Including and Teaching Children with Down Syndrome in Head

Start Classrooms

Susan Sandall

Head Start Center for Inclusion

ssandall@u.washington.edu

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.

What is Down Syndrome?

• Developmental disability

• Three copies of the 21st chromosome (rather than two)

• Associated with cognitive disability

Remember…

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

Early Identification

• 1 in 733 babies

• Occurs in people of all races and economic levels

• Incidence increases with age of mother

Rat

e P

er 1

,000

100.0

Maternal Age30

10.0

1.0

35 40 4515

Down Syndrome Rate Per 1,000 Livebirths by Maternal Age

20

Adapted from Hook E. B.

25

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

Hall's Cardinal Signs (1966)

1. Flat facial profile2. Absent Moro3. Hypotonia4. Dysplastic ear5. Webbing at neck6. Oblique palpebral fissures7. Hyperflexible joints8. Dysplastic pelvis9. Dysplastic middle phalanx - 5th finger10. Simian crease

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

Three Forms of Down Syndrome

• Trisomy 21– 95%

• Translocation– 3-4%

• Mosaic– 1-2%

Associated Medical and Health Concerns

• Congenital heart disease• Sensory deficits

– Hearing– Vision

• Endocrine abnormalities• Orthopedic problems• Dental problems• Obesity• Others

• 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.

Early Intervention

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

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)

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

Meeting the Needs of Children with Down

Syndrome

• Delays and disabilities across developmental domains

Early development performance of Down’s 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.

Smile

Age in years

4

Down’s syndrome progress

Normal progress

5 6 71 2 3 8 9 10

Sit

Walk

Words

Toilet Training

Birth

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

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

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

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)

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

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?

Challenging Behavior

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

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

Schooling and Adulthood

• Elementary and Secondary School– Reading, writing, math– Individual differences– Inclusion

• Adulthood– Work– Meaningful participation– Health

25 year follow-upHanson, 2003

• N=12 (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

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)

• Children’s educational placements

• Children’s lives in adulthood

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)