The Ultimate Guide to SLCN

Down’s Syndrome

Down’s syndrome, also known as Down syndrome or trisomy 21, is a condition that most people have heard of and as it is the most common form of Learning Disability, most people will have met a person with the condition. Despite this, there are still many misconceptions about people with Down’s syndrome.

Down’s syndrome is a condition that you are born with and is due, most commonly, to the presence of an extra chromosome (chromosome 21) in a baby’s cells at conception. This extra chromosome results in the characteristic physical features and specific learning profile of Down’s syndrome. It is unclear why this occurs and in the majority of cases, it is not an inherited condition.

The majority of children born with Down’s syndrome have some degree of Learning Disability and delayed development, but this is different for each individual. This means that people with Down’s syndrome may be slower to learn skills such as speaking, reading and writing, but they will be able to develop these skills, it just takes more time. Some health conditions are more common in people with Down’s syndrome including heart conditions, hearing and vision difficulties. Some people may have more complex needs, for example they may have an additional diagnosis of ASD or ADHD.

Most children with Down’s syndrome have some degree of speech and language disorder and their understanding of language is likely to be better than their expressive language, which can mean that their communicative and cognitive ability is sometimes underestimated.

Prevalence

Down’s syndrome is the most common form of Learning Disability and about 1 in every 1000 babies born each year has the condition. There are approximately 40,000 people living in the UK with Down’s syndrome. The average life expectancy is between 50 and 60, with a small number of people living into their 70s.

Learning Profile of children with Down’s syndrome

Areas of strength that facilitate learning

• Strength in remembering and processing visual information
• Benefit from a whole word reading approach to support language and literacy skills
• Tendency to copy behaviour and social skills from peer and adult role models
• Keen to communicate and socialise with others
• Benefit from practical activities, with concrete materials for demonstration of skills

Areas of difficulty that impact learning

• Weaker auditory (verbal) short term and working memory means that ‘learning from listening’ is very difficult for pupils with Down’s syndrome. Their ability to remember and process visual information is much stronger than for verbal information.
• Shorter concentration span and difficulty processing input from more than one sense at a time, e.g. writing and listening. Children with Down’s syndrome may appear easily distracted, flitting from one activity to another and can tire more easily.
• Language impairment particularly affecting understanding of instructions, understanding and using vocabulary including more abstract concepts such as those used in Maths, learning and using the rules of grammar, and learning and using social language.
• Developing clear speech can be a challenge due to the children’s smaller mouth and nose cavities and because of weaker mouth and tongue muscles.
• Many children with Down’s syndrome have some sort of visual impairment, with 60-70%being prescribed glasses before the age of seven. Children with Down’s syndrome are likely to have poor focusing skills and less detailed vision which can affect their ability to access visual resources. This may mean that children need enlarged images or pictures or materials that have high contrast or visibility, for example highlighting lines for writing on.
• A large number of children with Down’s syndrome have a hearing impairment, with over 50% suffering from conductive hearing loss as a result of glue ear and up to 20%having sensorineural loss.
• Children with Down’s syndrome also have poorer auditory discrimination skills, so they find it difficult to recognise and discriminate between speech sounds, affecting their phonological awareness skills and literacy development.
• Difficulty transferring skills learnt from one task or context to another. Children with Down’s syndrome need to be given more time to learn, generalise and consolidate new skills.

Strategies

Many of the general strategies for supporting children with SLCN will be very applicable for children with Down’s syndrome, in particular for supporting their weaker verbal memory, attention span and hearing impairment. Here are some specific strategies that have been found to be effective in supporting children with Down’s syndrome in the classroom:

• Use their strength in visual memory and processing to support learning; consistently support spoken language with visuals including signs, pictures, symbols and the written word. Use concrete materials and practical activities to support understanding of abstract concepts.
• Whole word reading is recognised as the best-practice method of teaching children
  with Down’s syndrome to read and this supports development of speech and language skills. The children benefit from having the written word, alongside the spoken word, when learning new vocabulary. It is important that children still access whole group phonic and letter sound sessions, alongside this, to develop their phonological awareness skills, but this may take longer.
• Children with Down’s syndrome need to be given additional time to process spoken information and to respond.
• Teach the routine and structure of the day, using clear visuals, e.g. visual timetable. This can support children to understand their environment, task expectations and support social inclusion.
• Use a range of short, focused, clearly defined tasks which vary the level of demand and support. Start with tasks where the level of demand is low, for example copying a written word and the level of support is high and then gradually increase the demand, before decreasing the support. This supports any anxiety and will help to reduce any avoidance behaviours.
• Change activity frequently and provide learning breaks, which could include physical/movement breaks.
• Teach new skills using a variety of materials and methods in a range of tasks and contexts to support transfer of skills. Continually check back to ensure that previously learned skills are retained and have not been lost due to new input.
• Avoid closed questions and encourage the child to speak in more than one-word phrases, with adults and in situations that they feel comfortable. Set up opportunities where they need to speak to others, e.g. taking messages to another adult in the school.

Role of SaLT

Most children with Down’s syndrome will be under the care of a variety of professionals, which may include SaLT, and school staff will need to work closely with them to ensure the best possible outcomes for the child. As children with Down’s syndrome have very individual needs, there is no ‘one size fits all’ package for SaLT support. If you have concerns about a child’s ability to understand and communicate effectively, it is recommended that you have a discussion with SaLT. Support from SaLT may include recommendations for support to provide within the classroom, strategies and advice for small group work or direct therapy intervention, as appropriate.

Myth Busting

Do all individuals with Down’s syndrome have a severe Learning Disability?

Most children with Down’s syndrome have a mild to moderate Learning Disability. A small percentage of children will be functioning at the lower end of the average ability range and similarly a small percentage will have profound learning difficulties, with most falling between these two extremes. A small percentage of children have Mosaic Down’s syndrome (where some of the cells of the body have trisomy 21 and some don’t) who will function within the low to average ability range.

Do all children with Down’s syndrome require specialist educational provision?

Many children with Down’s syndrome are educated in mainstream nurseries or schools with support. Research indicates that inclusive education can provide better language and academic outcomes for children with Down’s syndrome. Choices about education are made on an individual basis and each child’s needs should be considered when determining the most appropriate placement.

Are children with Down’s syndrome unable to learn to read and write?

Around 40 years ago it was widely believed that children with Down’s syndrome wouldn’t be able to learn to read or write, whereas now many children access mainstream education. In fact, for pupils with Down’s syndrome, whole word reading can be a strength that supports their learning and language skills.

Are children with Down’s syndrome all ‘the same’ and look the same?

Children with Down’s syndrome vary widely in their development and progress, in the same way that typically developing children do. Each child is unique with their own personality and interests. Although children with Down’s syndrome do have characteristic facial features, they also look like their family, just as other children do.

Further Information

Down’s Syndrome Association – www.downs-syndrome.org.uk

Down Syndrome Education Online – www.down-syndrome.org

Down’s Syndrome Scotland – www.dsscotland.org.uk