Including and Teaching Children with Down Syndrome in Head Start Classrooms

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Including and Teaching Children with Down
Syndrome in Head Start Classrooms

• Susan Sandall
• Head Start Center for Inclusion
• ssandall_at_u.washington.edu

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Head Start Center for Inclusion

• Goal
• To increase the competence, confidence, and
  effectiveness of personnel in Head Start programs
  to include children with disabilities
• Guiding Principles
• The success of inclusion depends on everyone
  realizing that it involves much more than
  children just being there.
• Inclusion refers to the full and active
  participation of young children with disabilities
  in everyday settings.

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What is Down Syndrome?

• Developmental disability
• Three copies of the 21st chromosome (rather than
  two)
• Associated with cognitive disability

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Remember

• Individuals with Down syndrome attend school,
  work, participate in family and community
  activities, make decisions, and contribute to
  society in many ways.

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Early Identification

• 1 in 733 babies
• Occurs in people of all races and economic levels
• Incidence increases with age of mother

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Down Syndrome Rate Per 1,000 Livebirths by
Maternal Age
100.0
10.0
Rate Per 1,000
1.0
30
35
40
45
15
20
25
Maternal Age
Adapted from Hook E. B.
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Early Identification

• 1 in 733 babies
• Occurs in people of all races and economic levels
• Incidence increases with age of mother
• Originally named based on collection of
  symptoms or characteristics

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Hall's Cardinal Signs (1966)

1. Flat facial profile
2. Absent Moro
3. Hypotonia
4. Dysplastic ear
5. Webbing at neck
6. Oblique palpebral fissures
7. Hyperflexible joints
8. Dysplastic pelvis
9. Dysplastic middle phalanx - 5th finger
10. Simian crease

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Early Identification

• 1 in 733 babies
• Occurs in people of all races and economic levels
• Incidence increases with age of mother
• Originally named based on collection of
  symptoms or characteristics
• Prenatal diagnosis

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Three Forms of Down Syndrome

• Trisomy 21
• 95
• Translocation
• 3-4
• Mosaic
• 1-2

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Associated Medical and Health Concerns

• Congenital heart disease
• Sensory deficits
• Hearing
• Vision
• Endocrine abnormalities
• Orthopedic problems
• Dental problems
• Obesity
• Others

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• Many of these medical conditions are treatable,
  so many individuals with Down syndrome lead
  healthy, active lives.
• Life expectancy for individuals with Down
  syndrome has increased dramatically.

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Early Intervention

• Most children with Down syndrome participate in
  infant-toddler (Part C of IDEA) programs and/or
  other special services

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Part C of IDEA

• Birth to third birthday
• IFSP
• Early education, therapies, other services,
  family support
• Variety of service delivery options
• Home visiting
• Groups (play groups, child care, preschool)

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Early Childhood

• Part B of IDEA
• IEP
• Early education, therapies, family support
• Variety of service delivery options and settings
• Classroom, itinerant services, consultation, dual
  enrollment

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Meeting the Needs of Children with Down Syndrome

• Delays and disabilities across developmental
  domains

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Downs syndrome progress Normal progress
Smile
Sit
Walk
Words
Toilet Training
4
5
6
7
1
2
3
8
9
10
Birth
Age in years
Early development performance of Downs syndrome
children raised at home compared to that of
normal children. The widest point in each diamond
represents the average age for performance, and
the spread of the diamonds represents the range.
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Meeting the Needs of Children with Down Syndrome

• Delays and disabilities across developmental
  domains
• Modifications
• Direct or deliberate teaching
• Embedded within ongoing activities and routines

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Physical Development and Intervention

• Hypotonia
• Refine gross motor skills
• Incorporate social aspects (play games,
  playground equipment)
• Refine fine motor skills
• Handwriting and tool use are difficult
• Importance of direct teaching
• Caution orthopedic concerns

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Speech and Language Development and Intervention

• Functional communication system
• Verbal speech
• Sign language (total communication)
• Picture systems AAC
• Comprehension
• Vocabulary building
• Reading
• Two areas of difficulty
• Syntax
• Intelligibility
• Caution hearing loss

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Cognitive Development and Intervention

• Mild to moderate delays
• Importance of direct teaching
• Divide tasks into small steps
• Repetition and practice
• Praise and other forms of reinforcement
• Visual supports and real objects
• Prompts (but aim for independence)

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Self-help Development and Intervention

• Divide tasks into small steps
• Repetition and practice
• Praise and other forms of reinforcement
• Visual supports and real objects
• Prompts (but aim for independence)
• Toilet training
• Determine readiness, work with family, work with
  special educator

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Social-Emotional Development

• Awareness and interest in peers - area of
  strength
• Delays in physical, language, cognitive skills
  may interfere
• Low stamina
• Importance of direct teaching - what skill is
  needed to participate?

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Challenging Behavior

• Common behavioral concerns
• Wandering off
• Stubborn/oppositional behavior
• Attention problems

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Addressing Behavioral Challenges

• Rule out a medical problem that might be related
  to the behavior (e.g., hearing)
• Use principles of positive behavior support
• Identify the function of the behavior and develop
  a plan

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Schooling and Adulthood

• Elementary and Secondary School
• Reading, writing, math
• Individual differences
• Inclusion
• Adulthood
• Work
• Meaningful participation
• Health

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25 year follow-upHanson, 2003

• N12 (15 in original sample)
• Participated in home-based EI for 3 years
  (1974-1977)
• Weekly visits, behavioral, parents as teachers
• Semi-structured interviews, parents and children

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Findings

• Parent perceptions and experiences (positive
  characteristics, positive aspects of child
  rearing, sorrows difficulties, hopes)
• Supports and services for families (advocates,
  importance of early intervention)
• Childrens educational placements
• Childrens lives in adulthood

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Importance of

• Quality educational programs
• Responsive home environments
• Good health care
• Support from family, friends and the community
• For long and fulfilling lives.
• (National Down Syndrome Society, 2009)

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