DOCUMENT RESUME

ED 278 183 EC 191 728

TITLE Down Syndrome: A Current Perspective. Bulletin1762.

INSTITUTION Louisiana State Dept. of Education, Baton Rouge.PUB DATE 85NOTE 19p.; Prepared by the Down Syndrome Project.PUB TYPE Information Analyses (070) -- Guides Non-Classroom

Use (055)

EDRS PRICE MF01/PC01 Plus Postage.DESCRIPTORS Child Development; *Cognitive Development; Delayed

Speech; Developmental Stages; *Downs Syndrome;Emotional Development; *Language Acquisition; *MotorDevelopment; *Self Care Skills; Social Development;*Special Health Problems

ABSTRACTThis informational document is intended to help

answer questions commonly asked by families, professionals, and thegeneral public concerning Down Syndrome. Medical problems associatedwith Down Syndrome include heart conditions, upper respiratorydisorders, ear infections and hearing loss, vision/eye problems,cervical problems, and gastrointestinal anomalies. In Down Syndromechildren, early cognitive development follows the same sequence as itdoes in nonhandicapped children (i.e., holding and mouthing objects,exploration and play, problem solving, imitation, conceptdevelopment) but is delayed in most or all areas. Four areas ofdifference in language, hearing, and speech include differentprelinguistic development, high incidence of middle ear pathology,and problems with incidental learning and generalization. Amonggeneral principles of motor development for Down Syndrome childrenare similar progression to that of all children, but slower rate anddependence upon others to avoid over exertion of the muscles. Selfcare skills including toileting and dressing are briefly consideredas is social emotional development. A final section containsobservations concerning older Down Syndrome children and adults.(DB)

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TABLE OF CONTENTS

I. Introduction

II. Medical Problems Associated with Down Syndrome

III. Cognitive Development

IV. Language, Hearing and Speech

V. Motor Development

VI. Self-Care Skills

VII. Social/Emotional Development

VIII. Beyond Preschool

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INTRODUCTION

The information in this packet reflects the personal perspectives of

Down Syndrome Project staff members in the various areas relating to

children with Down Syndrome.

The information compiled in this packet is a result of working with

children who have Down Syndrome and noting the most common questions asked

by families, professionals, and the general public. This material is not a

complete reference; rather, it is intended to be used as a response to

frequently asked questions.

Please call the Down Syndrome Project at 504/342-1257 if A!ou have any

questions or need more information. The staff is available for technical

assistance and inservice training at no cost.

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MEDICAL PROBLEMS ASSOCIATED WITH DOWN SYNDROME

Although there are many medical conditions associated with DownSyndrome, too much emphasis is often placed on them. The significance ofthe medical conditions must be kept in perspective. The medical conditionspresented in this packet are some of the most common in Down Syndrome andhave a significant impact on development and education. Awareness ofmedical problems by parents and educators is very important, and a goodmedical management program is essential.

Heart Conditions

Heart defects occur in approximately 40 to 60 percent of persons withDown Syndrome. There are several defects which occur. Parents of childrenwith a heart defect are well informed about the problem and are often a goodsource for information on specific disorders. The information below willbriefly outline the structure of the heart and the problems which can arise.

The heart is made up of four chambers. The right side of the heartreceives blood from the veins in the body and pushes it to the lungs whereit receives oxygen. From the lungs, the blood flows to the left side of theheart and travels through the arteries to carry oxygen to the body. Struct-ural defects may occur in the walls between the chambers, in the valves thatcontrol the flow of the blood, or in the position of the blood vessels. Theflow of blood in the body while in the uterus bypasses the lungs. Thissystem may fail to close at birth.

The treatment, if required, depends on the severity of the defect.Some may be treated with medication, others require surgery. Symptoms mayoccur immediately, or the condition may go undetected until signs of dis-tress occur. Symptoms, depending on the defect, may be mild or severe:difficult breathing, blueness, poor appetite, slow weight gain, rapid pulse,and others.

Recommendations: Encourage the child to engage in age-appropriateactivities. Increase the time alloted for feeding, etc. to prevent stress.If symptoms of stress such as increased difficulty in breathing, fatigue,blueness of lips or nails, or rapid pulse occur, the child should be allowedto rest.

aur Respiratory Disorders

Upper respiratory problems occur frequently in most young children withDown Syndrome. The frequency does seem to decrease as the individual getsolder. Conditions such as colds, sinusitis, bronchitis, and pneumonia arecommon. Some of these conditions may be chronic during the preschool years.There are many medications such as antibiotics, decongestants, and antihis-timines which some physicians use to treat upper respiratory diseases.

Recommendations: Observe the children for symptoms such as coughing,runny eyes, congestion, and any nasal discharge which is thick and dark.Parents and teachers need to know the side effects of all medications,whether taken at school or at home.

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Ear Infections, Hearing Loss

Because of the frequent respiratory problems, there is a high incidenceof ear infections and hearing loss in persons with Down Syndrome. Theinfections can cause fluid to accumulate in the middle ear, which is locatedbehind the tympanic membrane (ear drum). This fluid can cause pain and insome cases can rupture the tympanic membrane. Middle ear infections do notalways have obvious symptoms. The most frequent treatments for earinfections are medications and surgical interventions. Small aeration tubescan be inserted into the tympanic membrane which may help with some audio-logical problems.

Hearing loss is reported in 70 to 90 percent of children with DownSyndrome. The hearing loss may occur only in conjunction with the presenceof ear infections (intermittent) or it may be permanent. Most hearinglosses in this population are reported as mild, conductive losses, meaningthat the sounds do not travel through the middle ear cavity in the normalway. Any hearing loss can affect speech and language development.

Recommendations: Parents and educators need to be aware of the possi-bility of hearing problems. Good medical management and periodic hearingscreening are necessary steps to managing hearing problems in children withDown Syndrome.

Vision/Eye Problems

Visual problems are reported in up to 50 percent of persons with DownSyndrome. Muscle imbalance occurs in 12 to 23 percent of the Down Syndromepopulation. The person's eyes may turn in (esotropia) or out (exotropia).Small rapid eye movements (nystagmus), occurs in approximately 15 percentof persons with Down Syndrome. Nystagmus is usually secondary to lensopacities and/or refractive errors. Refractive errors such as myopia(near-sightedness) or hyperopia (far-sightedness) occur in as many as

70 percent of individuals with Down Syndrome.

Treatments such as medications, surgery, and corrective lens areavailable. Periodic screening for vision problems is important. Visionproblems can affect many areas of development and education.

Recommendations: Note any unusual eye occurrences and access appropri-ate medical personnel. Educators should be aware of diagnosed eye problemsso that proper modifications in programming and teaching can be carriedout.

Cervical Problems

A spinal condition, atlanto-axial dislocation, occurs in 12 to 17

percent of persons with Down Syndrome. This condition is also known asatlanto-axial sublaxation. In this condition there is increased movement ofthe first two cervical vertebrae. Children with this condition may notexhibit any symptoms; some, however, have gait problems. An injury to theneck of a person with atlanto-axial dislocation can result in paralysis andsometimes death.

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Recommendation: Children who have atlanto-axial dislocation and in

whom the condition has not been corrected should not engage in activitiesthat could lead to cervical spine injury, such as contact sports, trampolineexercises, rough play, and somersaults. Routine physical examinationsshould include a check for abnormal neurological signs. Some medicalauthorities recommend cervical spine x-rays at the time when children beginphysical play activities. Thirs-condition can be surgically corrected.

Gastrointestinal Anomalies

A significant number of children with Down Syndrome have malformationsof the gastrointestinal tract (4 to 35 percent). Atresia (lack of anopening), or stenosis (narrowing) of the esophagus, stomach, or the small orlarge intestine may occur. Other disorders may involve the lining of theintestine, fistulas and twisting of tIlte bowels.

Symptoms of the conditions may be present at birth, occur gradually, orsuddenly as the child becomes older. Some of the signs of intestinalobstruction are vomiting, constOation, distention, and failure to gain

weight.

Surgery is usually required.

Recommendations: Recognize and report changes in the child's eatinghabits, bowel and urinary output, and abdominal distention (tightness).

COGNITIVE DEVELOPMENT

Cognitive development for the young child can be described as the useof the senses and motor abilities for learning about the world. Children

begin to learn and understand objects and events in their surroundingsthrough observation, exploration, and interaction with the environment.

A young child begins the process of learning about the world by usingthe senses of sight, sound, touch, taste, and smell. Parents and teachersalike can stimulate this early cognitive development by providing oppor-tunities for a variety of experiences. For example, moving the child todifferent rooms in the home or different areas of the classroom will givethe child the opportunity to become familiar with different sights, sounds,tastes, and textures. Exploration of the environment is primarily throughsensori-motor activities, that is, understanding that the world develops bymoving around and using the five senses.

It is important for both parents and teachers to consistently monitor achild's vision and hearing. Without these two senses in proper workingorder, a child may be at a great disadvantage in interafting with the

environment. Monitoring the child for problems at an early age may helpprevent major problems in learning as the child gets older.

Early cognitive development can be divided in five areas. Theseareas do not develop independently of each other; ho4ever, each area doesinvolve a sequence of skills. As children explore and act on things intheir environment, they begin to build an understanding of the world aroundthem. They learn about objects through play. The way a child relates toobjects is an important area of early cognitive developw,Int. In this area,movement progresses from holding and mouthing objects to using objects inpretend play. The problem-solving area involves the methods of using thebody or toys to help solve problems during exploration. For example, thechild learns how to hold more than two toys and how to operate a mechanicaltoy. Object permanence involves the child's reacting to the presence orabsence of people and things in the environment, such as a hidden toy.

Imitation is a fourth major area in cognitive development. A childlearns many new skills by observing and copying others. As this skill ispracticed and perfected, learning may take place much faster. A final areaof early cognitive developent is pre-academic skills, or the development ofconcepts. In learning pre-academic skills such as matching and naming andselecting items, the child begins to put together many previous experiencesand understandings to form concepts about the world. With practice onpre-academic skills, his movement progresses from a concrete understandingto a more symbolic or abstract understanding. At this later stage, the

child develops an understanding of many concepts necessary for more formallearning, such as concepts of size, shape, colors, and numbers.

Early cognitive development can be enhanced by providing a variety ofexperiences for the young child. Play is the young child's best method oflearning to think. Encouraging initiation of and involvement in playactivities can help provide the stimulation for the proper sequence ofskills in the development of learning.

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In general, children with Down Syndrome have delays in most or allareas of development, including the cognitive area. However, the sequencein which each skill is attained follows closely with the sequence in which anon-handicapped child would attain the skill. The range of variability forthe acquisition of certain skills in the cognitive area by children withDown Syndrome is great. This variability in skill levels of some childrenwith Down Syndrome can be affected by associated conditions such as heart,vision, and hearing problems.

Children with Down Syndrome may have difficulty with the transfer fromconcrete to abstract methods of learning in the area of cognition. Childrenwith Down Syndrome have also been reported as having difficulty with conceptformation, with higher level integrative abilities, and with their abilityto cognitively process environmental information adequately and appropri-ately.

One factor teachers and parents must always keep in mind when workingwith young children with Down Syndrome is that each child is a uniqueindividual with his or her own learning style and abilities. Emphasis inprogramming should incorporate unique learning styles as well as rates oflearning new skills. The goal of parents and teachers alike should be tohelp each child develop to the fullest potential through a warm, stimulatinghome and school environment.

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LANGUAGE HEARING AND SPEECH

Most people are familiar with the idea that language and speech devel-opment will be delayed in children with Down Syndrome. The traditonalcommunlcation milestones (responding to sounds, responding to intonation,responding to commands, imitating sounds, using consistent sound combina-tions as words, naming pictures, etc.) will generally develop at a slowerrate. Just as there are variances among nonhandicapped children in lang-uage and speech development, there are variances among children with DownSyndrome in their development. Not all children win Down Syndrome exhibitthe same delays or the same differences. Instead of approaching communica-tion in the traditional sense of delays, attend to these differencesobserved between children with Down Syndrome and other children:

A. Young children with Down Syndrome appear to go through the jargon stageof prelinguistic development differently. They may not babble or theymay go from babbling to using true words, or they may stay in the jargonstage for a longer period of time.

Recommendations: Encourage each child to go through the normal stages ofearly language development, especially babbling and playing with Che soundsof the child's language. These prerequisite stages are important. Enjoythese early attempts at communication. Encourage production of true wordsonly after the child has had time to master several consonants and vowelsand has played with them by stringing together pairs of them. Model (or sayback) the true word when the child uses jargon to label or describe eventsin his environment. Acknowledge the child's attempt to communicate. Takeadvantage of the spontaneous use of language rather than demanding that thechild "say" or "tell me" single words or words out of context.

B. Some 70 to 90 percent of children with Down Syndrome may show some formof middle ear pathology. Problems could be related to recurrent upperrespiratory infections, congenital abnormalities of the ear andEustachian tabe, and/or generalized muscular hypotonia.

Recommendations: Otological and audiological evaluations should beconducted before the child's first birthday and repeated on a regular basis.The importance of early detection (through otoscopic examination, typano-metry, and puretone audiometry) and medical management cannot be over-emphasized.

C. Children with Down Syndrome may have difficulty with incidental learning,with generalization, and with processing information. In the area ofcommunication, these difficulties are reflected in the observations thatchildren with Down Syndrome use little spontaneous speech or communicateexperiences through language. It is also observed that delayed responsetime or inaccurate responses may be related to problems in processingwhat they have heard.

Recommendations: Structure the child's environment so that he/she has anopportunity and a need to communicate. Be careful not to predict oranticipate the child's needs. "Wait" - give the child a chance to processthe information, resolve the conflict, obtain the desired object, or relate

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the experience before you intervene. Provide visual as well as auditoryclues when teaching.

D. Intelligibility is often poor for the child with Down Syndrome. Some

children appear to use jargon for extended periods of time. Other

children appear to lack the oral motor skills for adequate articulation.Some children appear to be aware that their communication attempts areunsuccessful; others do not appear to notice and do not attempt to

change their verbal output.

Recommendations: Again, acknowledge the child's attempt to communicate.Model correct productions of words that the child may not be able to sayclearly. If you cannot understand a child's message, look at the child'senvironment for contextual clues. Encourage the child to resolve thiscommunication conflict, e.g. have the child point to what he/she wants, takeyou to the desired object, or use a sign or gesture for the object. Sign

language in conjunction with the spoken word has been successful for manychildren with Down Syndrome. Often the child will sign the word, providingthe listener with an additional clue for understanding. Articulationtherapy may be recommended. Integration of the movements of the speech

musculature may be delayed. More information needs to be obtained in thisarea.

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MOTOR DEVELOPMENT

Motor development is the most obvious sign of growth and maturation inyoung children. Most parents and educators observe motor delays in a

child's development before any other area of development. When teaching achild with Down Syndrome, the following general principles of motor develop-ment and learning should be used as a guide.

1. Motor development milestones usually appear in the same order for allchildren and are continuous regardless )f a handicapping condition.Children with Down Syndrome follow the normal progression of motordevelopment, but generally at a slower rate than do non-handicappedchildren. A typical example is a child with Down Syndrome learning towalk at two or three years of age, which is a skill generally learned atone to one and one-half years of age.

2. Specific motor skill development emerges from general motor skillability. Included in this principle is acquisition of large muscleskills before small muscle skills. Gross motor skills are the founda-tion for fine motor skills. In children with Down Syndrome, sitting(trunk control) is necessary before cube stacking (arm and fingercontrol).

3. Maturation of the nervous system must occur in order to perform motortasks. Children only achieve levels of development when they are ready.Readiness in this instance is neurological. Children are able to crawlonly after the nerve fibers used in the motor task of crawling havemyelinated (become neurologically mature).

4. Motor development begins with the head (cephalo) and proceeds to the

feet (caudal) and begins at the trunk (proximo) and moves to the fingers(distal). An example of this principle is found in a child's abilityto control his head, neck, and shoulders fo.: sitting before his hips,knees, fingers, and ankles for walking, as well as trunk control beforehand and finger control. Normal development begins with both limbstogether (bilateral) followed by both limbs on one side (unilateral)and finally movement of the opposite arm and leg together (cross-lateral).

5. Early reflexes must appear and then be integrated in order for voluntarymuscle movement to develop. An example is the grasp reflex, which whenintegrated allows for voluntary release of objects. Children with DownSyndrome may a) exhibit a delay in the time at which a reflex enterstheir motor system, b) often have an extended period of time in thereflex, and c) most likely experience a lack of intensity of the refelx.

6. Non-handicapped children independently stop performing activities beforeover exertion of the muscle. Often children whose movements areinitiated by someone else must depend upon the other person to stt.7) theactivity before over exertion of the muscles and allow sufficient timefor recuperation and rest. This is important with children with DownSyndrome because many of them have other health problems which would beaggravated by over exertion.

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7. Children involved in the process of learning are found to have periodswhen growth in certain areas will be slow because their mental energyand the environmental emphasis cause another area of growth to surgerapidly. For example, when a child begins walking, interest in communi-cation may decrease. Once walking is fairly well developed, interest incommunication will again surface.

Research shows that at least 90 percent and as much as 98 percent ofchildren with Down Syndrome have less than normal muscle tone (hypotonia).Some effects of hypotonia are delayed motor development and extreme flexi-bility. This is very obvious in the hip joints. Because of the increasedflexibility, children with Down Syndrome may be able to assume unusual bodypositions (such as "w" sitting, splits, and knees over head). Thesepositions should not be encouraged. Poor stability of the joints affectsall of the movements of the body. Instability along with poor muscle tonemandate that the person(s) working in the motor area start very early with aconsistent developmental approach to teaching the muscles appropriate,efficient movements using the above-mentioned principles.

It has been found in approximately 12 to 17 percent of the populationof ,:ersons with Down Syndrome that there is an abinrmal alignment of thefirst cervical vertebrae (atlas) and the second cervical vertebrae (axis).This condition, called atlanto-axial dislocation, is diagnosed by x-ray andtreatable with surgical fusion. Some cases of atlanto-axial dislocation canbe suspected by observing symptoms such as deterioration of ambulatoryskills, changes in neck posture and movement, neck pain, changes in bowel orbladder function, and weakness of any extremities. Caution must be taken insr.ilecting activities because of the possibility of neck injury which couldlead to paralysis or death. If atlanto-axial dislocation is diagnosed, thefollowing activities should be avoided: gymnastics, diving, starting blockentry and butterfly stroke in swimming, high jump, soccer, trampoline, andrough play where the cervical area could be injured.

Some general points to keep in mind:

a. Normal movement experiences provide a foundation for normal movement.

b. Only give the child the amount of support needed.

c. Programming and adaptive equipment should be designed to encourageindependent functioning.

d. Incorporate developmental principles into daily care activities, e.g.,lifting, feeding, dressing, etc.

e. Provide a wide range of developmental movement activities; childrenneed to experience a variety of positions and movement every day.

f. If you don't permit an abnormal movement, you must provide the childwith a more normal movement as a substitute.

g. Motor development activities should be coordinated with activities inother areas. Gains in social, self-help, cognitive, and communicationskills should occur with progress in motor skills.

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SELF-CARE SKILLS

Self-care or self-help skills refer to the child's ability to feed,dress, and toilet himself. The development self-care skills is crucialto a child's overall social development and the basis for eventual indepen-dent or semi-independent living. For the non-handicapped child, self-careskills are viewed simply as a means to an end; that is, the development ofskills follows a normal progression which the child picks up incidentallyduring the course of day-to-day living. Self-care skills are oftendeveloped to such a high degree of precision that a non-handicapped personno longer needs to think of them. For the child with Down Syndrome,however, self-care skills may be difficult to acquire and may often requiresustained practice in order to be maintained. Maturation is an importantfactor in the development of self-care skills for a non-handicapped child aswell as for the child with Down Syndrome. Before beginning to work on aparticular skill, educators and parents would do well to consult a sequen-tial scale of development to determine whether or not the child has acquiredthe necessary prerequisite skills.

The newborn infant with Down Syndrome may not stretch out his/her headfor the breast or bottle, but rather be passive until the nipple is placedin his/her mouth. There may be a weakness of sucking movements and ofswallowing for many. The feeding may be less Chan vigorous, leading to atoo early weaning, for which the child may compensate by tongue and lip

sucking. As the child grows older, feeding progresses from bottle to

strained foods, strained to textured food, and textured to regular tablefood. Progress in acquiring feeding skills is contingent upon the child'soral motor functioning and is determined by the child's developmental ratherthan chronological.age.

Toileting is a topic of concern to parents of non-handicapped as wellas handicapped children. A great deal of literature has been written onthis subject, and most experts agree that no child will be toilet traineduntil ready. The major developmental milestones of establishing bladdercontrol, establishing bowel control, and establishing a regular toiletingroutine can be task-analyzed into smaller and smaller sequential stepsdepending upon the needs of the child. It is important for the parents andteachers to coordinate efforts in this area, as in any other area. Know-ledge of when the child reaches each developmental milestone is necessary inorder to know when to begin efforts in toilet training. This can eliminatemuch frustration for the teacher and parent and most especially for the

child!

The operations involved in learning to dress and undress provide a richopportunity for children and parents to engage in problem solving together.In the initial stages of learning, children with Down Syndrome will befrustrated if faced with complicated buttons or zippers that they are unableto operate (the same is true of a non-handicapped child). Adults, whoaccomplish dressing and undressing almost without thinking, often havedifficulty breaking the task down into small steps. However, with a littleeffort the task can be broken down into steps which the child can accomplishwithout failure. Another good training technique for parents to use in

teaching the child with Down Syndrome to dress and undress is "backward

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chaining." This involves starting with the final result or product beingtaught and working backwa:ds from that point. As with non-handicappedchildren, children with Down Syndrome will first begin to help with dressingand undressing, then begin to pull off items of clothing on their own. The

child then progresses to learning to put on clothing and finally mastersdifficult fasteners such as buttons, zippers, and hooks. The trainingtechniques previously mentioned are useful in teaching any of the dressing/undressing sequences. Because of the shorter fingers associated with DownSyndrome, these children may experience some difficulty in acquiring dres-sing skills, especially in mastering buttons, zippers, and hooks. Parentsand teachers should exercise patience, be as encouraging as possible, andnot press a child to master a task for which he is not maturationally ready.

In the area of self-care skills, the child with Down Syndrome should beencouraged to become as self reliant as possible. Assistance (oral and/orphysical) should be reduced as the child gains independence. Practice inself-care skills may enhance communication as well as social and motorskills.

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SOCIAL/EMOTIONAL DEVELOPMENT

The social/emotional characteristics of individuals with Down Syndromehave stereotypically been classified as cheerful and placid. Recent studieshave suggested, however, that this population is no more homogenous than anyother exceptional population, and thus does not fit into a predescribed moldof social/emotional behavior.

It is evident that the social/emotional development of the child withDown Syndrome is dependent upon several factors. Intellect, temperament,age, sex, and environmental conditions all have a profound effect uponsocial/emotional development.

The development of a child with Down Syndrome progresses throughrelatively the same social/emotional stages with little variance from thatof any other child. The progression of the child through these stages,however, is determined by developmental level rather than chronologicalage.

Babies less than one year old are capable of expressing such adult-likeemotions as joy, anger, fear, and happiness in response to a variety ofstimuli. Early social experiences largely determine what sort of adultschildren will become. The child with Down Syndrome who is at a develop-mental social/emotional level of less than one year begins to learn to trustthe world. Consistency, sameness of experience, and continuity all play arole in the acquisition of trust. Suspicion and fear are the byproducts ofundependable, inconsistent, and unsafe experiences.

The child who-is functioning socially between the ages of two and threeyears begins to develop a degree of independence. Appropriate interactionswith parents and teachers who permit children to do what they are capable ofat their own pace and in their own way fosters the emergence of independ-ence.

Misunderstandings in communication may serve to complicate this patternof development. It has been documented that the parents and teachers ofyoung children with Down Syndrome have found that if they waited longer forthe child to respond, more responses were noted. It is important toemphasize that not all children with Down Syndrome exhibit delays inresponse; however, it is of vital importance to allow the child with DownSyndrome to respond or act before assuming that he is not going to respond.It is also important to remember that this technique of interaction mayrequire some practice before it is mastered, and that a certain level offrustration always accompanies the mastery of new skills.

The emergence of socialization occurs between the ages of three and sixyears. As with the child with Down Syndrome who is functioning at thissocial/emotional level, the number of contacts and quality of contacts withother children determines in part the progression of social development. Agood preschool experience may help to increase the number and quality ofsocial contacts with peers and may facilitate the social adjustment tofuture group settings.

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Appropriate social behavior is important in children with handicaps atany age. It is extremely important as the child grows out of the preschoolyears toward adolescence. Socially unacceptable behaviors such as kissingand hugging strangers should be discouraged and appropriate behaviors shouldbe fostered in home, school, and community environments.

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BEYOND PRESCHOOL

Through middle and late childhood the individual with Down Syndromewill continue public school education in special classes or regular classeswith resource help. Education in the academic areas continues. Training indaily living skills, such as dressing and grooming, and independent livingskills, such as public safety and handling money, enables the individual todevelop more independence. Adolescents and adults with Down Syndrome whoare pursuing an independent life situation often participate in work-studyprograms. In a work-study program, students spend part of the day in theclassroom and part of the day in on-the-job training. Sheltered workshopexperiences provide work opportunities for individuals needing a controlledworking environment. The work is usually subcontracted from businesses inthe community. With early vocational/work experiences some individuals arelater gainfully employed in their community.

The sequence of sexual development in individuals with Down Syndromeusually does not differ from that of their non-handicapped peers. Pubes-cence may be delayed, however. It is important that the adolescent withDown Syndrome be given direct and simple information about the physicalchanges in his/her body. Persons with Down Syndrome will have the samekinds of sexual feelings as their peers. With the help of understandingparents and teachers, the individual with Down Syndrome will learn sociallyappropriate ways to express those feelings. Females with Down Syndrome canbecome pregnant, and there is a 50 percent chance that the baby will haveDown Syndrome. Little information is available regarding the fertility ofmales; moreover, there is no report in the literature of a male with DownSyndrome fathering a child.

The adult's leisure and recreation skills should be similar to those ofother adults. Independence is not always easily attained, but it is

typically a common goal for adults with Down Syndrome and their families.The life expectancy of adults with Down Syndrome has increased over the lastseveral decades. Some individuals are now living into their sixties andseventies. Ongoing improvements in medical, educational, and socialservices should enable this trend to continue. This also means that manyadults with Down Syndrome will outlive their parents. Living at home may bean option for some adults but other options are available, such as grouphomes in the community and independent apartment living.

DOWN SYNDROME PROJECT3365 DALRYMPLE DRIVE

BATON ROUGE, LOUISIANA 70802(504) 342-1257

This public document was published at a total cost of $118.54; 100 copiesof this public document were published in this first printing at a cost of$118.54. The total cost of all'printings of this document, includingreprints, is $118.54. This document was published by the LouisianaDepartment of Education, P.O. Box 94064, Baton Rouge, Louisiana, 70804-9064, to provide information about special education and related servicesfor exceptional children under authority of P.L. 94-142, R.S. 17:1941 etItta. This material was printed in accordance with the standards forrinting b state a encies established ursuant to R.S. 43:31.

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