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Early Intervention:
Effects on Children with Down Syndrome
by Melody Solomon
April 16, 2002
Winthrop University

    It has long been thought by professionals in the education field that early intervention is always beneficial to students who have some kind of mental or physical disability.  This assumption is often made without sufficient evidence to warrant it a fact.  Does early intervention really have as great an impact on students as we expect it to?  Is early invention really a waste of time?  How, if at all, is early intervention helpful?

    Students who are born with mental retardation often receive early intervention services.  One common disorder associated with mental retardation is known as Down Syndrome.  Children with Down Syndrome are identified as candidates for early intervention soon after birth.

    Researchers have identified several characteristics of people with Down Syndrome that early intervention has sought to correct.  According to Hauser-Cram et al. (1999, p. 979), children with Down Syndrome show a "general decline in standard cognitive scores" as they get older, reaching performance scores "at least two standard deviations below the normative mean" by early childhood.  Not only is their intelligence low, but they also develop weaknesses in expressive language, communication, social and adaptive skills (p. 979).  Finally, children with Down Syndrome do not have the motor skills that their nondisabled peers have.  

According to Connolly, Morgan, Russel, Fulliton, and Shea (1993, p. 171) , children with Down Syndrome develop motor skills at a slower rate than children without Down Syndrome.  Generally, most researchers have concluded that children with Down Syndrome develop skills at a slower rate of acceleration than typically developing children (Hauser-Cram et al., 1999; Connolly et al., 1993; Mahoney, Robinson, & Fewell, 2001; Fewell & Oelwein, 1991; Hanson, 1987).  Thus, early intervention has sought to increase the rate of development in adaptive skills, motor skills, social and self-help skills, and cognitive skills.

    At least five research studies examined the effect early intervention has on motor development in children with Down Syndrome.  Most of these studies failed to show any positive effect early intervention might have had on motor skills.  One of the most comprehensive studies found, which focused entirely on early motor intervention, was conducted by Mahoney, Robinson & Fewell (2001).  Two different interventions, NDT and DevS, were used on children with Down Syndrome and children with Cerebral Palsy.  Both of these interventions were behavioral in nature, used to reach the goal of enhancing the children's rate of acquiring motor skills.  The children were assessed before the intervention and after one year of the intervention.  Several conclusions were made by the researchers.  Most importantly, the study showed that the children made no significant gains in rates of motor development  (p. 160).  This conclusion did not change when the type of intervention or the type of disability varied (p. 161).  It also did not matter whether the children received intervention by individuals with more or less specialized training (p. 155).  Nothing seemed to make a positive difference on motor development.

   Two additional studies made similar observations.  One study failed to show that early intervention increased the rate of motor development (Fewell & Oelwein, 1991, p.58).  The other study (Hauser-Cram et al., 1999, p. 984) found that family environment did not have any effect on motor development.  According to the listed research, early interventions do not aid children with Down Syndrome in motor development.  However, there are two additional details to note.  While the study conducted by Mahoney et al. (2001) was the most comprehensive study, the period of the intervention only lasted one year (p. 157).  Also, there was a very small significant difference in the number of sessions the children received and how much their rate of motor development improved.  For example, group one received one intervention session every three to four weeks and gained an average of five months in development (p. 161).  Group two received one session per week and gained seven months (p. 161).  Perhaps if the intervention had lasted longer, the children who received intervention treatments more often would have made even greater gains in motor development.

   Adaptive development is another problem area that children with Down Syndrome tend to possess.  Several studies examine how early intervention and other factors play a role in decreasing this problem.  For the purpose of this paper, adaptive development includes communication, daily living, and socialization skills.
   Some research concludes that early intervention does have an impact on adaptive skill development in children with Down Syndrome.  In a study focused on motor early intervention, researchers observed that children who received early intervention had a higher social quotient than children who did not receive early intervention (Connolly et al., 1993, p. 179).  Another study found that, when children with Down Syndrome received home-based and center-based early intervention, they were more likely to attain average developmental norms in social skills (Clunies-Ross, 1979, p. 175).

   Fewell and Oelwein conducted an early intervention model in 1991 that sought to increase the rate of developmental skill acquisition in the following areas:  gross and fine motor, cognition, receptive and expressive communication, and social/self-help skills (p. 58).  The model compared the children's skills before and after the intervention.  Research showed that in most areas, the rate of development was higher during intervention (p. 63).  Rate of development was not significantly different in motor or language domains (p. 63).  Mixed results for communication skills could be explained by a weakness in the assessment process.  However, it is clear that social and self-help skills improved with the use of early intervention.

   Family environment has also been shown to play an active role in the adaptive development of children with Down Syndrome.  Although the family environment is not necessarily an intervention, it is a factor that plays a role in implementing many early intervention programs.  In 1999, Hauser-Cram et al. (p. 981) hypothesized that "the family relational environment predicts the development of adaptive functioning over the first five years of life in children with Down Syndrome ".  This hypothesis was tested by examining the following: children's communication, daily living, and social skills; the mother's interaction with the child (which includes sensitivity to cues, response to distress, social-emotional growth fostering, and cognitive growth fostering); family functioning (emotional cohesion and adaptability) (p. 982-983).  Results of this study showed that family environment predicted communication, daily living, and social skills (p. 984).  It also showed that the greater the mother's education was, the more likely the child was to have better social skills (p. 984).  This study emphasizes the importance of the family in the growth of children with Down Syndrome.  The authors state:  "Families in which members feel more connected to each other, and in which mothers engage in emotionally supportive, contigently responsive and cognitive growth-promoting interactions with their child with Down Syndrome have children who, over time, demonstrate significant benefits in communicating and socializing with others and in their ability to engage in independent self-care tasks" (p. 985).  Indeed, since the family environment can positively influence a child with Down Syndrome, early interventions should always involve improving or maintaining such a healthy environment.

   It has already been shown that cognition is another area that can be improved by early intervention.  Fewell and Oelwein (1991, p. 58) reported that early intervention can increase the rate of cognitive development in children with Down Syndrome.  Connolly et al. (1993, p. 179) reported that, when comparing a group of children who received early intervention and a group of children who did not, the group of children who had received early intervention services had higher IQs.  Clunies-Ross (1979, p. 175) also reported that children with Down Syndrome reached average developmental norms in cognitive development after participating in an early intervention program.

   In her book, Teaching the Infant with Down Syndrome:  A Guide for Parents & Professionals (1987), Marci Hanson writes in detail about an example of an early intervention program implemented in western Oregon.  The intervention focused on teaching infants new behaviors in natural environments (p. 24).  Children were enrolled in the program between six weeks and four months of age.  Parents taught the children based on normal developmental goals and were given instructions in detail.  These instructions are compiled in Hanson's book.  All teaching was done in the home, fit into daily activities.  Parents were visited weekly at first, and then every two weeks by an advisor who offered assistance.  The parents were also involved in collecting data and assessing their children throughout the intervention program.

   Hanson's study documented the development of these children with Down Syndrome over a period of three years while comparing them with children who had not received any early intervention services.  The results of the study showed that the group of students who had received early intervention "scored higher on cognitive ability tests and achieved developmental goals" faster than children not in an early intervention (p. 29).  For example, one developmental goal for the children was to roll over.  Typically developing children usually achieve this skill at an average of four months of age.  The group without early intervention services achieved the goal at an average of seven months.  The group with early intervention achieved the goal at an average of 4.38 months (p. 29).  The group of children with Down Syndrome achieved most of their developmental goals at a very similar rate as typically functioning children.  Early intervention was especially helpful to these children!  Also, all of the children in the early intervention program eventually went to preschool and public school elementary classes in their community.  All of them have been integrated for at least part of their schooling, and several have been totally mainstreamed (p. 29).  This is an incredible achievement for children with Down Syndrome.

   The research concerning early intervention and children with Down Syndrome can be easily summed up.  First, early intervention programs are not likely to succeed in improving the rate of motor development among children with Down Syndrome.  Second, early intervention has been shown to improve the rate of adaptive development, especially in social and self-help skills.  Finally, studies have shown that early intervention services can particularly make a difference in the cognitive ability of children with Down Syndrome.

   Special educators and physicians who genuinely care about the well-being of children with Down Syndrome would be wise in taking these conclusions seriously.  As children with Down Syndrome get older, they are even more likely to lag in development compared to their typically developing peers (Hauser-Cram et al., 1999, p. 979).  Thus, it is important that early intervention begins as early as possible.  Also, since early intervention has not been shown effective in improving motor skills, perhaps more time should be devoted to improving communication, social, self-help, and daily living skills.  The family should also be very involved in the child's program.  Parents can be trained to teach their children, and they are usually able to devote more time to their children than a teacher or a physician ever could.  New parents of children with Down Syndrome should be educated and well-informed about how to help their child.  Physicians and special educators can make a difference, simply by informing parents about early intervention services and programs in their area.  Special educators can also become involved in improving early intervention services by offering advice or assistance.  The more help the family of a child with Down Syndrome receives is the better chance that the child will succeed.



   References

Clunies-Ross, G.G. (1979).  Accelerating the development of Down's Syndrome infants and young children.  Journal of Special Education, 13 (2), 169-175.
Connolly, B.H., Morgan, S.B., Russell, F.F., Fulliton, W.L. & Shea, A.M. (1993).  A longitudinal study of children with Down Syndrome who experienced early intervention programming.  Physical Therapy 73(3), 170-182.
Fewell, R.R. & Oelwein, P.L. (1991).  Effective early intervention:  results from the model preschool program for children with Down Syndrome and other developmental delays.  Topics in Early Childhood Special Education 11(1), 56-69.
Hanson, M.J. (1987).  Teaching the Infant with Down Syndrome:  A Guide for Parents and Professionals, second edition.  Austin, Texas.  PRO-ED, Inc.
Hauser-Cram, P., Warfield, M.E., Shonkoff, J.P., Krauss, M.W., Upshur, C.C. & Sayer, A. (1999).  Family influences on adaptive development in young children with Down Syndrome.  Child Development 70(4), 979-989.
Mahoney, G., Robinson, C., & Fewell, R.R. (2001).  The effects on early motor intervention on children with Down Syndrome or Cerebral palsy:  A field based study.  Journal of Developmental and Behavioral Pediatrics 22(3), 153-162.




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