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Benefits of
Early Intervention
- enhances the development of
infants and toddlers with special needs
- provides support network for
families of children with Down Syndrome
- reduces the effects of developmental
disabilities among these children
- prepares children for the eventual
mainstream in public and private schools
Intervention
Strategies
All
facets of development, including gross and fine motor skills,
language (speech and comprehension), cognitive abilities,
and social and adaptive skills should be evaluated continuously.
Since infants with DS are at risk for developmental delay,
prompt referral should be made to an early intervention program.
Research has shown that stimulation during early development
improves the child's chances of developing to his or her fullest
potential - mentally, physically, emotionally and socially.
Early intervention
programs (for 0-3 years) are designed to comprehensively monitor
and enrich development, focusing on feeding, gross and fine
motor development, language and personal/social skills. Preschool
programs for children with special needs include physical,
occupational, speech and educational therapies. In these programs
each child receives individualized multi-source stimulation.
Therapy is mostly play-based and not strenuous (ie. heart
condition). Tasks are often taught in a step-by-step manner
with frequent reinforcement and consistent feedback.
Language is
often taught using 'total communication" (combining both signing
and oral language) as signing permits these children to communicate
more effectively at a time when their expressive language
abilities may preclude the development of intelligible speech.
As well, these children frequently understand spoken language
better than they can express themselves verbally. Some individuals
may also benefit from the use of augmentative (computer based)
communication devices.
Inclusion
of the family as a part of the intervention team is imperative.
Siblings, parents, teachers, friends etc. can all aid to the
child's communicative success - language is a part of daily
life, and as such should be practiced and reinforced there.
Intervention must relate to the child's educational setting,
as well as reflect the child's position in the community (ie.
religious groups, scouts etc.). The involvement of all communicative
partners not only promotes positive interaction, but provides
communicative models as well.
Treatment Plan
Since
the treatment plan is developed as a result of the assessment
process, the categories used during informal assessment, will
be used here as a outline for treatment.
1) General behavioural
performance (including levels of attention and play)
- activities are chosen individually
to help the child attend to tasks and progress in play -
this is done by modeling the desired play behaviour (ie.
role playing, acting)
- the setting of the session might
be modified to assist the child in mastering behavioural
controls
Examples
of treatment activities:
- For the child who needs
external controls to maintain attention to task - stations
might be set up around the room, with the child and the
clinician moving physically from station to station, requiring
the child to complete one activity before moving on to the
next
- For the child who has difficulty
with transition - cardboard clock faces showing the
time to begin and end the station may be used to assist
the child in moving from one activity to another
- For the child that has trouble
with joint attention - may employ the use of prompts
and cues - the child may require a series of cues in order
to follow a direction (ie. "Jack, look at me, listen, draw
a circle"); as the child progresses, the amount of cues
may be reduced (ie. "Jack, draw a circle" - they no longer
need to look at the speaker)
2) Oromotor skills
- the purpose of this treatment
is to strengthen the oral, lingual and labial musculature
and increase its mobility and range of motion - this
is important since children with DS often have trouble with
swallowing and tongue thrusting
Examples
of treatment activities/aids:
- Mirror - an important component
of the oromotor program - provides the child with focused
visual feedback ·
- Other oromotor tools include:
blowing whistles, musical instruments with various sized
mouthpieces, blowing bubbles etc. - (those used specifically
for labial strengthening include: button pull, marshmallow
twist, lip compression around a tongue depressor or food,
balloon blowing and lip prints
- Tongue exercises are designed
to exercise the tongue musculature (ie. tongue commands
such as touching the tongue to the right corner of the mouth,
holding Cheerios® to the alveolar ridge with the tongue
and using the tongue to clear the lips of peanut butter)
3) Receptive and
expressive language
- receptive and expressive language
treatment for the school aged child focuses on those skills
that enable the child to successfully function with
the school, home and community settings
- the intervention strategy used
is the "whole language approach" (using 1 activity that
targets both comprehension as well as production, articulation
etc.)
Examples
of treatment activities:
- Pick a theme and use it to target
comprehension, vocabulary, syntax, morphology, sequencing
etc. (refer to Appendix 2-C))
- Pacing board - provides visual
aid in teaching auxiliaries, articles, verb tenses and pronouns
- assists the child in increasing the mean length of utterance
(MLU) and remediation of syntactical and morphological errors
(refer to Appendix 2-D)
4) Speech Skills
- targets articulation, phonological
deviations, rate & fluency, voice quality & resonance, motor
planning for speech and intelligibility
Examples
of treatment activities:
- Articulation - may focus on
a sound, or a group of sounds (those all using tongue tip
elevation)
- Phonological deviations - determine
whether the child deletes or includes sounds in final position
- Pacing board - increases awareness,
and greater success in producing the structure, and results
in more consistent generalization of the skill
5) Pragmatic Skills
- children with DS have trouble
with pragmatic skills (appropriate language use - verbal/non-verbal)
- thus every session should target facial expression, eye
contact, intent, greeting, discourse skills etc.
- intervention strategies would
include the whole language approach using a particular theme
(ie. a breakfast theme) - eye contact, greetings and
discourse skills (including turn-taking, requesting, protesting
and initiation) would be emphasized
- with older children, pragmatic
goals would be targeted using (ie) a plant theme
Examples
of treatment themed activities:
- "Cooking Eggs/Breakfast" -
child requests eggs, if help is required, therapist provides
a model for the child - may also use a violation by giving
the child cereal instead, then modelling the appropriate
response - may use cues such as holding the object near
her face to encourage the natural eye contact; greetings
would be routinely built into each session
- "Garden Shop" - role playing
might be used with the child playing the role of the customer
and the clinician playing the role of the salesperson in
the garden shop - requests, greetings, eye contact, facial
expression would be addressed - videotaping is suggested
since it motivates the learner and provides a visual and
auditory record which can later be reviewed and critiqued
by the child and clinician
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