Down Syndrome
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Down Syndrome PRESENTATION created by FTTA
Disclaimer
Please note that FTTA presenters, lectures and staff are not medical professionals. This information is designed to be used for education assistants under the supervision of professionals and some parts may be incorrect, outdated or the authors’ opinion.
Down Syndrome Down Syndrome occurs because of a chromosomal abnormality that happens while
the cells are pairing and dividing at conception.
It is the most common genetic condition where people have an extra set of chromosomes. People with Down Syndrome all share similar, unique facial features. FTTA
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What is Down Syndrome?
Generally people have 46 chromosomes in each cell with 22 pairs and 2 sex chromosomes.
While the egg begins to divide, each cell divides and so each cell will have the same genetic code. If the cells do not pair off correctly, an error called nondisjunction occurs. 47 chromosomes are now developing, duplicating itself and a baby with Down
Syndrome develops. FTTA
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/// How is DS
Diagnosed?
Pre-natal Diagnosis Screening Test: estimates the risk of having a baby with DS Between 15 and 20 weeks gestation “The Triple Screen” blood test Ultrasound i.e. thickness of skin around neck
IS NOT AN ACCURATE DIAGNOISIS
Diagnostic Tests Diagnostic Test: determines if baby actually has DS Amniocentesis performed between 15 and 20 weeks gestation Chorionic Villus Sampling (CVS) conducted between 8 and 12 weeks
If a baby is suspected to have a chromosomal abnormality, a blood test analysis is conducted shortly after birth
Percutaneous Umbilical Blood Sampling (PUBS) performed after 20 weeks
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Types of Down Syndrome Mosaic Down Syndrome
Trisomy 21 Most common form affecting 94% Chromosome aligns with 21st pair of chromosomes (hence Trisomy 21)
Translocation Down Syndrome 3-4% of cases,
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2-3% A mosaic effect of cells that have and have not divided correctly. People affected with Mosaicism MAY be affected by the syndrome
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/// Common Facial Characteristics
Epicanthal fold - Eyes that have a slant and
an extra fold of skin on the inner side
A thinker neck, or extra fold of skin Brushfield spots - Small white flecks on the iris
Ears are generally smaller and tops may slightly fold over and sit lower on the face
Smaller, flatter nose Broader face FTTA
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Transverse palmer crease - Single crease across the broader hand with a pinkie
/// Common
that may appear crooked
physical characteristics
Low muscle tome and loose ligaments
Big toes widely spaced
Range of associated medical conditions, including vision and hearing problems and reduced immune function FTTA
Congenital heart defects found
in 50% from before birth
Smaller and or shorter limbs and smaller and chubbier fingers
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SOME FACTS /// Young mothers can have a child DS
It is not the age of the mother, but the health of her eggs that is the factor.
Not all eggs age at the same rate
A woman is born with over one million eggs. Genetic, environmental, age of eggs and other factors all play an impact on the health of the eggs.
It was once considered a high social status to have a child with DS Women who had children in later years were often wealthy and naturally at a higher risk of having a child with DS.
1950’s movie star Mickey Rooney was rumoured to have DS Mosaic Down Syndrome does not always affect intelligence unlike the other types of DS.
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Downs Syndrome STATS In Australia, babies born with DS is approx 1:1100
Since 2007 around 270 babies a year are born with DS
There are over 13,000 people with DS in Australia
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Current life expectancy for a person with DS is around 60
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///What is early intervention? In WA, most babies born with Downs Syndrome are referred to the Disability Service Commission to have an Individual and Family Services Program (IFSP) developed. Occupational Therapy Provides support for infants and young children with developmental delays or disabilities
Speech Therapy
Physiotherapy FTTA
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/// Developmental Milestones
If it is expected, a child by 5 will be walking, toilet trained, dress with minimal help and feed themselves
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Visual Learners. Focus on using
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Teaching Strategies
visual processing and visual memory skills More is understood than is said
Classroom rules and behaviours can be followed. Structure and routine are important Use shorter phrases and visual clues
Keep the expectations for behaviour and attitude high, as with any other child
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/// Functional
Curriculum
needs
When
1:1 teaching
learning social skills
Small group work
Possible whole class instruction
Repetition
Taking off jumper
of activities
skills are a
priority
is valuable
Recognising correct toilets
Eating lunch / recess at correct
Toileting
Contingency plan for
needs must be accidents
time
considered
Toilet trained
Walking out route so student
Modified FTTA
understands how long it takes
Curriculum
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Celebrate success…however small
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You were being told to do something you were unsure of?
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How may you act if…
Your language skills were not developed enough to express your concerns or views?
Children with DS like structure. Refusal can
occur when trying to get
the child to try new things. You did not understand why you have to do something this new way that you do not understand?
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This is because they resort to doing what they know
is safe
You may appear Stubborn! ///
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What does stubbornness look like?
sitting
withdrawing
Not looking Throwing themselves down FTTA
pouting
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Strategies for
“Stubbornness”
Start seeing the behaviour as resistance to the unknown Discuss the Prepare the child for the
changes
upcoming changes Help child to
Social stories
feel safe with new activity FTTA
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Inform student you are displeased
Structure
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with voice and body language Routine
Behaviour Management Strategies
Black and white rules
Explicit and clear expectations
Developmentally appropriate consequences Consistency and follow through CATCH THE STUDENT BEING GOOD! FTTA
Strategies to alleviate resistance to change
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Types of Physical & Medical Conditions Specific Learning Difficulties
Hearing Eyesight
Immune system
Heart Defects
Speech and Language Gross & fine motor skills
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Do lots of reading activities – this builds knowledge base
Allow extra time for response
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for when their speech communication improves Model what you want
Communication Strategies
Poor listening skills
Have visual cue cards for the child to point to when communicating
Teach hand gestures for the child to use when communicating. Makaton is
Having higher receptive (understanding) skills than expressive skills, frustration can easily occur when not understood
useful. Ask child to show what they want Encourage lots of speech and sounds –
Give clear and simple
spend at least 5 minutes a day talking
instructions one at a
with the student
time Eye contact
FTTA Do not allow other children to respond for the child
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Hearing
implications
1
Delayed speech and language
2
Student may not notice
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During hearing infections, loss of
Frequent colds and
upper respiratory infections and small ear canals can cause varying degrees of hearing loss FTTA
development
instructions being given in noisy
classroom
hearing can be up to 40 db in one day. Playground siren may not be heard
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Hyperacusis: over-sensitive to
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Possible refusal to join noisy
loud noises
situations such as assembly
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Hearing
strategies
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Sit student close to teacher and not
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‘Face-to-face’ instructions
3
Clear language suited for
4
Include visual cues and signing
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Reduce background noise or
looking into bright light
developmental level of child
move student to quieter part of room. Headphones.
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Behaviours to watch
Implications for
Eyesight
Impaired vision is very common
for include: Tilting head too far back
Regular eye
Seating
checks
position
Working too
close to a book
Ensure glasses are worn
Very sensitive to sun exposure FTTA
Hat and
Gradual
sunglasses
deterioration of
worn outside
eye tissue
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Immune System
Implications & Strategies
Illness such as upper respiratory infections are more common
Frequent use of antibiotics may affect toileting
An underdeveloped immune system is common FTTA
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Heart Defects Found in up to 40% of students Heart defects are operable
implications May tire easily
Some physical activities can be
harder for full participation
strategies Obtain current medical information
A ‘pigeon chest’ is no need for concern
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Monitor physical activities and allow student to sit out when required
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Poor muscle tone
Poor motor planning
Possible ‘flat’ footed
///Implications & strategies for Gross Motor Skills
Floppy & loose jointed
Difficulties with co-ordination and gait
Difficulty problem solving with using equipment May have less stamina than peers
Encourage participation Make games friendly FTTA
Model and talk
Assist child verbally
student through
and physically while
problem
gaining confidence with play equipment
Allow for extra rest time
Ensure orthotic devices are in
correct shoe 26
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Poor dexterity and manipulation skills
Songs and games
Fine Motor Skills strategies & implications
Difficulty cutting, handwriting etc
Too small for furniture, box under feet
that develop muscle
Messy writing
strength in arms,
picture
wrists, hands and fingers - pictures
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‘Key Steps’ program
Extra structured handwriting program 27
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High level of supervision in areas of risk
Toilet procedures may need extra monitoring
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Response plan if student leaves the school
Duty of care
grounds Poor understanding of boundaries and other concepts. Show exactly where student can play
Greater responsibility for the
Protective Behaviours program
Mandatory reporting
Swimming lessons – does
welfare of the student is needed
student need ear plugs, can they hear with swim cap, extra supervision in bathrooms, assistance with clothing?
FTTA Buddy system
Monitor and remind student about weather needs i.e. jumper, hat
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Want to know more? http://www.genetics.edu.au/Publications-and-Resources/Genetics-FactSheets/FactSheet28/view
http://www.thesebrokenvases.com/2010/10/physical-characteristics-of-down.html
www.downsyndrome.org.au/down_syndrome_popuation_statics.html
http://www.australianreview.net/digest/2012/05/spandagou.html www.ndsccenter.org/resources/general-information/ds-news-articles/stubborn-isas-stubborn-does/ http://www.dswaasn.au/what-is-down-syndrome.html http://www.nads.org/pages_news/fact.html FTTA
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