A child in Need
An important component of the inclusion programme has been the introduction of pre-school education in order to allow children with disabilities and impediments to their learning to develop the skills that will allow them to maximise their chances of future success in the classroom. The benefit of EI on children with DS however, remains inclusive (Wishart, 1996). This in turn highlights the issue of whether it is possible or desirable to integrate children with DS into mainstream education. Within this scenario the research will be assessed to decide whether EI is effective for children with DS and what is the best course of action to follow in the case of the child in question.
DS is a chromosomal disorder characterised by the presence of an extra #21 chromosome. Instead of having 46 chromosomes in each of his/her cells, a person with DS has 47. DS is the most prevalent chromosomal disorder, and also the most frequently recognised cause of physical and intellectual impairment (Selikowitz, 1990). What this means is that children with DS develop intellectually at a much slower pace than other children who do not have a learning disability (Selikowitz, 1990). However as with all children their rate of development varies considerably, with some developing more slowly and others at a faster rate. According to Wishart (1993), the 'range of ability levels in DS children at all ages is in fact unusually wide for a learning disability of known aetiology' (Wishart, 1993:391). Such variation can be attributed to both biological and environmental factors, which will have an impact on the level of ability acquired by children with DS (Laws et al., 2000).
In the past people with DS were perceived as being sub-human and labelled 'uneducable'. By the 1960's attitudes, treatment and expectations of people with DS had begun to change. Research into the condition of DS illustrated various degrees of intellectual impairment among individuals with DS, dispelling the myth that DS is a homogenous condition (Carr, 1988). The implication of this is therefore that theories such as EI may be able to impact on some DS. EI to enhance early development is a relatively new phenomenon as it was still widely accepted that intellectual functioning was largely innate (Goddard, 1916) and thus training would not affect a child's intellectual ability (Lerner, Lowental and Egan, 1998). However numerous empirical studies have disputed this notion by demonstrating that a person's intellectual development can be changed by environmental experiences (Hunt, 1961; Bandura 1976). The emphasis is on the early years in human development because development is at its most receptive to learning during this period of human life. In fact child development research has established that the rate of human learning and development is most rapid in the pre-school years. For example Bloom's research into cognitive growth found '...that 80% of the child's development is completed by age four' (Lerner, Lowenthal, and Egan, 1998:27) - hence the sooner EI commences the better.
EI can be defined as 'systematic strategies aimed at the optimal development of infants and toddlers with special needs...' (Mitchell and Brown, 1991:xii).The importance of EI particularly applies to children of school age or younger who may be at risk of having developmental problems. The rationale being that if early development proceeds at a faster rate, more closely approximating a typical developmental course, higher final levels of cognitive, linguistic, adaptive, academic, and other skills can be attained (Spiker and Hopman, 1996). Many studies have demonstrated the positive effects of participation in EI. This evidence is particularly strong with respect to school readiness for children from families of limited education and low income who are deemed to be at risk as 'school failures'. These children often enter the school system with smaller vocabularies and fewer critical skills than do their more advantaged peers. The Perry Pre-school Project conducted from 1962- 1967 is an example of the success of such early intervention programmes. Taking an active learning approach based on the work of Piaget they were able to raise attainment of students with low IQ scores from families of a low socioeconomic status that were identified as at high risk of school failure (Schweinhart and Weikart, 1997). The longitudes research follow ups showed lasting effects of EI for participants identified as environmentally at risk. Other longitude research using similar samples (see Reynolds et al, 2001) have corroborated such findings therefore establishing that not only is EI effective in proving cognitive skills but also has long term benefits.
The field however is very much divided about the benefits of early development on children with DS. For example, Gibson and Harris (1988), in their review of 21 early intervention demonstration studies for infants with Down syndrome, concluded that evidence has yet to be obtained that children with Down syndrome are better off in EI programming than if they were taken care of by 'ordinarily prudent parents'. These findings are also supported by Spiker (1990) who using the same technique has Gibson et al (1988) reported that effectiveness of EI for children with DS remains a premature statement to conclude. However such studies have used comparisons with retrospective data from early studies where expectation was less positive and often failed to consider variables such as medical problems and parental education. Evidence also indicates that there is a wide range of ability amongst individuals with DS and therefore such drawn conclusions are far too rigid and pessimistic.
One way of measuring the benefits of EI programmes on children with DS is to compare it against other children with DS who have not experienced EI. For example Cunningham (1983) compared data gained from their research with cognitive developmental data of several other longitudinal studies. The findings indicated that 'compared to no intervention, intervention groups attain higher developmental scores' (Cunningham, 1986:102). More recent longitudinal comparative studies such as those carried out by Connolly et al (1993) and Hines et al (1996) are generally consistent with such findings, thus indicating that EI programmes can have immediate benefits for children with DS including IQ achievement. In fact skills previously assumed to be beyond the ability of persons with DS are now being taught successfully and that formal skills such as reading are being attained by much younger ages than previously as a result of earlier teaching methods (Bryne et al, 2002). Studies carried out by Pueschel and Hopmann (1993), Farrell and Elkins (1995) and Bryne et al (2002) generally indicate that children with DS can acquire basic reading skills. In addition Buckley et al (1996) having studied individual case histories of older children with DS who had been identified as having better reading levels found that all the children had been taught to read at a young age. It was therefore concluded '...that it might be valuable to start teaching children to read from as early as 2 or 3 years of age' (p.271).Gains in other areas such as language and memory are less pronounced indicating that children with DS fare better in learning to read compared to all other cognitive skills. However as already noted there are various degrees of intellectual impairment, thus these finding should not blind us to the fact that despite intense early educational activities some children's developmental capabilities will be more limited than others.
The long term success of EI for children with DS is far more difficult to substantiate. In contrast to findings for children environmentally at risk research on the long term effectiveness of EI for children with DS is often limited and contradictory. This may be attributed to the progressive decline in the rate of development for children with DS. It has been shown that, until adolescence, measured intelligence in children with DS decreases with increasing age (Carr, 2002). Numerous studies show evidence of loss of previous gains at follow up testing - evidence of regression. However there is enough evidence to suggest that participation in EI will slow that decline down. For example Connolly et al (1993), compared a group of 10 adolescents who had participated in early intervention in Tennessee with 10 age-matched adolescents who had not. They reported that the early intervention subjects had significantly higher scores on measures of cognitive abilities and adaptive behaviour than did the comparison subjects.
Although evidence exists of more advanced development in DS infants, this may not be entirely attributed to EI. According to Cunningham (1986) changes in expectation and child-rearing practices have been equally important. Previously parents of DS children '...were given low expectations and little incentive to teach their child...Thus many Down's syndrome children probably received less stimulation then their normal peers...' (Cunningham, 1986:102). Family support is pivotal as rearing children with disabilities presents challenges beyond those of rearing a child without disabilities. Theories such as EI have encouraged parents to provide more positive stimulation with DS children and it may be this that initiates development rather than the EI theory itself. In addition Rao (1997) found that children with DS who attended both centre based educational intervention and integrated pre-school fared better then those who only attended EI programmes. It therefore seems likely that additional stimulation from attending integrated pre-school provisions enhances the effect of EI programmes. Furthermore, '...children with Down syndrome not involved in early intervention programs, but attending regular preschools, tend to show higher cognitive functioning than those who are only in home care or receive only home based services' (Rao, 1997:184). In fact it is now widely advocated that pre-school children with 'special educational needs' including those with DS can benefit academically and socially in integrated settings.
The ideological commitments to integration or inclusion, combined with financial constraints of school districts, are now making segregated settings for children with Down syndrome less common. Since the introduction of the Warnock report (1978) government policy has aimed to increase the number of children with 'special educational needs' including those with DS to be educated with typical developing peers within mainstream schools. Mainstreaming is often considered to be synonymous with integration. The fundamental ideal underlying the concept of integration is the belief that people with disabilities have a right to participate in inclusive environments. It's premise derives from the principle of normalisation which '... emphasizes the desirability for people with learning disability to live a lifestyle as close as possible to the norms of the surrounding society' (Thomas and Pierson, 1995:249) Undoubtedly integration of children with disabilities into mainstream education is an ideal to be desired. But we need to assess whether this process is effective for children with DS in terms of their academic and social development.
Increasing evidence suggests that there may be also academic advantages for children in mainstream schools. For example Cunningham et al (1998), in a review of the extent and impact of mainstream placements, suggest that the overall evidence is for greater educational development among children with DS in mainstream education. In order to weigh up the advantages of integrated provision for children with DS a comparison needs to be made with alternative options - special schools. A longitudinal study by Casey et al (1988) examined the cognitive development and academic attainments of 36 children with DS over a period of two years. 18 of these attended mainstream schools and 18 were in schools for children with mild learning disabilities. Over the two year period of the study, children in mainstream schools performed better on all the measured variables and showed significant gains in mental age compared with their counterparts. These findings are also substantiated by more recent studies. For example Law et al (2000) again found notable achievements in grammar and numeracy among children in mainstream schools compared to children in special schools matched for age and receptive vocabulary supported by Bryne et al (2002) which also illustrates that children with DS attending mainstream schools tended to have the highest academic scores. These findings indicate a strong relationship between the type of school attended and academic ability. In fact the effect of school placement on vocabulary development is considerable with Law et al (2000) reporting '...a difference equivalent to about one-and-a-half years development between the samples overall. When the younger children were considered separately, the children at mainstream school were ahead by an average of two-and-a-half years' (p.453) again demonstrating that the learning and development of all children is particularly crucial in the early years. The results are particularly interesting given that language acquisition and use is a specific deficit for people with DS. It is generally agreed that wider exposure to verbal interaction with a linguistically more able peer group may help develop communication skills in children with DS and lead to acquisition of more advanced skills (Casey, 1988; Laws et al, 2000). There are suggestions that mainstreaming may influence continued progress in early adults years (Turner and Alborz, 2003), however there is a lack of empirical evidence to support this view.
A possible explanation for the difference in academic achievements between mainstream and special education schools is that the former is associated with higher expectation of behaviour and academic ability. In fact research has found that staff in a mainstream setting place more emphasis on academic ability (Sloper et al, 1990) whereas those in special schools place more emphasis on practical activities such as cooking (Cook et al 2001), therefore inhibiting children from reaching their full potential. Cook et al (2001) also found that children socially benefited from attending mainstream schools as those who lived at home and attended ...
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A possible explanation for the difference in academic achievements between mainstream and special education schools is that the former is associated with higher expectation of behaviour and academic ability. In fact research has found that staff in a mainstream setting place more emphasis on academic ability (Sloper et al, 1990) whereas those in special schools place more emphasis on practical activities such as cooking (Cook et al 2001), therefore inhibiting children from reaching their full potential. Cook et al (2001) also found that children socially benefited from attending mainstream schools as those who lived at home and attended special schools tended to be isolated from their peers. In addition being artificially separated from everyday situations may not in the long run adequately prepared children with DS for life after school. In fact Pitts and Curtin (2004) in their interview with older children with disability found that many felt that attending mainstream school is an essential preparation for the 'real world'.
The effects of integration on the social development of children with learning disabilities including those with DS are now widely publicised. Research carried out by Dew-Huges (1999) which compared the social development of children with severe learning disabilities (SLD) being educated mainstream to those in special schools indicated a positive effect of integration on maturity, self-confidence and socialisation of children with SLD. In addition children, who attend mainstream schools, learn to interact socially with their peers and create friendships in natural conditions. The development of positive relationships and friendship between peers is seen by advocates of mainstreaming as one of the most important benefits resulting from integration. Not only does it increase their social competence but promotes better community relations and greater opportunity for inclusion and acceptance in wider society. Generally children with DS are more likely to be integrated in early years as the ability gap is not so apparent and the fact that younger children accept differences more easily. Hall and McGregory (2000) found that children with DS who were integrated in mainstream education at an early age had established stronger peer friendships at a later school age than those denied this opportunity. Likewise mainstream pupils are also more likely to learn about acceptance, tolerance, and compassion whilst sharing the same environment as children with learning disabilities. As a result of such findings, a recommended practice of EI is to place children in mainstream provision.
However caution must be drawn about the extent to which mainstream schooling can meet the needs of children with special educational needs including those with DS. The slower intellectual development makes it harder for children with DS to deal with content, and tasks planned for peers of their age in regular classroom lessons. Many therefore require differentiated work in order to participate and/or Learning support teachers to be allocated. Much of the responsibility regarding integration therefore lies with the teacher to differentiate tasks and resources so that work set is accessible to all. However Scruggs and Mastropieri (1996) found that even though teachers support integration, many felt a lack of necessary time, skills, training, and resources to implement inclusive factors. In fact Petty and Sadler (1996) found that the great majority of teachers had little experience with children with DS and perhaps most importantly had received little or no specialist training either during their initial training or in their teaching career. Arguably therefore the degree of planning required to teach pupils with 'special educational needs' are more likely to be effectively met in special schools where teachers are trained and more experienced and allocated the time to do so specifically (Farrell, 1997). In addition mainstream schools may not provide the individualised teaching more readily available to children within specialist schools, nor have regular access to specialist professionals such as speech and language therapists (Pitt and Curtin, 2004). In fact lack of resources has consistently been identified as a barrier to successful integration. Therefore children with DS who are more likely to have speech and language deficits may lose out on the benefits of such input. The issue of receptivity towards children with DS must also be taken into consideration when placing them in mainstream education. Although this is not a particular issue during the early years of education, research shows that older children with learning disabilities including those with DS despite having friends at school typically suffer isolation and segregation from their mainstream peer (Pitt and Curtin, 2004). Where as in special schools, even though they were geographically isolated Cooks at al reports, (2001) there are positive and personal effects of being with other children with disabilities.
John is a two old child with DS, therefore under sec. 17(10) of the Children Act 1989 he is defined as a 'child in need'. Under this provision the local authority has a duty to assess the needs of John and to provide services outlined to minimise the effect of his disability (Schedule 2, paragraph 6), underpinned by the Education Act, 1996. Based on the information gathered John is at a critical age where learning and development is at it most receptive as identified by child development research. Clearly the fact that he is two years of age is significant in this case as it allows the option of entering an EI programme. The EI programme has met with some success but the research is divided and clearly there is no guarantee that John will develop because of EI. But the opportunity for him to make progress would lead me to conclude that John is therefore most likely to benefit from having EI in order to optimise his chances of acquiring and developing cognitive, linguistic, reading and other skills. In particular schemes to develop reading skills should be made readily available as research indicates the children with DS are most likely to acquire basic reading skills which in turn can assist in the development of language. The EI option is also one that the parents clearly would support as they wish to assist in John developing his intellectual capabilities. The question of the parents is problematical as they have been described as 'pushy'. They would have to understand very clearly that the EI programme has no guarantee of success. They would have to be very supportive and co-operative towards their son's development. The aim is to help John to develop to his own greatest potential not for him to be driven beyond his capability. Research indicates that placing stress on children with DS usually leads to poorer performance rather than better. Therefore it is very important not to create unrealistic expectations in the parents but rather to harness their skills. Research indicates that much of the progress may be provided by the support from parents and the family in providing stimulation to the DS child therefore the parents need to be supported in providing an appropriate balance to their efforts. The availability of support outside the family will also be an important factor in contributing to the development of greater resilience. Taking part in an EI programme is not guaranteed to be successful but does not represent an undue risk as there is no evidence it does harm and it reflects the parent's right to choose the education for their child. In addition John would benefit from attending a local mainstream play school as the importance of integration has been identified within research in facilitating intellectual and social development. The prime aim is for John to be socially included at an early age as well as adequately preparing him to join mainstream education at the age of five. The importance of early integration has been established whereby children with DS who are integrated in mainstream education at an early age are more likely to established stronger peer friendships at a later school age than those denied this opportunity. In the event of EI not developing his skills or integration into mainstream schooling being unsuccessful then it may be appropriate to consider special school placement in the future, but at this point in time the EI programme and mainstream education should be the preferred choice.
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References
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Farrell, P (1997) Teaching Pupils with Learning Difficulties: Strategies and Solutions. London, Cassell.
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The longer term plan would be for John to join mainstream education at five as the importance of integration has been identified within the research in facilitating intellectual and social development. In preparation for this John would benefit from attending a local pre-school playgroup whereby he is socially included at a young age building blocks to prepare children for inclusion into mainstream school can be learnt in these environments.
In the early years, the prime aim is social inclusion. Social inclusion aims for the young child with Down's syndrome
* Learning to participate and respond appropriately.
* Responding to verbal requests and instructions.
* Learning appropriate patterns of behaviour e.g. taking turns and sharing, lining up, sitting.
* Learning to play co-operatively.
* Developing independence: self-help and practical skills.
* Developing friendships.
Many children with Down's syndrome enjoy attending their local pre-school playgroup and most of the basic building blocks to prepare children for inclusion into mainstream school can be learnt in these environments. In the early years, the prime aim is social inclusion. Social inclusion aims for the young child with Down's syndromeNowadays, most children with Down's syndrome attend mother and toddler
groups, nursery, play groups and other clubs alongside their peers. These
activities have many benefits; the child will develop coordination and strong
muscles as well as learning good social skills, communication and becoming
more independent from their parents. Most importantly, they are taking their
place within their community.
For example Pueschel and Hopman (1993) report wide variation in communication skills across a wide age-spread of children with DS.
).++ Development is controlled by the brain. Children with DS have brains that are slightly differently formed from those of other children. This makes the process of learning new skills less efficient (Selikowitz, 1990:45).
in Part III of the Children Act 1989 There are also the benefits of being amongst peers whose behaviour is likely to be age appropriate therefore.
Integration has been an issue of increasing momentum for children with 'Special Educational needs' including those with Down syndrome (DS). Since the introduction of the Warnock report (1978) government policy has aim to increase the number of children with learning difficulties to be taught in mainstream education. This has had important implications on the nature of early intervention (EI) for children with DS. LINK EI with InterG
In fact
Connolly, Morgan, Russell, and Fulliton (1993) compared a group of 10 adolescents who had participated in early intervention in Tennessee with 10 age-matched adolescents who had not. They reported that the early intervention subjects had significantly higher scores on measures of cognitive abilities and adaptive behavior than did the comparison subjects. The mean IQ of the early intervention group was 40.1 compared with 30.5 for the comparison group, with IQ ranges of 25-53 versus 17-45,
For example Connolly et al (1993) longitudinal study on the effectiveness of EI found that children with DS who had received EI did not show decline typically seen with age in children with DS as supported by Carr (2002).
who found anddo not show as much decline in IQ scores as those who had not participated in EI Programme findings which are substaianted (Ludlow and Allen, 1979).
Imitate and model behaviour and develop socially accepted attitudes appropriate to their age.
To sum up, it does seem that early intervention in chidren with DS, given the methodological shortcomings of the field, provides support for reliable effects across different developmental domainsThe evaluation of early
intervention programs for children with Down syndrome is difficult, due to the wide variety of experimental designs used in interventions and the tremendous variability in the developmental progress among children with Down syndrome, a consequence in part of the many complicating medical factors. In addition Strategies and techniques that might be useful to facilitate developmental progress with typically developing infants and children may or may not have similar facilitative effects with children with Down syndrome if the latter children demonstrate qualitatively different learning styles (Wishart, 1993). Nevertheless research carried out generally indicates that with appropriate education, children with DS can certainly develop more rapidly than was formerly thought possible; but cannot 'catch up' with typical peers. Should not blight us to the fact that despite intense early educational activities that some children's developmental capabilities will be more limited to others and therefore stimulation.
compared cognitive development and academic attainment of children with DS in mild learning disability schools with those in mainstream schooling. Over the two years period of the study, children in mainstream schools performed better on all the measured variables and showed significant gains in mental age compared with their counterpart.
made significant gains in numeracy, comprehension and mental age. Overall those found in mainstream schooling performed better on all measured variables than their counterpart.
).+++JEZ Interestingly general findings suggest that children with DS at mainstream schooling fare better in language competence and memory, grammar comprehension distinctive deficits of DS than their counterparts and therefore demonstrate that needs may be better met at mainstream schools schooling.+++
).++ Development is controlled by the brain. Children with DS have brains that are slightly differently formed from those of other children. This makes the process of learning new skills less efficient (Selikowitz, 1990:45).What this mean is that children with DS develop intellectually at a much slower pace than other children who do not have a learning disability (Selikowitz, 1990). ++Cicchettit and Ganiban (1990), in a review on the organisation and coherence of developmental processes in children with DS, comment '...that the higher level information-processing skills that motivate and direct attention in non-handicapped infants are impaired in these children. Although they have the ability to perceive information accurately they are delayed in their ability to use and interpret this information' (Turner and Alborz, 2003:564).+++
By comparing the children's scores with samples from earlier published data (e.g., see Carr, 1988), the authors concluded that the expected declines in developmental levels were reduced for this group of children.They were tested on intelligence, language, reading and arithmetic, and their daily living skills were assessed. Comparison with the same tests given 9 years earlier showed almost no change. As before, higher scores were found for the women, those brought up at home, and, for language and reading, for those from social class nonmanual (NM) families but fewer of the differences were now significant. These results, demonstrating considerable stability over the period from age 21-30, are discussed with reference to other relevant research.
However, lack of resources has consistently been identified as a barrier to successful intergration.
It is alos feared that resources currently available through special education will disappear as inclusive models are implemented, where in fact the resources should be reallocated based on the needs of the child. Specialist support such as speech therapy found at spe may not be readily available at mainstream schools
to verbal interaction with a linguistically more able peer group may help develop communication skills
The evidence from this study is that Down's Syndrome children whose ability levels are congruent with those of children with moderate learning difficulties are capable of having their special educational needs met within mainstream curriculum and the environment and the environment of the mainstream primary school (Casey et al, 1988:286).
According to Wishhart (1993) 'evidence is weak that early intervention leads to substantial or long-lasting cognitive benefits although indirect benefits also need to be considered in any cost-effective evaluation' (p. 390)
To place the early intervention enterprise into context, it is important to understand the longer term developmental course and functional outcomes of children with Down syndrome. In one of the few comprehensive long-term follow-up studies of a sample of children with Down syndrome,
Sloper at al (1990) reported similar findings and found a strong relationship between type of school attended and academic attainments.
Other variables are found to be influential on the rate of cognitive developmental.
have been conducted to assess the effects of early intervention, the information is limited and contradictory regarding the long-term success of early intervention for children with Down syndrome. In light of these findings, intervention should be viewed as a worthwhile, but not realistic expectation The implications of these findings for strategies to use in early intervention are not straightforward, but they alert us that generalization of presumably acquired skills to a variety of situations cannot be taken for granted. At
In fact reviews of the literature yield inconsistent findings in ++++evidence suggest that children recieveing
their research on the effectiveness of EI for children with DS
The standard developmental tests used in EI programmes
Byrne, A., MacDonald, J. and Buckley, S. (2002) assess '...revealed that children with Down syndrome made slow but steady and signicant annual progress in learning to read over the two year period'p523 thus confirming that children with DS could be taught to read however the
Strategies and techniques that might be useful to facilitate developmental progress with typically developing infants and children may or may not have similar facilitative effects with children with Down syndrome if the latter children demonstrate qualitatively different learning styles. For example, as is described next, Wishart (1995) has conducted a number of studies of learning in infants with Down syndrome that indicate differences in acquiring and consolidating such basic developmental tasks as object concept. Her findings suggest that, as early as 6 months of age, infants with Down syndrome engage in specific search and exploration behaviors that she describes as "counterproductive" to learning. To ignore these differences, failing to consider their impact on intervention strategies and goals, may mean contributing to new biases that will hinder the very progress that early intervention efforts seek to advance.
In her summary of a series of studies of children with Down syndrome from birth to age 11 years to investigate cognitive development and problem solving (studies of operant learning, object concept development, and standardized intelligence test performance), Wishart (1993) reported many examples of qualitative learning difficulties experienced by the group with Down syndrome. To illustrate, in operant learning studies, infants with Down syndrome took longer to learn contingencies and seemed more content with noncontingent reinforcement schedules than did typically developing infants. In object concept studies, they showed reduced levels of engagement with tasks they had passed earlier and patterns of developmental instability (loss of performance attained earlier). This seemed to indicate that the acquisition of these skills was not well consolidated. This developmental instability was also noted in IQ test performance over time. Wishart worried that these data indicate a "counterproductive learning style" (p. 400), which results in skill development that is poorly consolidated and therefore developmentally unstable
Background: Many of today's young adults with Down syndrome never had the opportunity to learn to read. However, an increasing number of children with Down syndrome are currently attending mainstream schools and being taught to read. As a consequence, it is now possible to systematically study reading development in children with Down syndrome.
Aims: The aim of this study was to chart the development of reading, language, and memory skills in children with Down syndrome and to investigate the relationships between these abilities.
Sample: Twenty-four children with Down syndrome aged between 4 and 12 were followed over two years and compared to 31 children matched for reading age, and 42 children of average reading ability, selected from the same mainstream classes as the children with Down syndrome.
Method: Standardised assessments were administered annually to obtain measures of reading, spelling, language, memory, and general intelligence.
Results: The children with Down syndrome had relatively advanced single word reading ability compared to their other cognitive skills. The reading progress of the children with Down syndrome did not differ significantly from that of the reading matched group even after two years. Different cognitive abilities were highly correlated with one another in all groups. However, after controlling for age, many of the partial correlations between reading and the other measures were reduced to non-significant levels.
Although there is a wide range of ability and varying degrees of learning disability within this population most children with Down syndrome experience significant difficulty in acquiring and using language' (Byrne, MacDonald, and Buckley, 2002:515).
The best way to make comparison that child with DS travels the same path to those of typically developing children but at a slower pace spending more time at each stage
The rationale being that if early development proceeds at a faster rate, more closely a
Over the last two decades government policy has aim to increase the number of children with learning disability to be taught in mainstream education. The fundamental ideal underlying the concept of integration is the belief that people with disabilities have a right to participate in inclusive environments ().This has had important implications for the nature of early intervention for children with DS.
Assisting children with delays and disabilities to develop skills that will maximise their chances of success in regular education classrooms has become important with the trend to inclusion.
Whilst numerous studies have been conducted to assess the effects of early intervention on the intellectual development of children
the field remains divided over its possible benefits(). This in turn highlights the issue of whether it is possible or desirable to integrate children with DS within mainstream education whether integration the integration of children with severe learning disabilities is still a matter of controversy. Students in our school systems have the right to the best, most appropriate education that can be provided. Students with special needs are no exception. The field however is sharply divided over the extent which this education can - and should - be provided within the structure of regular education.
In the past people with DS were treated has subhuman. Their treatment was based on the dominate ideology in society very much influenced by Darwin theory of evolution t children with DS were labelled as 'uneducable'. By the 1960's attitudes, treatment and expectation for people with DS begun to change ++++
Among the stereotypes that are being dispelled are that Down syndrome is a homogeneous condition in which all individuals are highly similar in intellectual, behavioral, and other characteristics and that the expected intellectual, developmental, and functional outcomes are poor. As a variety of research shows, although Down syndrome is an identifiable condition with many characteristics shared across individuals, there is considerable variation among individuals with Down syndrome-medically, physically, intellectually, and psychologically.
important implications for the nature of early intervention for babies with Down syndrome.
Two particularly important changes have occurred since the 1960s that have influenced attitudes, treatment, and expectations for people with Down syndrome and have important implications for the nature of early intervention for babies with Down syndrome. As most middle-age and older Americans can readily report, there now exists widespread acceptance and support for raising youngsters with Down syndrome at home and having them participate in a variety of activities as part of community integration, rather than placement in institutional settings.
Among the stereotypes that are being dispelled are that Down syndrome is a homogeneous condition in which all individuals are highly similar in intellectual, behavioral, and other characteristics and that the expected intellectual, developmental, and functional outcomes are poor. As a variety of research shows, although Down syndrome is an identifiable condition with many characteristics shared across individuals, there is considerable variation among individuals with Down syndrome-medically, physically, intellectually, and psychologically. In contrast, ideological commitments to integration or inclusion, combined with financial constraints of school districts, are now making segregated settings for children with Down syndrome less common in the out-of-home activity that occupies most of the waking time of children-school. Furthermore, children with Down syndrome are now taking advantage of participation in a wide variety of natural settings (e.g., church, scouting, sports, play groups) uncommon in the past.
as the child reaches school age and middle childhood and the developmental differences from typical peers become more noticeable.
Early intervention of intellectually impaired infants and young children is a quickly expanding field and new methods are being developed around the world. Early intervention can be defined as "systematic strategies aimed at promoting the optimal development of infants and toddlers with special needs and at enhancing the functioning of their families and caregivers" (Mitchell and Brown, 1991, p. xii). These preventive strategies can be considered as primary or secondary. Primary prevention is concerned with averting the conditions which cause disabilities. This chapter addresses secondary prevention which has to do with the early identification of conditions which are likely to place a child's development at serious risk, and the implementation of measures to ameliorate or reduce the severity of any disability which might result from such factors (Mitchell and Brown, 1991).
The assumption behind starting an early intervention programme is usually that the sooner one begins specialized activities with the infant, the more likely one is to prevent or reduce future problems of development (Cunningham, 1988). Intensified activities, together with the plasticity of the developing organism, are thought to produce positive outcomes (Casto, 1987). There are great hopes for the effects of early intervention and it is a general finding that early intervention programmes do have substantial immediate benefits for disabled populations (Casto, 1987). There are, however, many questions which have to be answered, in particular whether there are any beneficial long-term effects of early intervention programmes for impaired infants. For the time being, there is a lack of well-designed, controlled evaluation studies which can demonstrate that the intervention programmes, those already in use and those being developed, really do have long-term benefits and are cost effective.
People who have Down syndrome have been found to display distinctive problems in language development and use which cannot be explained by the intellectual impairment alone (Cardoso-Martins, Mervis and Mervis, 1985; Mundy, Kasari, Sigman and Ruskin, 1995; Smith and von Tetzchner, 1986). They are further behind in their language development than are mental-age-matched, normally developing children or other groups of intellectually impaired children. Besides the general language deficiency, the development of speech seems to be especially delayed in children with Down syndrome (Bray and Woolnough, 1988; Dykens, Hodapp and Evans, 1994). The reason for these difficulties is not yet properly known, and considerable individual variation is evident in the development of children with Down syndrome (Dykens et al., 1994).
Previous studies emphasize that acquisition of preverbal communication skills provides an important foundation for the emergence of language in both normally developing children and children with Down syndrome (Bates, Camaioni and Volterra, 1975; Goldin-Meadow and Morford, 1990; Mundy et al., 1995). Many researchers share the observation that the communication of children with Down syndrome is already deviant in the early preverbal phase (e.g. Mundy et al., 1995; Smith and von Tetzchner, 1986). Children with Down syndrome tend to be more passive and show less initiative in their interactions than normally developing infants (Cardoso-Martins and Mervis, 1985; Fischer, 1987; Levy-Shiff, 1986). Parents seem to be more directive in their interactions with their child with Down syndrome than with other children (Cardoso-Martins and Mervis, 1985; Maurer and Sherrod, 1987), and, in some cases, surprisingly blind to the communicative behaviour of the infant with Down syndrome (Smith and Hagen, 1984). The opinion about children's passivity seems to be more generally accepted than the lack of communicative skills of parents, where there seem to be larger individual differences. The concept of maternal directiveness, as such, has been called into question (e.g. Pine, 1992), and the findings of several studies suggest that parents of children with Down syndrome are able to adjust their communicative style according to the child's skills (Fischer, 1987; von Tetzchner and Smith, 1986).
Several researchers have reported deviant auditory processing in persons with Down syndrome (Marcell and Weeks, 1988; Pueschel, Gallagher, Zarter and Pezzullo, 1987; Varnhagen, Das and Varnhagen, 1987). In the study by Marcell and Weeks (1988), subjects listened to or looked at increasingly longer sequences of digits and attempted to recall them either orally or manually. The results suggested that normally developing persons or other groups of intellectually impaired people typically show better memory for sequences of auditory than visual information while individuals with Down syndrome display either the reverse pattern or equivalent auditory and visual recall. Pueschel and associates (1987) used the Kaufman Assessment Battery for Children to investigate sequential and simultaneous processing in children with Down syndrome, their siblings, and a group of children matched for mental age scores. The children with Down syndrome performed significantly less well on subtests which included auditory-vocal and auditory-motor tasks than on subtests with visual-vocal and visual-motor tasks.
However, the communicative abilities of individuals with Down syndrome are not characterised solely by difficulties and weaknesses. Their pragmatic skills are often good and they tend to use compensating strategies in order to be understood: mimicry, gestures, actions, and - if possible - signing (Bray and Woolnough, 1988). Several studies suggest that it is easier for people with Down syndrome to learn manual signs than spoken words, at least in the early stages of language development (e.g. Abrahamsen, Lamb, Brown-Williams and McCarthy, 1991; Johansson, 1987; Layton and Savino, 1990; Le Prevost, 1983).
Ballard, K.D. (1991). Assessment for early intervention: evaluating child development and learning in context. In D. Mitchell and R.I. Brown (Eds.), Early intervention studies for young children with special needs. London: Chapman and Hall, pp. 127-159.
Development in children with DS: maximising potential
Down syndrome (DS) is relatively well known as a genetic disorder to the general public and children with this syndrome form one of the most readily identifiable groups of children with moderate to severe learning difficulties. It is over 130 years since Langdon Down first described DS and 30 years since the presence of the defining extra copy of chromosome 21 was identified by Lejeune and his team of French geneticists. The adverse effects that DS has on children's development are widely assumed to be well understood by now and the belief that DS is invariably associated with very limited abilities is deeply entrenched in the public's mind. Many professionals who work with children with DS are as susceptible as to the man on the street to the stereotype of children with DS as loving, sociable but not very bright children, and indeed even parents of children with DS will often agree that such a stereotypical description broadly fits their own child - although paradoxically considering it inappropriate to describe other children with DS (Wishart & Johnston, 1990).
The widely held stereotype of children with DS reflects a belief that children with DS are all very similar in their ability levels and personalities. Little scientific evidence supports either of these generalizations and findings from a significant number of studies directly contradict them. This paper will focus mainly on learning ability in children with DS but studies of personality and temperament also support the view that there is considerable individual variability (for reviews, see e.g. Cicchetti & Beeghley, 1990; Stratford & Gunn, 1996). In the case of cognitive abilities in early childhood, evidence for the existence of a very wide range of ability levels is particularly long-standing. Some children with DS experience profound levels of mental handicap but the majority fall into the moderate to severe range, with a minority demonstrating borderline normal levels of intelligence. Reviews of longitudinal and cross-sectional psychometric studies of IQ levels (e.g. Carr, 1985, 1995) show that the IQ scores in children and adults with DS can vary over 50-60 IQ points. This is not very different to the spread of IQ in the rest of the population, albeit displaced to the lower end of the normal distribution.
This last statement should not in any way be taken as implying that most children with DS do not experience significant learning difficulties throughout childhood. Some children do indeed do remarkably well in school and go on to cope well with semi-independent living in adulthood, achieving all sorts of skills previously thought to be beyond the reach of those with DS. Access to early intervention services, better health care, family support services and, most importantly, access to proper schooling in recent decades have all contributed to lifting overall levels of achievement. Claims for what is potentially achievable by anyone with DS given appropriate educational and social support are sometimes immoderate, however, and it is important to recognise the severe biological limitations placed on development by the underlying genetic anomaly. The number of genes implicated in the syndrome is large and the presence of extra copies of these leads to harmful gene dosage effects which undermine many aspects of the developmental process from the very earliest stages onwards. However, the wide variation in achievement levels seen in those with DS at all ages also demonstrates that in itself DS does not necessarily and inevitably result in profound or severe levels of mental handicap. Clearly other factors must be playing a significant role in impeding or facilitating progress in individual children.
Identifying those factors and understanding how and when they impact on developmental processes is a major task for researchers interested in DS and especially for those with a specific interest in trying to help children who have DS to make the most of their abilities. Throughout life, the process of development reflects a complex interplay between genes and the environment. Chromosome 21 is one of the smallest human chromosomes and although present in triplicate rather than duplicate in DS (also known as Trisomy 21), all of the triplicated genes are 'normal'. They also represent only a tiny proportion of the genetic complement which children with DS inherit from their two biological parents. This notwithstanding, standard Trisomy 21 shows only a weak correlation between the degree of learning disability experienced and parental IQ levels, inheritance factors which normally strongly influence children's achievement levels. This suggests that other non-biological factors, including psychological factors, may play an important role in determining the progress made. Since family socioeconomic status also shows only a weak correlation with difference in developmental outcomes, clearly any environmental factors in play are more subtle than those which are usually associated with childhood achievement levels.
The learning environments experienced by children with DS, along with individual differences in response to these, would seem obvious targets for further investigation. Despite the very large number of children who have DS and the levels of difficulties they face in their learning, surprisingly little psychological research addresses these problems directly. In recent years in particular, children with DS have more often been used as controls in studies of normal cognitive development than studied in their own right. Implicit in this use is an assumption that DS development is basically a slowed-down version of normal development. This assumption is difficult to reconcile with the specific pattern of disruption to brain functioning and development now known to be associated with DS. This clearly underpins many of the children's cognitive difficulties but there is also now some evidence that they may add to their inherent disadvantage by becoming increasingly reluctant learners as they grow older. Psychological factors may therefore be playing an important role in the failure to maintain developmental rate which is characteristic of later years in DS. In contrast to biological factors, these psychological factors may well prove to be open to facilitative intervention.
The key problem for children with DS - learning
Many scientists interested in DS are interested in the genetic disorder in its own right and for many their research does not involve any direct work with those who have DS. To developmental psychologists, however, the core defining feature of DS is the effect it has on the ability of those who have it to learn. It is perhaps worth reminding ourselves just how little we have progressed in this particular area. Unpopular though it may be to say so, the evidence is that most programs of early intervention have not yet had the impact that we would have hoped for on children's learning skills and on achievement levels (see e.g. overviews by Gibson & Harris, 1988; Spiker and Hopmann, 1996). Although the supportive value to parents of participating in such programs cannot be overestimated, in many cases the effect is often simply to bring forward the age of acquisition of skills which are normally delayed but would appear in due course. Skills which are truly cognitive - and language skills - have so far proved much more resistant to early intervention, a fact which is also unfortunately largely true in respect of educational success in these areas in later years. Many children with DS do not progress beyond the intellectual capabilities of the average 6-8 year old and a significant number do not achieve even that. Children with DS may be leading healthier and happier lives and benefiting greatly from the growing acceptance of their right to take their place in the community but psychologists have so far made disappointing progress in identifying ways of helping them to compensate for the very real problems they encounter in learning basic childhood skills.
When working only with children with DS, it can be all too easy to see only the progress being made and to lose sight of what is not being achieved and indeed may never be achieved. It is therefore especially important in evaluating findings from empirical studies of children with DS to have access to data from concurrent control groups of typically-developing children. Many studies, however, simply evaluate outcomes by comparing them with developmental norms for children without learning disabilities or with other findings in the DS literature. For lots of reasons, even when control groups have been used in empirical studies of development in DS, studies have more often been cross-sectional than longitudinal in design - looking at a group or groups of children across a specific age range but testing each individual child usually only once, or sometimes twice. Many of these have focused on a very limited age range of children and on the 'ifs and whens' of learning rather than on the actual dynamics of development. Averaging snap-shot data from cross-sectional studies of children of differing age levels is a very crude way of investigating the developmental process and given the huge variability in rate known to characterise development in DS, it is a method which can at best provide very limited developmental information. Longitudinal research is time-consuming and expensive and with children with DS often scattered across a wide range of schools, large scale studies are often logistically problematic. This kind of research is nevertheless crucial to achieving any real understanding of developmental processes in DS.
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