Early intervention programs for children with down syndrome

What is Down Syndrome? Service Overview This is a specialized treatment program for children between the ages of 15 months and 6 years. The program includes: individual treatment sessions which focus on intensive speech and language stimulation group treatment sessions which focus upon beginning socialization skills, as well as carry-over of language skills within a group setting play-oriented treatment sessions to provide "hands-on" experiences while emphasizing imitation of speech direct parent training with observation of treatment sessions to enable the learning of stimulation techniques for use within the home Skills of Speech-Language Pathologists Our nationally-accredited staff members are clinically certified in speech and language pathology and are specialists in the areas of pediatric speech and language disorders.

The law requires that states provide early intervention services for all children who qualify, with the goal of enhancing the development of infants and toddlers and helping families understand and meet the needs of their children. The most common early intervention services for babies with Down syndrome are physical therapy, speech and language therapy, and occupational therapy. Early intervention should begin any time shortly after birth, and usually should continue until the child reaches age three.

An amendment to IDEA in allows states to have early intervention programs that may continue until the child enters, or is eligible to enter, kindergarten. Development is a continuous process that begins at conception and proceeds stage by stage in an orderly sequence.

There are specific milestones in each of the four areas of development gross and fine motor abilities, language skills, social development and self-help skills that serve as prerequisites for the stages that follow. Because of specific challenges associated with Down syndrome, babies will likely experience delays in certain areas of development. However, they will achieve all of the same milestones as other children, just on their own timetable.

In monitoring the development of a child with Down syndrome, it is more useful to look at the sequence of milestones achieved, rather than the age at which the milestone is reached. Physical therapy focuses on motor development.

For example, during the first three to four months of life, an infant is expected to gain head control and the ability to pull to a sitting positions with help with no head lags and enough strength in the upper torso to maintain an erect posture.

Appropriate physical therapy may assist a baby with Down syndrome, who may have low muscle tone, in achieving this milestone. Before birth and in the first months of life, physical development remains the underlying foundation for all future progress. Most children are expected to achieve each milestone at a designated time, also referred to as a "key age," which can be calculated in terms of weeks, months, or years.

Because of specific challenges associated with Down syndrome, babies will likely experience delays in certain areas of development, but they will achieve each of the same milestones as other children, just on their own timetable.

In monitoring the development of a child with Down syndrome, it is more useful to look at the sequence of milestones achieved, rather than the age at which the milestone is reached. What are the types of early intervention therapies? How does each type address specific aspects of a baby's development? Appropriate physical therapy may assist a baby with Down syndrome, who may have low muscle tone, in achieving this milestone.

Before birth and in the first months of life, physical development remains the underlying foundation for all future progress. Babies learn through interaction with their environment. To do so, an infant must have the ability to move freely and purposefully. The ability to explore one's surroundings, to reach and grasp toys, to turn one's head to follow a moving object with one's eyes, to roll over, to crawl in pursuit of a desired objective--all of these behaviors are dependent upon gross as well as fine motor development.

These physical, interactive activities foster understanding and mastery of the environment, stimulating cognitive, language, and social development. Another long-term benefit of physical therapy is that it helps prevent compensatory movement patterns that individuals with Down syndrome are prone to developing.

These patterns can lead to orthopedic and functional problems if not corrected. Speech and language therapy is a critical component of early intervention. Even though babies with Down syndrome may not say first words until 2 or 3 years of age, there are many pre-speech and pre-language skills that they must acquire first.

These include the ability to imitate and echo sounds; turn-taking skills learned through games like peek-a-boo ; visual skills looking at the speaker and objects ; auditory skills listening to music and speech for lengthening periods of time, or listening to speech sounds ; tactile skills learning about touch, exploring objects in the mouth ; oral motor skills using the tongue, moving the lips ; and cognitive skills understanding object permanence, and cause-and-effect relationships.

Fifty mother-child pairs participated in this evaluation. The average age of the mothers was Subjects received RT during weekly one hour parent-child sessions.

They received an average of 33 sessions over a one year period of time. A comprehensive child development assessment was conducted at the beginning and end of intervention to evaluate the effects of this intervention. Mothers' style of interaction and children's pivotal behavior were also assessed from a seven minute videotaped observation of children and mothers playing together. As expected, pre- post comparisons indicated that the Responsive Teaching strategies helped mothers make significant increases in their levels of Responsiveness and Affect while interacting with their children.

In addition, over the course of intervention, children made improvements in all seven of the pivotal behaviors assessed by the Children's Behavior Rating Scale.

To assess intervention effects on children's cognitive and language development a proportional change index PCI was computed. PCIs compare children's rate of development during intervention to their rate of development before intervention.

Children with DD did not have social emotional problems at the beginning of intervention as indicated by their TABS scores, and made little improvement in this domain during intervention. This was evident on three TABS subscales, detached, under-reactivity, self regulation. To determine whether Responsive Teaching was truly responsible for these developmental improvements, analyzes were conducted to examine if the changes in mothers' responsiveness and children's pivotal behavior that were promoted through Responsive Teaching were related to the developmental and social emotional improvements that children made.

Results from these analyzes produced the following findings. These findings indicate that there was a linear relationship between the degree to which mothers changed their level of responsiveness with changes in children's pivotal behavior.

When mothers did not change their responsiveness, children made negligible increases in their pivotal behaviors. However, when mothers became more responsive, the degree that children increased their pivotal behavior was directly related to the degree to which parents changed their responsiveness.

The more responsive mothers became during intervention, the more children increased their pivotal behavior. In other words, how much children's pivotal behavior changed during intervention was related to the improvements in their Developmental Ages.

Children who did not change their pivotal behavior attained developmental age scores that were comparable to their expected Developmental Age scores.

However, children who increased their pivotal behavior attained Developmental Ages that were greater than their Expected Developmental Ages.

Third, analyzes were conducted to examine how changes in children's pivotal behavior contributed to changes in their social-emotional functioning. Results indicated that changes in children's pivotal behavior were not related to their social emotional improvements.

Results from this evaluation indicated that children made remarkable developmental and social emotional improvements when their parents used Responsive Teaching with them. The magnitude of developmental improvements that we observed is comparable to, and in most cases far greater than, the level of improvements that have been reported for most other early intervention procedures c. While there was no Control group, the analyzes that were conducted suggested that the effects of treatment were causally related to Responsive Teaching.

Approximately one third of the parents who participated in this project were not very successful in using RT strategies. This was indicated by the fact that the RT strategies had no impact on these mothers' level of responsiveness with their children.

Children of these mothers made no improvements in either their pivotal behavior or in their development or social emotional functioning during intervention. However, for the remaining two-thirds of the sample, the picture was just the opposite. RT strategies were effective at helping these mothers learn to interact more responsively with their children.

How much these mothers improved their responsiveness was related both to increases in their children's pivotal behavior and to improvements in their children's developmental and social-emotional well-being. There are several important implications that Responsive Teaching has for children with Down syndrome and their parents. First, it is important to note that children with Down syndrome and their parents were the starting point for developing this curriculum.

As explained earlier in this paper, the process of developing the intervention procedures that are now known as Responsive Teaching were initiated because of research findings which suggested that parental responsiveness played a major role in fostering the cognitive and communication functioning of young children with Down syndrome. Although only one child with Down syndrome was included in the Responsive Teaching evaluation sample, the overall results of the evaluation suggested that RT can improve the developmental status of children with a wide range of disabilities.

The child with Down syndrome who participated in the Responsive Teaching evaluation made developmental gains that were comparable to the other children in our sample.

While these results are encouraging, clearly they are not sufficient for claiming that Responsive Teaching is an effective intervention for these children. To make this claim, Responsive Teaching would need to be validated with a larger, more representative sample of children with Down syndrome, and intervention outcomes would need to be examined for more than one year of time. Second, one of the unique features of Responsive Teaching is that this curriculum promotes social emotional functioning as well as cognitive and communication development.

In fact, the same RT strategies that are recommended to promote pivotal behaviors related to children's cognitive and communication development are also used to promote pivotal behaviors related to social emotional development. In the evaluation of Responsive Teaching, children's progress in each of the three developmental domains had less to do with extent to which intervention focused on these domains, and more to do with how responsive children's mothers became during intervention.

The instructional strategies that RT recommended to promote children's cognitive and communication development also helped to address children's social-emotional needs, even though this was not the focus of intervention.

One implication of these reports is that developmental interventions must not only address the cognitive and communication problems of children with Down syndrome, they must also attempt to prevent or address behavioral or social emotional problems as well.

We are unaware of any developmental intervention other than Responsive Teaching that has been reported to address all three of these developmental domains. Future evaluations of Responsive Teaching with children with Down syndrome and other disabilities need to determine whether this intervention is effective at addressing the social emotional functioning of these children as well.

Third, one of the primary things that parents request from their children's early intervention program is information about what they can do at home to support or enhance their children's development. Responsive Teaching is designed specifically to address this need. Many interventionists are unsure of what they should ask parents to do at home, since often the types of activities that they do with children in classrooms or clinics do not translate easily into activities that parents can do with children during their daily routine.

Because Responsive Teaching was developed from observations of how parents typically interact with their children, RT provides parents with information that can be easily incorporated into the routine activities they have with their children.

When we conducted the evaluation of RT, one of the questions we were concerned about was whether RT would place additional stress on parents. We measured how stressed parents were at the beginning and end of intervention using the Parenting Stress Index Abidin, We found that RT did not increase parents' stress, but rather was associated with slight decreases in overall stress.

While parents reported that they used RT approximately 2 hours each day with their children, this occurred mostly during the normal activities they had with their children, such as feeding, bathing, dressing and other routine social and communicative exchanges.

While parents were asked to play with their children to practice RT strategies, this lasted no longer than 5 minutes at a time and only as many times during the day as parents desired. As parents became more proficient with RT strategies, intervention recommendations shifted to encouraging parents to incorporate RT strategies into their routine interactions with their children.

Thus, while RT requires parents to invest small amounts of time to learn to use these strategies, the time parents are asked to devote to this intervention over and above the time they normally spend with their children decreases over time. Rather than being a burdensome intervention, most of the parents who have participated in this intervention report that RT enhances their enjoyment of being with their children. In this paper we have described a promising new early intervention curriculum called Responsive Teaching.

This curriculum is designed to help parents become more effective at promoting their children's development and social emotional well being by infusing Responsive Teaching strategies into their routine interactions with them. It evolved from research conducted with children with Down syndrome which suggested that parents promote children's cognitive and language functioning by engaging in responsive interactions with them.

A one year evaluation of this curriculum showed that it was highly effective at enhancing the development of children with autism and other developmental disabilities. While only one child with Down syndrome participated in this evaluation, the research findings that led up to the development of this intervention point to the likelihood of its effectiveness with children with Down syndrome.

Gerald Mahoney, Ph. Abidin , R. Parenting Stress Index, 3 rd Edition. Odessa, FL. Ainsworth , M. Mother-infant interaction and the development of competence. Bruner Eds. The Growth of Competence pp. New York: Academic Press. Bagnato , S. Temperament and Atypical Behavior Scale. Baltimore, MD. Bailey , D. Teaching Infants and Preschoolers with Handicaps.

Columbus, OH: Merrill. Bates , E.