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  • 1. Behavioral Patterns in Children with Down Syndrome<br />Euridiki Damoulianou, Elina Korotkevica, Kyriaki Alexiadi<br />Instructor: Barbara Kondilis<br />PSY220 Developmental Psychology I (Child)<br />Hellenic American University<br />Winter 2011<br />Abstract<br />This paper contains a detailed observational analysis of children with Down syndrome, an overview of the causes of this abnormality, its historical background and the physical and cognitive traits that children with Down syndrome have. In this observational study, 10 boys and girls with Down-Syndrome (Greek, white, ages 7-18) were observed in their natural environment (classroom). Specific behaviors on behalf of the teacher were applied in order to figure out the behavioral responses of children. It was concluded that children with Down Syndrome interacted effectively with each other, experienced some kind of anxiety after distracting their routine and adjusted relatively well after the distraction. The Likert scale (points 0-5) was used to measure children’s emotions and behavioral responses. In the discussion section, several limitations of the study are mentioned and suggestions are proposed for further research. <br />Behavioral Patterns in Children with Down Syndrome<br />Down syndrome is a “set of mental and physical symptoms that result from having an extra copy of chromosome 21” (www.nlm.nih.gov). In other words, it is set of physical, mental and behavioral characteristics that are due to a specific genetic abnormality. It was in 1866 that a physician named John Langdon Down published an essay in England in which he described a group of children possessing common traits that differed from other children with mental retardation (Leshin, 2003). In the beginning, children with Down syndrome were referred as “mongoloids” because they looked like people from Mongolia but as this brought up later conflicts among Asian researchers, the term was changed (upon the name of the physician) to Down’s syndrome (Leshin).<br /> In 1959, Jerome Lejeune and Patricia Jacobs, working independently, were the first to determine that the cause of the syndrome is trisomy (triplication) of the 21st chromosome (Leshin, 2003). Specifically, every cell in the human body contains genetic material stored in genes that carry inherited traits which are grouped in structures called chromosomes.  The nucleus of each cell contains 23 pairs of chromosomes, half of which are inherited from each parent.  Down syndrome is caused when an embryo has three copies of chromosome 21 instead of the usual two (www.ndss.org). This supplemental chromosome 21 changes the embryo’s development and causes the characteristics associated with Down syndrome.<br /> People with Down syndrome share certain physical and mental features; however, symptoms may vary from mild to harsh with mental and physical development being slower in children with Down syndrome than in those without it (www.nlm.nih.gov). The common features that those people share, involve flattened face and nose, short neck, a small mouth sometimes with a large tongue, small ears, upward eyes that may have small skin folds at the inner corner, probably white spots on the iris, short, broad hands with short fingers with a single crease in the palm and poor muscle tone (www.medicinenet.com).<br />Apart from the observable physical characteristics, children with Down syndrome have an increased risk for various medical states such as heart defects, hearing problems, Alzheimer's disease, leukemia, and thyroid conditions (www.ndss.org). Furthermore, they experience cognitive delays and difficulties in developing basic language skills, motor skills and generally learning abilities such as memory problems and concentration problems difficulty in solving problems and difficulty in the comprehension of consequences of their actions (www.nhs.uk).<br />Many researchers have noted that children with Down syndrome have a significant deficit in language abilities that surpass deterioration in visual-spatial capabilities (Carr, 1970; Melyn & White, 1973, as cited in Vicari, 2006). In particular, they show significant lower rates at their development, have motor difficulties, and tend to experience more often hospitalization due to possible poor health conditions (Iarocci, Reebye & Virji-Babul, 2006). Furthermore, any of the risk factors described above may impair an individual’s ability to get involved in social interaction both with his or her parents and other people (Iarocci et al., 2006). Various studies have also found that children with Down syndrome do not obtain motor skills at the same speed as typically children of the same age do (Vicari); yet, they seem to pursue the same order of motor milestones of typically developing peers (Vicari). For example, infants with Down syndrome most of the times sit with legs wide spread, and walk with a vast pace (Lydic & Steele, 1979, as cited in Vicari). These unusual postures can be linked to the existence of hypotonia which is often connected with the syndrome (Vicari). However, other studies suggest that the muscular dysfunction in children with Down syndrome is depicted by a lack of control of muscles stiffness (Davis & Kelso, 1982, as cited in Vicari).<br />Moreover, previous studies suggest that children diagnosed with Down syndrome may experience limited peer involvement (Stoneman et al., 1988, as cited in Guralnick, 2002) with noticeable difficulty in socializing with their peers and developing a social network (Guralnick). Young children seem to have less peer contacts and engage in relatively less activities with other children in comparison with their siblings and sibling’s friends (Guralnick). In particular, past research has shown that parents play significant role in structuring their children’s relationships and involvement with his or hers peers (Parke & Ladd, 1992; Parke at al., 1994; Guralnick & Neville, 1997; Guralnick, 1999, as cited in Guralnick). However, about one-third of children with Down syndrome seem to have no friends to play or interact with at all (Byrne et al., 1988, as cited in Guralnick). <br />With rare exceptions, children and adolescents with Down syndrome typically lack sufficient linguistic capacities too (Vicari, 2006). With no evidence suggesting that language impairment in those children is slightly due to hearing loss, Vicari claims, that “ this is reported for 40-80% of individuals and, usually it is a consequence of recurrent periods of otitis media from mild to moderate and, less frequently, sensorineural loss in young adults” (p.356). Other studies suggest that those children show lower performances in linguistic tasks as a result of impairment of the frontocerebellar structures which are involved in articulation and verbal working memory (Vicari). Indeed, when children with Down syndrome are compared with the typically developing peers, this language impairment is obviously evident (Vicari).<br />Furthermore, despite few exceptions, only a small number of people with Down syndrome have been reported to possess intelligence quotient (IQ) in the normal range (Vicari, 2006). Intelligence quotient in people with Down syndrome, who are moderately to severely retarded, ranges from (IQ=25-55) with mental age being approximately at eight years (Gibson, 1978, as cited in Vicari). Most importantly, when comparing the typically developing children to individuals with Down syndrome, their IQ tends to decrease as they grow older instead of remaining constant as it appears for most of the people (Pennington et al., 2003, as cited in Vicari).<br />Most children with Down syndrome appear to have significant behavioral or emotional problems. Dykens (2007) supports that “children with Down syndrome are more apt to exhibit such eternizing behaviors as stubbornness, compositionality, inattention, speech problems, difficulties concentrating, attention-seeking, and impulsivity” (p. 273). Previous studies have also shown that adolescents with Down syndrome, between 14-19 years old, showed visible declines in certain behaviors such as attention seeking and concentration difficulties compared to children with Down syndrome in ages between 4-14 years old (Dykens). Additionally, adolescents with Down syndrome in ages between 15-20 years old were rated by their parents as less outgoing, humorous, fun, and cheerful, as when they were at younger age (Dykens). <br /> The purpose of our study was to investigate the behavioral patterns that children with Down syndrome display and their interactions with their social environment. It is difficult for a scientist to define the feelings of the other humans, especially the emotions of persons with abnormalities because they are too complex and multi-dimensional. Nevertheless, via some specific external behaviors (such as crying and aggression) researchers can evaluate to a certain degree the emotional state of a human being. As far as the children with Down syndrome are concerned, through their behavior and interactions with others, we are able to examine the existence of negative emotions such as frustration and anxiety.<br />Thus, our hypothesis, based on previous studies, literature and common sense, was that children with Down syndrome show significant disturbance when their routine is changed and generally have major difficulties in their interrelationships, are very sensitive seeking for attention and affection all the time and experience serious behavioral and emotional problems such as aggressiveness, anger and continuous crying. <br />Method<br />Participants<br />The participants of the observational study were 10 children diagnosed with Down syndrome from the middle childhood through adolescence, aged 7 -18 years old. There were five boys and five girls, Greek, white, from families of different social and financial background.<br />Likert Scale<br /> The five-level Likert scale (see Appendix C) was used to rate emotions and behavioral patterns ranging from 1(no emotional state /disturbance) to 5(strong emotional state/disturbance).<br />Procedure<br /> The observational study was conducted in a school for children with special needs. The emotions which were observed and ranked by using the Likert scale were: crying, anger, happiness and affection (see Appendix A) The behavioral patterns and interaction styles that were observed and evaluated using the Likert scale were: self /group play and aggressiveness among the children with Down syndrome (see Appendix A). To start with, we visited a school of children with special needs (after taking permission from the director of the school, see Appendix B) in order to observe their general behavior in the classroom environment. Before going to the classroom we had a brief discussion with one of the teachers in order to describe us (based on the experience he had with teaching children with Down Syndrome) the behavioral and emotional predispositions that children with Down syndrome display. <br />Afterwards, we went to a classroom that consisted of 10 children (half boys and half girls) with Down syndrome and we stayed there for about 2 hours, observing them carefully but from a distance so as not to disturb them or catch their attention. The Likert scale enabled us to evaluate the behavioral patterns that we wanted to observe. During the first 30 minutes, their teacher read them a story and then asked to describe him (verbally or through facial expressions) their emotions or thoughts about the story. Then, every child was free to do any activity that he or she wanted. The children engaged in several activities such as drawing, talking with each other, playing various computer games or group games such as monopoly and reading some books with short stories and a lot of images. Ten minutes before we left the class, their teacher tried to “disturb” them a little bit (as we asked him to do during our discussion) in order to test their reactions. He took away the books that two children were reading and the painting that another child was holding. He also increased the tone of his voice, did some quick movements inside the class and spoke to children more strictly than usual. <br />When we left the classroom (after having stayed there for about two hours), we went to another empty classroom where we evaluated and filled in the Likert-scale with the behavioral patterns observed. We also wrote in the Likert-scale our comments about the observation. At that point, the observational study ended. During our observation we did not interact with the children at all and tried not to make them realize that we were observing them; our purpose was to let them behave naturally.<br />Research Design<br />The independent variable of the proposed study, according to the research hypothesis, was the teacher’s behavior and the dependent variable was the behavioral patterns of children with Down syndrome, reactions and social interactions. <br />Results <br />In general, the children were quiet and shy, not aggressive and did not articulate verbally their emotions. They expressed their emotions mainly using body language and facial expressions. They interacted with each other quite well (apart from one child who obviously had higher degree of mental retardation compared to the other children) and they seemed to enjoy both self –play and group-play. Every time they got upset or angry they overcome it quickly and asked very often for affection and hugs. They got only upset if someone got away their things or spoke to them in an aggressive way, however, they forgot it very easily.<br />More specifically, while their teacher read them a story and asked them to express their emotions about it, eight out of the ten subjects used facial expressions and body language to show their feelings. Only two of the participants talked about their emotions for the story. The other subjects every time they heard about an unpleasant event that happened in the story expressed their unhappiness by putting their tongue out, their head down and closing their eyes. Only two girls cried every time they heard about a sad event that happened to the story. This might be an indicator that gender plays a role on the degree of sensitivity in children with Down syndrome.<br />During the free- time activity, nine out of the ten participants (apart from the boy with the high degree of mental retardation who was sitting alone most of the time) interacted with each other without evident difficulty. They collaborated harmoniously with each other and played some group games without showing aggressiveness or stubbornness .They often smiled and hugged with each other. This showed that they wanted to have friends and needed affection and love from the others. They also seemed to enjoy self- play (for example to play a computer game). This shows that despite their mental- retardation they enjoyed performing various activities instead of just sitting alone and doing nothing.<br />When their teacher tried to test their reactions to examine how they would react if someone disturbed them, it was found out that if someone tried to take away their personal things or speak to them aggressively they got upset and frustrated. The children observed did quick movements and showed their anxiety using facial expressions associated with anger and tremble. Nevertheless, if the teacher showed show affection and hug them, they calmed down very easily and their routine became usual without difficulties. <br />The mode (the most frequent score among the 10 participants of the observation) for crying was 0 – 5 (only two of the subjects cried but the others did not cry at all). Regarding self-play, nine out of the ten participants seemed to fully enjoy self-play and for group-play, four out of five (almost all children seemed to enjoy to a significant degree the group- play with their peers). As far as the happiness mode is concerned, it was 4 out of 5 (most of the children seemed to be generally happy and calm and if they got upset they calmed down very easily). The mode for anger and anxiety in general was 0 but if someone disturbed or behaved aggressively against them it was 4 out of 5. Moreover, the mode for affection was 4 out of 5 (the children asked very often from the teacher and from each other for love, hugs and affection) and the mode for aggressiveness was generally 0 out of 5, they were generally very quiet and if someone disturbed them (for example, when their teacher took away the books of two children), although they felt anxiety (clearly observed through their facial expressions), they did not display any violent reactions.<br />Discussion<br />Obviously, the mental retardation and the physical impairments that characterize children with Down syndrome do not permit them to participate in a full functional way in the society. They face various difficulties such as limited linguistic abilities, memory and concentration problems and an increased risk for various medical problems. All these problems make difficult their adaptation to various environments and make them prone to developing problematic behaviors and negative emotions. There is also high probability of developing an anti-social personality. As far as our observational study is concerned, our initial hypothesis (that children with Down syndrome have difficulties interacting with other and display abnormal behaviors and significant impairment when disturbed) was not proven. The children in our observational study seemed to interact with each other effectively, be happy and calm and not to display aggressiveness or any other problematic behavior.<br /> However, a lot of factors have to be taken into consideration. Firstly, our study has a limited external validity, because we examined only a sample of 10 individuals with Down syndrome and we do not know if our results can be applied to all children suffering from the syndrome. Secondly, nine out of the ten subjects examined, had medium mental retardation and therefore, it cannot be estimated or predicted how children with higher mental retardation would behave. Thirdly, although we conducted our study in a natural setting (classroom) and we observed how children with Down syndrome behave; we still do not know how these children would interact with the other or behave in their homes or in other settings apart from their schools. There is high probability that if we put the children with Down syndrome in other settings that are less familiar to them and are full of people who they do not know, they will behave differently.<br />Moreover, the behavioral patterns and the degree of interaction that children with Down syndrome display are not due merely to their medical condition but also to the degree of stimuli they get from their families and their environment. For instance, there are many children with Down syndrome (in contrast to the children of our study) who do not attend school and do not receive enough stimuli, social support or warmth from their families. If we had made an observational study based on those children, we might have noticed different behavioural patterns (for example anger rate at 4 out of 5 and happiness 1 out of 5. Thus, there is not only the Down syndrome itself that has an impact on the general behavior of children but several other factors as well. Therefore, before making any conclusions about the results from our observational study, all these limitations and factors have to be taken into account.<br /> Our suggestions for future observational studies on children with Down syndrome include scientists investigating a larger sample of children instead of just only 10 participants, include participants with various degrees of mental retardation (as in our study we examined children with a moderate degree of mental retardation) and finally, conduct the study in different environments (school, home, parks.etc).<br />References<br />Dykens, E. M. (2007). Psychiatric and behavioral disorders in persons with Down syndrome. <br />Mental Retardation and Developmental Disabilities, 13, 272- 278.<br />Guralnick, M. J. (2002). Involvement with peers: Comparisons between young children with<br />and without Down’s syndrome. Journal of Intellectual Disability Research, 45(5), 379- 393.<br />Iarocci, G., Reebye, P., & Virji-Babul, N. (2006). The learn at play program (LAPP): Merging family, developmental research, early intervention, and policy goals for children with Down syndrome. Journal of Policy and Practice in Intellectual Disabilities, 3(1), 11-21.<br />Leshin, L. (2003). Trisomy 21: The story of Down syndrome. Retrieved February 25, 2011 <br />from http://www.ds-health.com.<br />Medline Plus. (2011). Down syndrome. Retrieved February 25, 2011from <br />http://www.nlm.nih.gov/medlineplus/downsyndrome.html.<br />Medicine Net. (2011). What are the characteristic features and symptoms of Down<br />syndrome? Retrieved February 25, 2011 from http://www.medicinenet.com/down_syndrome/page3.htm.<br />National Down Syndrome Society. (2011).What causes Down syndrome. Retrieved February <br />25, 2011 from http://www.ndss.org/index.php?option=com_content&view=article&id=60:what-causes-ds&catid=35: about-down-syndrome.<br />National Health System. (2011). Symptoms of Down’s syndrome. Retrieved February 25, <br />2011from http://www.nhs.uk/Conditions/Downs-syndrome/Pages/Symptoms.aspx. <br />Vicari, S. (2006). Motor development and neuropsychological patterns in persons with Down <br />syndrome. Behavior Genetics, 36(3), (doi: 10. 1037/a0021109).<br />Appendix A<br />Table used to rate emotions and behaviors<br />Observers’ Names:<br />Emotions / BehaviorsCommentsSubjectsRate: 0-51234 5 678910CryingAnger/ FrustrationHappinessAffectionSelf-playGroup-play<br />School: <br />Date:<br />Supervisor:<br />Appendix B<br />Informed Consent Form<br />You are asked to participate in a study aiming to gain insight in human behavior and ethics. This research project is being conducted by the Hellenic American University students Euridiki Damoulianou, Elina Korotkevica, and Kyriaki Alexiadi, who are majoring in Psychology under the supervision of Professor Barbara Kondilis.<br />Children at this school are going to be observed in their natural environment under the supervision of their teacher. They will not feel any distress at all and we will be as discreet as possible. <br /> All individual information gathered in this study will remain anonymous and confidential and not identified with you at any way. Participation in this study is entirely voluntary and the decision not to participate will not have any consequences. If you feel uncomfortable, you may withdraw from the study at any time.<br />………………………….. …………. …………………………………………<br />Signature Date <br />…………………………….<br />Print Name<br />Appendix C<br />Likert five-level item scale<br />No disturbance /emotion<br />Little disturbance /emotion<br />Moderate disturbance /emotion<br />High disturbance /emotion<br />Very high disturbance /emotion<br />