Accordingto the Developmental Medicine Center at Children’s Hospital Boston, “One in tenchildren has behavioral problems that are serious enough to be diagnosed by aprofessional…One in three children with Down Syndrome has behavior problemsthat are serious enough to be diagnosed by a professional.” Diagnosed behavior problems are much morecommon in children with Down Syndrome. There are also children with Down Syndromewhose actions cause issues for their family but are not serious enough to bediagnosed. Managing the troubles these children face can be challenging. Thediscipline process begins with identifying common behavior concerns.
Downsyndrome individuals share many of the same behavior concerns that typicallydeveloped children also face. There is, too, a list of reasons Down Syndromechildren may face these issues. For example, trouble relating well with otherchildren and adults, trouble controlling impulses, trouble communicating, andtrouble dealing with frustration (CHB). These troubles coupled with triggersand reinforcing factors make behavior issues especially more common. Byunderstanding the underlying cause of many of the actions of children with DownSyndrome, one can appropriately apply disciplinary action. Undesired behaviorin children with Down Syndrome can be managed by understanding common behaviorsand triggers, following the discipline process, and encouraging positivebehavior.
Sometimes the behavior of a child with Down Syndrome may be quitedifficult for parents and supervising adults to manage. Understanding thenecessity for structure and positive discipline is crucial for success. Onemust also remember that this child is developmentally delayed and will strugglemore with discipline than the typical child. Down Syndrome effects everyonedifferently, so each child’s needs should be met appropriately.
The firststep to understanding the concerning behavior of a child is to evaluate thechild as a whole. Chronic or acute medical problems can be an underlying causefor these behavior changes. Examples of medical problems that may be associatedwith this conduct are issues such as: anemia, sleep apnea, constipation, visionor hearing deficits, Thyroid function, celiac disease, gastroesophageal reflux,depression, anxiety, etc. (Patterson). An important component of the initialwork-up for behavior problems in children with Down Syndrome begins with anevaluation by the child’s primary care physician. Atypically developing child’s behavior concerns are usually not that differentfrom those seen with Down Syndrome. Although they have very similar actions,they may last longer and occur at different ages. An example of this would be theway a two or three-year-old throws a temper tantrum, compared to a child withDown Syndrome, which may begin around age three or four (CHB).
Children withDown Syndrome need to be understood in context of their developmental agerather than their chronological age. Expressive and receptive language skillsalso need to be considered. Many issues can be related to frustration incommunication. By finding ways to help the individual communicate moreeffectively, some of these behaviors can be corrected. From the earliest interaction with a childwho has Down Syndrome, one must focus on positive reinforcement. Children withthese special needs respond well to encouragement and positive disciplinerather than scolding and physical action (Philadelphia). These negative ways ofcontrol are damaging to the child and present no advancement in managing theirbehavior.
Approaching the situation with a positive attitude, minimal anger,and patience is key to consistently encouraging the child to behave in an acceptablemanner. An angry outburst from an authority figure is likely to upset the childeven further, which is difficult to control. Behavioris a form of communication. A child’s behavior, even the worst, can send amessage that he or she may not have a skill needed, is physicallyuncomfortable, frustrated, or countless other messages. One should alsoconsider emotional stress factors at home or in school that may have anindirect impact on his or her reaction. It is crucial to recognize reinforcingfactors and triggers that cause an undesired behavior from the child.Remembering that behavior is a message of an underlying cause can help managethe problem and prevent future episodes from occurring. Successfuldiscipline includes providing nurturance while also maintaining structure.
Nurturance fuels the child’s mental and emotional health by practicing love andacceptance. Structure defines the rules, routines, and consequences set for thechild’s behavior to guide his or her growth. Balancing the two will set afoundation for the child to grow into a caring, competent, responsible adult.When the child is misbehaving, try to intervene early in the process while onecan still practice positivity and patience rather than letting their ownemotions and frustrations get in the way of proper discipline. By thinking ahead, monitoring the child andsupervising his or her environment, many undesired outbursts can be prevented.
One approach to plan for upcoming difficult events is called Social Stories (Swiezy).By using picture books that sometimes contain words, a child with Down Syndromecan become more familiar with what will happen in a future event. These SocialStories help with difficult situations such as blood drawing, a birthday party,or a vacation where the child may feel overwhelmed by the environment.
Whengiving directions, it is best to have a distraction-free environment. Ask thechild to step away from his or her toys and the television to ensure theinstructions are understood. It is best to practice speaking in a firm, yetpositive voice and maintaining eye contact when giving instructions. Childrenwith Down Syndrome often struggle with language (CHB). If your speech is morecomplicated, the child is less likely to follow through with your request.
Directions should be simple, clear, and contain as few steps as possible. Forexample, try, “Brush your teeth, please.” instead of, “Please go upstairs tobrush your teeth before you go to bed.
” Speaking with a Speech-LanguagePathologist or a private provider for other options such as sign language or apicture exchange system may benefit certain children with special needs. Childrenwith Down Syndrome tend to rely on positive contact with others to maintaingood behavior (Swiezy). It is important to have positive, fun interactions withthe child even when events take a turn for the worst. Try to spend quality timeeach day doing activities such as playing a game, reading a favorite book,drawing, or even cooking something fun. This will help maintain positive vibesin the environment, encouraging desirable behavior. Parents and siblings canalso help encourage the child by setting an example. Model behavior works verywell for children with Down Syndrome (Patterson). For example, siblings canspecifically ask permission before going out the door or leaving an area.
Thiscan help prevent the child’s impulse to run off by knowing he or she must askpermission before leaving. Encouraging siblings to set examples of desirablebehavior is an excellent strategy to begin managing performance.Oncedesirable behavior is established, a parent or supervising adult must continueto track compliance. If the child seems to be making progress, be sure toreward success. This could be anything from buying a new book or a day at thepark. Along with rewards, one must also remember to establish consequences.When the child is behaving in an unacceptable manner, discipline him or herwith the appropriate action.
Behaviors can change quickly, but assuring theystay appropriate requires consistency. Overall,children with Down Syndrome are different than the typically developed child.Therefore, their needs are also different and must be addressed properly. Byunderstanding common behaviors and triggers, following the discipline process,and encouraging positive behavior one can manage these undesired behaviors. Thekey to beginning to control this poor performance is understanding the childand the factors that trigger these behaviors. Once one can identify specific behaviorsand their causes, he or she can properly discipline the child. Positivediscipline is one of the necessary components to changing behaviors.
Behaviorcan change quickly but applying consistency will help assure they remaincorrected in the future. Providing nurturance while also maintaining structureto a child with Down Syndrome will help he or she grow into a caring,competent, responsible adult.