Inclusion: Primary Schools That Includes Children With Down Syndrome
In very cell in the human body there is a nucleus. In the nucleus our genetic material is stored in our genes, which carry all the information responsible for our traits inherited from our parents. They are grouped in rod like structures and are called chromosomes. The nucleus of each cell contains 23 pairs of chromosomes which we inherit from each parent. Down Syndrome occurs when there is a full copy of the chromosome 21. In the year 1866 an English physician named John Langdon Down, published an exact description of a person with Down Syndrome, and referred to it as a distinct and separate entity, differentiating if from mental disability, hence becoming the “father” of the syndrome. Initially the named the condition “mongoloid” since the children very much resembled the Blumenbach’s Mongolian race. Only in the early 1970s the condition was referred to as the Down Syndrome.
Down Syndrome can also be referred to as Trisomy 21, or Nondisjunction. In 1959 a French physician named Jerome Lejeune identified the Down Syndrome as a chromosomal condition. We typically have 46 chromosomes in our cells, with 23 inherited from each parent. With people with Down Syndrome there is an extra copy of the chromosome 21, allowing there to be 47 chromosomes in every cell. This additional DNA is responsible for all the physical and developmental attributes. Down-Syndrome is one of the most common autosomal aberration among congenital non-inheritable disabilities. An impairment that can occur in all races around the word, drawing information from a statistic from North America and various European countries, in a group of two thousand new-borns around three children contain Trisomy 21. (Schmid, 1987, S. 16) The cause for Down Syndrome is still unknown. With a ratio of 1 out of 800 babies is affect with the disorder, it is proved to be the most common genetic birth defects. There is no scientific research that indicates that environmental factors or the parent’s lifestyle have any impact. The only factor that has been linked is the age of the mother. A 35-year-old mother has about 1 in 350 chance of conceiving a child with Down Syndrome. By age 40 the rate raises to 1 in 100, and by age 45 1 in 30.
Characteristics of Down Syndrome
Physical Characteristics
Facial Features
Although Trisomy 21 differentiates from person to person, it is still noticeable simply due to the distinctive appearance of those with the syndrome. Many features are visible in the facial area. For example, they suffer from Brachycephaly with signs of a smaller head that is flattened in the back. Their eyes are slanted upwards. In addition, they also have a feature described as “Epicanthal Folds”, which are inner-corner folds of skin, dramatizing the common almond eye shape. The pigmentation is affected by DS also tends to have “brush field” spots, which are lighter spots positioned in the outer ring of the iris. The noses have a button appeal due to the narrow bridge which gives a flat facial profile. Smaller ears and folded helix are also common features. A flatter profile is also common amongst individuals with down syndrome, because of the flatter nose profile and the typical low depth of the forehead. Due to weaker muscle tone, the mouth, typically small which makes the tongue seem protruding, appears to be in a constant relaxed frown and the teeth are often smaller, uniquely shaped and are often out of place. The tongue can sometimes have deep fissures. Lastly, their hair is commonly thinner and straighter. However, many DS individuals also have different hair textures, it is also always thinner.
Body Features
However, not only the facial area is affected by this syndrome. The neck of those with Trisomy 21 are seemingly thicker and contain excess flaps of skin in the back. The neck features are the most obvious when detecting down syndrome in an ultra sound. Crooked, thicker, and shorter figures are common, as well as gaps between the big toe and second toe referred to as sandal gap. They tend to have wide hands with short stubby fingers. Their little finger tends to be curved inward. Sometimes they can also suffer from single palmar crease, where they only show one crease in their palm. They suffer from low muscle tone, scientifically known as “Hypotonia”, where their muscles appear weakened and floppy. Children with DS have difficulties rolling over, standing, and talking. Loose joints, and short heights are plausible features too.
Impairments
Vision Impairments
Down Syndrome affects the developing eye and the need of glassed is very common. While many babies, affected by DS or not, are born either long or short sighted, the average being three dioptres. However, children tend to emmetropise, which means they outgrow their baby errors and enter the state of zero. However, children with DS tend not to emmetropise and typically suffer from vision problems like near-sightedness called myopia, farsightedness called hyperopia or cross-eyes. The greatest difference however, is the is difficulty changing the focusing power on something that is near, called accommodation. A child’s interest is mostly close at hand, in their hand, and this is where the learning takes place. Children with DS focus very poorly, they cannot accommodate by a large amount. Approximately 60% of children with DS will wear glasses by the time they enter school, and of that 40% of children with DS will need to ear bifocal glasses to be able to accommodate.
Motor Skill Impairments
Motor skills can be divided into first the basic skills which are necessary for everyday life. These skills are sitting, Walking, climbing stairs, but also picking up objects, Holding and using pencils, scissors and Cups. Then there are the recreational skills which include throwing and catching, riding a bike, kicking a ball, and any other sporting activities. Then we also differentiate between skill gross Motor and fine Motor skills. When the entire Body is involved we refer to the gross motor. skills. If we only use our fingers and Hands for fine manipulation we talk about fine Motor skills. Children with DS can acquire all those skills but are delayed. For example, a child with DS can learn to crawl at 18months, and walk at 18 months, while a child not impacted by DS will crawl at 8 months and walk at 12 months. However, children need basic Motor skills because they have an important Impact on their social and cognitive development. A child can only learn within their physical world, if they can grab and object. They can explore freely with their Hands, if they are able to sit. Children with DS approach learning differently, and they benefit greatly from visual learning. Being able to walk and follow their mother increases their social interaction and visual learning opportunities.
Hearing Impairments
The importance of hearing cannot be overemphasized, and surveys suggest that as many as 80% of people with Down syndrome will have some problem with hearing. Down syndrome: Common paediatric ear, nose and throat problems. Down Syndrome Quarterly, 5(2), 1-6. A handful of children obtain language by using their hearing skills, good hearing is involved in the development and progress of speech and language as well as socialization. Early on detection of hearing impairments is crucial for the children with down syndrome, hearing test show be performed every 4 to 6 months.
One common hearing issues is Conductive loss, which is common, accruing in 83% of DS children’s deafness reasons and is due to an inference with the function of the middle ear by infection and / or ear glue. Middle ear infections are also not uncommon, this is due to the problems of poor drainage of sticky glue and the infection-prone characteristic down syndrome has. Another common hearing difficulty is Sensorineural loss, this occurs when the acoustic nerve is damaged. Some studies show that this often occurs later in child development, however regular check-ups on conductive loss are mandatory. This has a serious effect on understanding, since the frequencies that give speech its comprehendible audibility are affected. It is also known to be difficult to detect, because it is not uncommon for a deaf DS child to not be notticed as deaf, due to them reacting on sounds but only on frequencies that are typically low and not completely audible. There is no cure for Sensorineural loss, however hearing aids are very beneficial, and most DS with Sensorineural loss depend on their hearing aids and their ability to lip read.
Speech Impairments
As stated in the prior paragraph, DS children face the challenge of auditory tonal processing. Many children cannot process tones correctly, resulting in issues in processing language. In addition, children with Trisomy 21 show cognitive delay, which effects the development of their use and understanding of words and context. Children with DS also have anatomical and physiological differences in the mouth and throat region that affect feeding, swallowing, and oral motor skills. Hypotonia, poor muscle tone in the mouth area is another cause for poor speech skills, speech difficulties range from mild to severe from patient to patient. Poor oral motor skills affect the rate of speech, the proper intonation and the proper stress on words. This can be noticed as speech sound disorders; this category includes two types of disorders, Articulation Disorder and Phonological Disorder.
Articulation Disorder is defined as children having issues in making individual sounds, Phonological Disorder is seen as problems with groups or patterns of sounds. Dysarthria is also not uncommon, which is when all muscle movement in the mouth, face and / or respiratory system may be weak or move slowly. However, with this in mind not all DS children with low tone classify as having Dysarthria. Some individuals with Trisomy 21 have apraxia, similar to dysarthria, apraxia is a motor speech disorder. Different to dysarthria, it is not because of weakness, however the brain has difficulties planning the movement of the muscles that allow speech. Signs of this include limited consonant and vowels, and appearance of combining movements when trying to say sounds, and inconstant sound errors that do not have any relevance to another speech disorder. Lastly Stuttering is common as well, described as a disorder in which speech flow is broken by frequent repetitions ((li-li-like this), prolongations (lllllike this), or abnormal stoppages (no sound) of sounds and syllables.
Social Intelligence
DS Empathy Understand the emotions of others
Down Syndrome children typically have outstanding receptive skills, a particular priority for those with DS is to be aware of and sensitive to their immediate social environment. They are exceptionally good at picking up and reacting on social cues, notably the feelings and emotions of those immediately around them. Due to this, people with DS are known for having unique and great social skills and empathy. It is not uncommon to meet very friendly and social beings who can responded positively to welcoming and fun situations and environments. They also relate well to others, specially to significant figures, i. e. parents, siblings, teachers and close friends. DS people are generally classified by care givers and family members as “striving to please others”, this is most likely due to their love for positive atmospheres and reduction of negative emotions, but it may also include their key role of an interesting sense of affection and caring for others. These high social skills and social sensitive helps people with Down Syndrome in many areas of their lives. This helps them make and maintain positive relationships in all key areas i. e.: with family and potentially siblings at home, with friends in social and recreational settings, with students and teachers in schools and educational atmospheres.
Acknowledging this immense strength in persons with DS, there can be a big down side to this particularly and valuable social sensitivity. It is often the case that children are potentially too sensitive to negative feelings and emotions. With this said, it is understandable that it defies their golden rule of wanting to please others. Likewise, to them being very cognitive about the positive feelings of others, they are especially aware and sensitive to feelings and emotions such as sadness, fear or anxiety experienced or expressed by others. Undoubtedly DS children are move affected by negative feelings in close family in friends, however it is also very prominent and concerning for them when they experience theses emotions being portrayed by people in their current social environment even strangers.
Down Syndrome people have issues distancing themselves from these feelings. Sadness and negative feelings are very difficult for DS individuals to encounter; however, anger is most likely the most a sensitive area in comparison to other emotions. Parents have said that is very difficult to comprehend and deal with anger when direct at them, or even when others direct anger at others. It is peccable that this over sensitivity relates back to their superb intuitive and empathic ability to pick up on feelings and emotions in others. These children have outstanding receptors even tend to pick up on emotions that are not obviously and directly expressed by others, caregivers even noted that DS children know and understand their emotions even before they do themselves. However, no matter if the feelings perceived are openly or indirectly expressed, many persons seem to have problems and to some extend hinders to effectively and adaptively manage negative feelings once received from others. This can potentially cause issues in blocking or fending off the feelings and results in overwhelming. This could possibly relate back to their speech difficulties and language limitations, which makes it problematic when it comes to seeking help from others to process or vent off these emotions. “It is possible too that because of their reliance on concrete forms of thought, they may have some difficulty understanding that the emotions of others are separate from their own. ”
One could say the situation and emotions the DS individuals undergo in such cases is the number one reason which is underappreciated and yet significant causes of stress for people with DS. Understanding the fact that everyone with DS is individually different it is still very prominent that most DS children have a heightened sensitivity to the emotions of others. In many cases the stress from being overwhelmed from overly sensitivity and encounters with strong emotions can be rather sever and enfeeble, resulting in depression, anxiety and increase in obsession or compulsions. Some strategies to cope or reduce a stressful situation for DS children is to alert a figure i. e. teacher, staff member, supervisors, who could help manage the source or at least reduce the negative energy. A child could also be taught to remove or distance themselves from the person or situation causing stress fir them. However, this is dependent on the given environment. It is however always helpful to teach the child a strategy to distance themselves from the potential stress by preoccupying themselves with a task. For example, it may be possible to divert attention toward some activity that is calming for the person, such as to copy letters or words or to listen to favourite music with earphones.
