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Children with Additional needs

Down Syndrome

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Aoife Lawless

08/01/2018

 
 

 

 

 
 

Down
syndrome
Also known
as Trisomy 21 is a genetic condition cause by the presence of a third copy
of chromosome 21. This condition usually consists of physical growth delay,
abnormal facial features and a range of intellectual disabilities. There
are approximately 7000 people living with Down syndrome in Ireland. It s
estimated that every 1 out of 547 babies are born with Down syndrome. There
is a higher risk of a child being born with Down syndrome depending on the
age of the mother, the higher her age the higher the risk (under 46, 1-20
chance). People with Down syndrome experience the stigma and stereotypes
that is associated with this condition i.e. they all look the same, they
are stubborn, they are overly affectionate etc. There are 2 other types of
Down syndrome translocation and Mosaicism.
 
·        
Translocation occurs
in 2-3% of people with Down syndrome. It occurs when part of the 21st
chromosome breaks away and attaches to another chromosome.
·        
Mosaicism occurs in
around 2% of people with Down syndrome and is caused by an uneven balance
of chromosomes in cells.
 
Causes:
Normally
every child is born with 23 pairs of chromosomes and 2 sex hormones, half
from their mother and half from their father. This disorder is caused
during fertilisation through abnormal cell division. The extra gene on
chromosome 21 causes changes in the development of the embryo and
ultimately the foetus, causing physical and mental abnormalities. Down
syndrome can be diagnosed while the baby is still in the womb. Blood test
and ultrasounds can be used to screen for Down syndrome and other
disabilities. More extensive tests can be preformed if Down syndrome is
suspected like amniocentesis and chorionic villus sampling.
 
Characteristics
 
There are
many characteristics associated with Down syndrome. They can be sub divided
into categories of physical, intellectual, emotional, social, language and
communication.
 
Physical: 
These
characteristics are visual and are most commonly associated with Down
syndrome. These characteristics distinguish the disability at first sight.
 
·        
It is easily
recognised during and after birth.
·        
Growth retardation
·        
Incomplete growth of
skull and skeleton
·        
Flat facial profile
·        
Sunken eye sockets
·        
Smaller mouth,
protruding tongue
·        
poor muscle tone
·        
hearing impairment
·        
sight impairment
·        
heart problems
·        
Prone to infection due
to poor immune system.
 
 
Intellectual:
·        
The severity of the
intellectual disability varies between each person.
·        
Cognitive delay, poor
auditory memory. Good visual memory
·        
Can live very
successful and fulfilling lives within society.
·        
IQ can range from
50-70 in a mild disability and 35-50 in moderate.
 
Emotional:
·        
Very affectionate,
sometimes seen as inappropriate.
·        
Tend to look to their
peers for guidance.
·        
Don’t tend to
understand different emotions i.e. sadness, anger
·        
Tend to be overly
friendly and gullible.
·        
Can also be upset
easily.
·        
Take things literally
and get offended easily.
 
Social:
·        
Tend to play alongside
other children instead of with them
·        
Like repetitive games
and routine.
·        
They tend to repeat
themselves e.g. jokes
·        
Require guidance in
learning good manners, acceptable behaviour etc.
·        
Plenty of practice in
social situations.
·        
Teens prefer to
interact with older adults instead of their peers
 
Language
and communication
·        
Tend to understand
more than what they express
·        
Thrive in areas of
vocabulary and social language
·        
Difficulty on areas of
grammar and sequencing
·        
Their ability of
speech is not inhibited by intelligence it is usually caused by timing and
muscle movement associated with speech, known as Hypotonia.
 
A child
with DS will probably have another disorder (co morbidity) most commonly
autism, ADHD and epilepsy. They also are more prone to other health conditions
like heart conditions, constipation/ diarrhoea, sleep disruption, infection
and Alanto-axial instability (joint in the neck).
 
 
Medicinal
treatments
 
There is
no “cure” as such for Down syndrome although there are some medicinal
treatments to aid the other conditions associated with Down syndrome, like
thyroid and immune problems.
 
1.    Treatment for thyroid condition
2.    Surgery for heart conditions
 
 
 
1a. Children
with Down syndrome suffer with thyroid conditions.
The
thyroid gland produces hormones that are needed to regulate hormones,
temperature and energy.
An example
of a common thyroid condition is Hypothyroidism, this is when the thyroid
gland produces little or no hormones, causing imbalance in the body.
A
treatment for this condition would involve oral hormone supplements or
subcutaneously. Children with Down syndrome may be born with a thyroid
condition or they may develop one later in life. Health care professionals
recommend a thyroid examination at birth, 6 months and then throughout
life.
 
 
 
 
Alternative
treatments
 
3.    Physiotherapy
4.    Speech and language therapy
 
3a.
Children with Down syndrome suffer from Hypotonia (poor muscle tone). Poor
muscle tone and poor strength contribute to delays in early development. It
causes difficulty in rolling over, crawling, sitting up and walking. Even
though they struggle with these tasks, it doesn’t inhibit them from
participating in activities with other children. Physiotherapy helps the
child to develop in areas of physical strength, balance and cognitive
development. Use of exercise balls, balance swings and other equipment help
them gain core muscular strength. Physiotherapy can also aid with digestion
and other health problems associated with Down syndrome.
 
The roles
of a multidisciplinary team
 
Throughout
their life a Person with Down syndrome will come across many members of the
multidisciplinary team. A multidisciplinary team consists of a group of
health care professionals within different areas of profession e.g.
Physiotherapist, Speech and language therapist, Occupational therapist, Learning
support teacher, Nurse and SNA. All members of the multidisciplinary team
will work together and compile a care plan for the child. This  co ordinates their services and allow
them to reach their goals.
 
1.   
Physiotherapist
 
As
discussed, children with Down syndrome suffer from poor muscle tone and over-flexible
joints.  The role of a
physiotherapist, when working with a child with DS, is to help to improve
their physical strength, muscle tone, balance, coordination and posture.  They will focus on specific areas
relevant to the individual. They can also compile techniques for the
parents to implement at home.
 
 
2.   
Speech and language
therapist
 
A speech
and language therapist’s main objective is to assess, diagnose and manage
communication and Dysphagia (swallowing) disorders. People with Down
syndrome suffer with speech and Dysphagia disorders due to a larger tongue
and misshapen facial features. They find it difficult to articulate and
eat. Speech and language therapy can be very beneficial and treatment
depends on the individual and their circumstances.
 
3.   
Occupational
therapists
 
Occupational
therapists work with people with many disabilities, including DS. They
focus on mastering skills in the individuals self care, independence, fine
and gross motor skills, social interaction, and behaviour in school. They
guide the individuals and their families to allow them to reach their
potential throughout life.
 
4.   
Learning support teacher
 
Learning
support teachers are usually based in primary and secondary schools. They focus
on supporting children with additional and special needs who require
additional supplementary teaching either in a group or one-to-one
environments.
They help
children to overcome and develop the skills needed to assist them in the
classroom. They help to encourage independence and self confidence within
the child.
 
5.   
Nurse
 
Children
with Down syndrome, as discussed, suffer from many other co morbid
conditions. A nurse plays a large role in the lives of the parents and a
child with Down syndrome. Nurses are there to take the pressure off with
drug administration, drug dosage and to keep track of any illnesses and how
to prevent them.
 
6.   
SNA
 
The role
of an SNA is to provide for the care of the individual. My role as an SNA
for a child with Down syndrome would depend on the specific care needs of
the child. Every child is different and so every child will have different
needs. Some roles may include assistance with class activities, assistance
to the bathroom and assistance with behavioural difficulties. They also
provide feedback, support and keep the teacher informed of progress and
difficulties in class.
 
Educational
options
 
There are
many different options of education for children with Down syndrome
including, full time mainstream, mixed placement, unit attached to
mainstream, special school.
“Mainstream”
is defined as educating a child with special needs in a normal classroom
environment.
 
·        
Full time mainstream
means the child will have a scheduled day (usually 9.30-3pm) they will
usually require an SNA or support staff and may need addition classes with
resource teacher.
·        
Mixed placement means
the child will be in a special school but will attend mainstream part time,
this type of education allows the child to experience mainstream
environments but it can leave them feeling confused, they may not build
strong thriving friendships, feel different etc.
·        
 A mainstream school with a unit attached
is a normal classroom environment with a specially designed unit/room
within the school for children with special needs
·        
A special school is a
school designed for children specifically with special care needs. These
schools are better equipped to meet the needs of the child and to give them
the best opportunity to thrive academically.
 
In my
opinion children with Down syndrome should be included in mainstream
schools. Children with Down syndrome have the ability to learn like every
other child, and have the capacity to succeed. In today’s society children
with Down syndrome are nearly all educated in mainstream schools, unless
their care needs or disabilities are more extensive and require additional
assistance.
 
Like all
children their abilities vary but they have a typical learning profile like
most children do. Each child with Down syndrome will be issued with an
Individualized Educational Programme or IEP. This will determine what and
how the child should be taught. It allows the child to have access to the
mainstream curriculum, to be given support where needed and focuses on building  their skills in areas such as speech and
language, social, fine motor, literacy, numeracy etc. Children with DS in
mainstream will achieve better socially and academically, they will gain
confidence, make friends and not feel excluded or different. Mainstream
schools offer a better curriculum, higher expectations, more social
development through extracurricular activities and after school activities.
 
 
Activities
an SNA would assist with:
 
1.    Activities in classroom:
Different Activities in the class focus on
different areas of development, it could be mathematics, reading, writing.
Participation in these activities will allow the child to develop their
social and interaction skills with the other children as well as their
education. The SNA can monitor their interaction and help them if they
don’t understand certain situations or instruction. The SNA will help them
to stay organised, stay on task, help them focus and praise them during the
activity.
 
2.    Care
           
Assisting
the child in areas regarding their personal care, feeding, their safety
within the classroom and school, administering medications, assisting them
in the bathroom and helping them keep on track with their timetables and
schedules.
 
3.    School outings
 
Children require assistance on school
outings e.g. swimming, day trips. They need to be supervised and escorted
to these places. They may need help in tasks such as getting changed; help
on and off of school bus and to keep them safe in new environments.
Assisting them on these trips allows them to take part in the activity and
feel included.
 
4.    Within the school
 
SNAs provide help for the child within the
school, they escort them to different classrooms and help them transition
between rooms and teachers as well as helping them to stay safe within the
school. SNAs also supervise on yard duty to keep an eye on the child with
disabilities for their safety and safety of the other children.
 
5.    Behaviour
 
SNAs monitor the child’s behaviour within
the class and give support in times of frustration and upset. They aim to
keep the child calm in certain environments and prevent the child from
feeling discomfort or anxiety before it arises. They can assist child to
take a sensory break or a walk to calm down.
 
 
 
 
Visual
timetables
 
Visual
timetables are very beneficial to a child with special or additional needs.
They assist children in understanding what the structure of their day consists
of e.g. school day. It consists of pictures and symbols to represent the
lessons, activities and tasks that they will be fulfilling that particular
day. Visual timetables are there to give a visual display of what is
happening instead of telling the children. They may understand better
through a visual description compared to an oral description.
 
Visual
timetables have been proven to
·        
Increase  independence
·        
Prevent and reduce
anxiety
·        
Increase confidence
·        
Strengthen their
visual learning ability
·        
Strengthen their
desire and need for a schedule, routine and organisation.
 
Young
children may work off a daily timetable whereas older children or more
independent children could benefit from a weekly timetable.
 
The
criteria for a visual timetable depends on the individual; some might like
certain colours or shapes, whatever the child likes best.
 
The
activities could be printed and laminated and attached to the schedule with
Velcro, making all activities interchangeable. This can also be done with
days of the week, weather etc.
 
This is an
example of a visual timetable. The possibilities are endless when it comes
to layout, colour etc.

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