Including and Teaching Children with Down Syndrome in Head Start Classrooms

1. Including and Teaching Children with Down Syndrome in Head Start Classrooms Susan Sandall Head Start Center for Inclusion ssandall@u.washington.edu

2. 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.

3. What is Down Syndrome? • Developmental disability • Three copies of the 21st chromosome (rather than two) • Associated with cognitive disability

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

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

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

7. 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

8. Hall's Cardinal Signs (1966) • Flat facial profile • Absent Moro • Hypotonia • Dysplastic ear • Webbing at neck • Oblique palpebral fissures • Hyperflexible joints • Dysplastic pelvis • Dysplastic middle phalanx - 5th finger • Simian crease

11. 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

12. Three Forms of Down Syndrome • Trisomy 21 • 95% • Translocation • 3-4% • Mosaic • 1-2%

13. Associated Medical and Health Concerns • Congenital heart disease • Sensory deficits • Hearing • Vision • Endocrine abnormalities • Orthopedic problems • Dental problems • Obesity • Others

14. 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.

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

16. 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)

17. 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

18. Meeting the Needs of Children with Down Syndrome • Delays and disabilities across developmental domains

19. Down’s syndrome progress Normal progress Smile Sit Walk Words Toilet Training 1 2 3 4 5 6 7 8 9 10 Birth Age in years 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.

20. 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

23. 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

24. 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

25. 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)

26. 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

27. 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?

28. Challenging Behavior • Common behavioral concerns • Wandering off • Stubborn/oppositional behavior • Attention problems

29. 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

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

31. 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

32. 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

33. 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)