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Down syndrome what lies beneath the stereotype? John Down was the first to formulate and describe the disease that is known now as Down Syndrome (which will be called DS within the scope of this report). The people he described had mental deficits and were called idiots (Down, 1866). Brousseau (1928) gives a more thorough description of the physical as well as the mental characteristics of people with DS. Her list of physical features includes: small, rounded head; short, flat nose; small, slanted eyes; short stature; muscular weakness; small, round and frequently open mouth; and large abdomens.
She noted that children with DS often displayed delays in gross motor activities, such as walking, and production and recognition of language as well as other cognitive processes. Beginning early, parents, and especially mothers, were blamed for their child's condition. Brousseau has a long list of causes for Mongolism; they are parental alcoholism, syphilis, tuberculosis, neuropathic heredity, consanguinity, age of parents, birth order, physical and mental state of mother during pregnancy, and injury to the fetus (1928). In 1907, Seguin listed four circumstances, which favor the conception of idiocy: endemic, hereditary, parental, and accidental. He believed "the share of the mother in the circumstances favoring the production of idiocy is the larger" (p. 31) Finally in 1959, geneticist Jerome Lejeune identified the chromosomal abnormality associated with DS and alleviated some pressure off parents who blamed themselves for their children's disorder. This abnormality, called Trisomy 21, arises when a child is born with three 21 st chromosomes instead of the normal two (Patterson, Great, Gusella, & Watkins, 1987).
More recently it has been found that 95 % of the extra chromosomes come from the mother and older women are more likely to carry a fetus with DS to term (Ezzell, 1991). Because DS accounts for 1 in every 600 births, many pregnant women today have a blood test and ultrasound done in the first trimester of pregnancy that can identify about 90 % of the cases of DS (Cody and Kamphaus, 1999). They may also have an amniocentesis, which can definitely determine if the fetus will be born with DS (Henderson, 2000). While Down gave a description of physical features of people with DS, there are many more biological characteristics that are common to this group. People with DS have many medical concerns. Individuals often have visual problems ranging from poor eyesight to a loss of vision due to cataracts.
Because of their larger tongues and smaller mouth, oral hygiene is a problem, also. Many people with DS have gingivitis, missing teeth, or a furrowed tongue. The main cause of death for people with DS is cardiac abnormalities. Many children are born with congenital heart problems but survive after having corrective surgery. The lungs are another body part that is smaller in people with DS and they often contract lower respiratory tract infections and pneumonia. Other common problems include high susceptibility to bacteria infections, ear infections, liver disorders, smaller livers, dislocation of the spine and hip, and hypotonic (Cody and Kamphaus, 1999).
People with DS also have neurological and psychiatric problems. It is common that people with DS have fewer neurons, abnormalities in the neurons, and lower brain weight. Many individuals also have seizure disorders. Some studies have shown strong links between DS, Alzheimer's Disease, and dementia, though these are not conclusive (Cody and Kamphaus, 1999). Children with DS usually display delays in motor function, cognitive development, and language acquisition with very individual variations in rate and level of achievement. These children display the same types of temperaments as normally developing children.
Language skills are delayed and progress at varying speeds; a lot of development occurs in this area before the age of seven. Though commonly stereotyped, children with DS are not more sociable than other children and often have a hard time fitting in with their normally developing peers. Individual factors of medical problems affect the growth of motor skills in a child with DS. Though at a much slower pace, the sensor motor development of children with DS is more like that of their non retarded peers. They have a reduced short-term memory and a lot of trouble recalling auditory information. Children with DS may often develop an adjustment disorder because of the hard time they have functioning socially (Cody and Kamphaus, 1999).
Jon Miller (1999) has reviewed the extensive literature on language development in children with DS. He also has conducted his own experiments to find if children with DS develop language the same way that normally developing children do. Many researchers believe that language production skills in children with DS develop much slower than language comprehension and other cognitive skills. Two reasons Miller presents for this discrepancy is the problem of speech-motor control and the lack of opportunity to talk.
Using established measures such as the Bayley Scales of Infant Development-Mental Scale and Stanford-Binet Intelligence Scale, Miller found that over a time period of 24 months none of the children with DS improved their productive language skills. This is very interesting considering all of the children were in special education programs. Children with DS often have a much slower rate of learning words compared to typically developing children. Miller also found that this slow rate does not match the speed of acquiring other cognitive skills; these skills are learned much faster.
As a problem with his and other studies Miller notes "children do not talk readily to unfamiliar people such as researchers, and they do not talk much at all when first producing single words" (p. 31). It is this fact that leads him to believe that using parent report measures are often helpful to learn about children's lexicon. Mark Leddy (1999) believes there is a biological basis of speech problems in people with DS. This biological problem with speech stems from abnormalities of the mouth and throat.
Children with DS often have a much smaller mouth and throat, a narrower palate, and a larger, more muscular tongue. These physical characteristics can control how well a child can pronounce syllables and words, influencing whether or not others will understand these children. A child may then simplify their language and only use a few words, which they can clearly pronounce and have a lot of meaning attached to them. Leddy believes that speech can be improved among people with DS as a "result of a well-designed therapy plan that includes not just the person with Down syndrome and the speech-language pathologist but also family members, educators, and members of the community" (p. 76). Beeghly, Weiss-Perry, and Cicchetti (1990) wondered if "the language deficits of children with Down syndrome are part of a broader symbolic deficit that can be observed in other aspects of representational functioning, such as communicative skills or symbolic play? Or are their expressive language delays limited to more structural aspects of language?" (p. 359).
Beeghly et al list many cognitive problems as potential characteristics that may affect the quality of social interactions that children with DS have. Though children with DS are delayed in their pace of play development, they follow the same sequence of normal children. However, there are a few exceptions to this rule. Children with DS spend more time engaging in simple manipulative object play, repeating symbolic actions, and engage in fewer object transformations during pretend play. But generally, despite their language deficits, children with DS possess symbolic capacities that parallel those of normally developing children. Beeghly et al hopes that because of this, in addition to standardized testing, play situations may be used to evaluate cognitive competence of children with DS.
Some researchers are increasingly becoming more interested in the social relations of children with DS. More specifically, they are interested peer relations, which are thought to be an integral part of all children's well being. Infants with DS are often reported as having minimal social alertness and responsiveness (Serafica, 1990). But in early and middle childhood, children with DS appear to be quite sociable. In her review of the history of peer relations of children with DS, Serafica (1990) has found that this population has been labeled cheerful, good-tempered, and amiable. Whether or not these labels accurately describe all children with DS, it does affect how they are treated and perceived by others.
Serafica believes that some tests that were supposed to measure the sociability of children with DS were actually measuring social attractiveness. It has happened in some studies that casual observers and playground staff have believed that children with DS are socially accepted and very similar to the other children in the playgroup. However, this was not the case. Children with DS engaged in little verbal interaction with the group, spent quite a bit of time in un constructive and attention-seeking behavior, and only appropriately interacted with adults. "This behavior was in contrast to their behavior in a nursery school limited to handicapped children" (p. 385). In this setting, children with DS showed a pattern of eye contact as well as engaging in constructive and imaginative play. Many children with DS are born with physical abnormalities that affect their motor development.
In a literature review, Block (1991) outlines a few. Many children with DS have congenital heart disease, which can lead to reduced overall growth and physical activity. These children often have skeletal abnormalities such as hyper flexibility. Obesity and hypotonic are also very common as are hearing and visual impairments. Block found that from birth, children with DS often follow the same developmental steps of motor functioning that normal children do but at a slower pace. They will sit before they crawl and crawl before they walk.
However, they have unique ways of reaching each stage of development. For example, children with DS often sit with their legs extremely far apart and use various arm positions to help them sit up. Hypotonia and hyper flexibility are often mentioned as reasons for this. As children get older they seem to fall further and further behind their...
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