Problem Behaviors in Down syndrome Children
Consideration Guidelines for Problem Behaviors
1. Whether that behavior intervenes learning and development
2. Whether that behavior impedes activities in a family, school, work place
3. Whether that behavior poses any danger to a child or others
4. Whether that behavior differs from the expressions of other children at the same age of development
The first step of evaluation for children/ adults with Down syndrome, who express problem behaviors, is the investigation of acute or chronic medical dysfunctions relating to those behaviors. Medical symptoms may have some relationship with behaviors change as follows.
1. Visual or hearing deficits
2. Thyroid functions
3. Celiac disease
4. Sleep apnea
5. Anemia
6.Gastroesophageal reflux
7.Constipation
8.Depression
9.Anxiety
Therefore, being evaluated by a doctor is the important factor at the beginning of troubleshooting the problematic behaviors among children/ adults.
Problem behaviors found in children with Down syndrome does not differ from those discovered in normal children. However, the symptoms will occur slower and longer. For instance, temper tantrums are frequently found in children aged 2-3 years old while children with Down syndrome will start showing symptoms when they are 3-4 years of age. Thus, the key of evaluation is to consider the developmental age, not actual age, and knowing level of receptive language and expressive language as well since many problem behaviors are associated with difficulties in communication. Several evidences indicate that efficient communication support is the point of troubleshooting.
Approximately 60 % of children with Down syndrome are free from problem behaviors while in severe grade of children with developmental delay or children with additional diseases like autism or ADHD show more tendency to have problem behaviors. Each of children with Down syndrome is different and has different levels of social skills. Social development and behavior are influenced by family background, emotional foundation and experience with other people like children in general.
Behavior problems in children with Down syndrome that have been usually reported by the parents/teachers.
Walk / run around. The important thing to concern is a child safety. This may be done by locking the door and putting the alarm at the door. Draw an IEP plan for school about the role of each individual child. Going out of the classroom or going to the playground, permission is required for all children. This will help remind children with disorders to realize to ask for permission before getting out of the room/ house.
Refractory/ resistant behavior. Describing their behaviors during the day either at home or school may sometimes help identify events that could induce counterproductive behavior/ disobedience. It is often found that these behaviors arise out of means of communicating grievances or a lack of understanding of the problems of communication/ language. When faced with the difficult task, Down syndrome children are becoming very proficient in making parents or teachers frustrated.
Inappropriate behavior to show love/ fondness. Down syndrome children may show greetings to strangers by embracing them. However, it is usually observed that this inappropriate behavior is often encouraged by the consent and support of parents and teachers.
Concentration and attention problems. Down syndrome children can have symptoms of ADHD (Attention Deficit and Hyperactivity Disorder), and should be evaluated by age, attention span and impulsiveness following their developmental age. The actual age should not be focused on. Using measures by parents and teachers, such as Vanderbilt and Connors Parent and Teacher Rating Scales will help diagnose. In addition, anxiety disorders, problems with processing language, and hearing loss can cause concentration problems and attention as well.
Think or do repeatedly. Down syndrome children may have behaviors attached to a toy or activity. For example, they may want to take the same chair all day or play with a single piece of toys. This pattern of behaviors is often seen in children with Down syndrome at a young age. And the number of children with Down syndrome who express repeated actions/ iterations does not differ from normal children at the same mental age as well.
Nevertheless, frequency and severity in children with Down syndrome are even more.
Self-stimulatory behaviors. Down syndrome children may have made
some strange noises or put fingers in his mouth so these behaviors may be made just to reflect the senses or to distract attention from offensive activities.These behaviors may impede the learning process and isolate themselves from society.
Things parents should do when a problem behavior in children with Down syndrome is present.
1. Take a child to a hospital for a medical diagnosis to see whether there are some medical problems causing problem behaviors.
2. Discover mental stress at home/ school/ work which may affect the child's.
3. Work with professional personnel, including psychologists, behavioral pediatricians and consultants in planning to tackle behavioral problems using primary ABC (Antecedent, Behavior, Consequences of behavior).
4. Medication may be used if necessary, such as ADHD and autism.
Concentration problem in children with Down syndrome is ADHD or not?
ADHD (Attention deficit, hyperactivity disorder) is a childhood diagnosis of ADHD. Symptoms are like decreased attention span, impulsive behavior, hyperactivity, and excessive or uncontrollable movements. Impulsive behavior found in children with Down syndrome may experience a surge to run out of the classroom to greet people, supplant monologue, and switch to a new activity to do while the ongoing one is not yet done.
All children, including children with Down syndrome may occasionally be as such. However, Down syndrome children may display those characteristics more often than other children at the same age level. Does this mean that Down syndrome children have the symptoms of ADHD? It might be true or false. But these symptoms should remind us to a medical problem that needs to be managed or needs some more modifications in their education or communication. Down syndrome children with concentrating problems have not yet been diagnosed with ADHD until the irrelevant problem is eliminated from consideration.
Medical problems that make a child behave like ADHD.
1. Hearing and visual problems
Children who can concentrate on teaching materials must be able to hear and see. Hearing and visual problems are common in children with Down syndrome. Ear infections are common causes, even though it has been treated. However, it can cause hearing loss for a number of weeks. Down syndrome children with an abnormal middle ear structure will have hearing loss in the low - medium levels through lifetime.
Both short and long eyesight are common problems in children with Down syndrome as well as cataracts and lazy eye.
Children with hearing and visual problems, from the tests, can cause concentration and attention problems. Hearing tests done by ABR (an auditory brainstem response test) or OER (oto-acoustic emission) should be monitored and checked during, at least, the first 3 months as a baseline data. Auditory screening should be done annually until a child is 3 years old and every year thereafter. Evaluation result found that children with hearing loss should see an Ear Throat- Nose - doctor (otolaryngologist) to treat the cause of hearing loss.
Down syndrome children should be evaluated by an ophthalmologist during the first year and annually thereafter. However, some children may need to be monitored more often, depending on the result of visual diagnosis.
2. Gastrointestinal Problems
Children with Down syndrome have risks associated with the small intestine called celiac disease which the body cannot change proteins in wheat and other grains. Common symptoms of celiac disease include diarrhea, weight loss, and slightly increased weight. Such condition affects the strength and behavior. Down syndrome children often have constipation. If it is severe, it can cause abdominal pain, low appetite and hyperactivity. Currently, suggestions for dealing with gastrointestinal disorder are having children screened when they are 2-3 years old. This screening should include measurement of IgA antiendomysium antibodies and total IgA.
3. Thyroid Problems
About 30% of Down syndrome children have thyroid disease in a certain range of age. The most common thyroid condition depletion (hypothyroidism) or low thyroid function or minimal symptoms were found. There are very few case that thyroid functions more than normal (Graves disease).When the thyroid gland is working less, it will cause children lazy and lack of attention If thyroid gland functions too much, it can also cause disruptive behavior and hyperactivity. Therefore, both of these two abnormal functions not only result in children behave like the problem behavior ,but they are also have low interest Since thyroid dysfunction is frequently found in Down syndrome children and it is hard to discover from only a medical examination, blood drawing check for thyroid examination has been recommended in the checklist.
4. Sleep problems
sleep disorders were observed in children with Down syndrome. Sleep disorders have different causes. No matter causes that disturb sleeping at night can lead to insufficient rest. Consequently children feel fatigue and show some. One common causes is symptoms such as irritability, hyperactivity and loss attention in learning.
The other problem of sleep disorders commonly found in Down syndrome is stop breathing briefly during sleep (Sleep apnea) because they have narrow airways. They are often found to be weak, and sometimes stop breathing during sleep which can be caused by tonsillitis , large adenoids or the wall or respiratory airway is weak.Regardless of any reasons that hinder breathing, people tend to wake up briefly to fully breathe. Some patients with sleep disorders of sleep apnea have to wake up to 100 times a night to breathe.
Associated symptoms, but not specific to Sleep apnea include snoring, excessive daytime sleeping. Oral breath and sleeping in unusual positions, such as sitting or sleeping posture bent forward. Children with suspected disorders of sleep should be evaluated from reliable Sleep Center.
Problems in communication similar to ADHD
Down syndrome children may have problems similar to ADHD due to lack of effective communication. Frequently, it is found that receptive language skills of Down syndrome children is much better than expressive language skills. Parents often say that "he knows what he wants to say to us but he cannot combine words together" or "We have not seen him speak. We know that he knew what he wanted to say."
1. Learning Problems
Down syndrome children often have difficulty in participating class due to communication problems. Children may explode their frustration or be distracted. Down syndrome children have different ways of learning. Therefore, it may be more than one method to teach them. So we have to find the best way that works for them. If the teaching media is not compatible with their learning style, they may exhibit behavioral irritability, hyperactivity, boredom and very naughtiness. For instance, the explanation for children who will need to use visual media and guide is needed. The media can be a problem. If this is too difficult for the child's intellectual level, the child may have inattentive behavior. If the media are so easy, the child may be bored, ignore and show no interest.
2. Emotional problems
Because of the communication problems, Down syndrome children may have difficulty in talking about things that trigger anger or regret. Major changes in their lives such as the loss or separation may cause inappropriate behaviors at school or at work.
ADHD and Down syndrome
It is not apparent regarding the frequency of ADHD in children with Down syndrome. However, symptoms similar to ADHD in children with Down syndrome are more found compared to normal children. Symptoms associated with such repetitive behaviors (Stereotypy / repetitiveness), hyperactivity, anxiety, like ADHD symptoms may indicate certain disorders such as autism, bipolar disorder, or obsessive compulsive disorder.
Uncomplicated ADHD symptoms are common in children with Down syndrome at young age. However, many school-age children with ADHD often have other behaviors as well as oppositional defiant disorder or disruptive behavior disorder or think or do repeatedly (obsessive compulsive traits). If the problems of the child relating to a decreased attention span, impulsive behavior and hyperactivity or uncontrollable movements, consultation from behavioral pediatrician or child psychiatrist should be sought.
Behaviors that requires attentions in children with Down syndrome
The teeth grinding (bruxism) found in children with Down syndrome does not differ from that found in other children. According to the investigation in Mexico, Sue Buckley (2007) conducted a study of 57children with Down syndrome at the age of 3-14 years, teeth grinding was found in 42 percent of children with Down syndrome. No significant difference in the rate of gnashing between gender and level of disability. A few teeth grinding in preschool children was reported. The most teeth grinding was also observed in children aged 6 to 8.11 years and the rate decreased in children aged 9 years old up.
Grinding teeth can be caused by anxiety and tension, toothache, earache, improper position of the teeth, such as tooth displacement, fluted crown/ bridge, tooth with crown and too high lower teeth caused by excessive teeth.
There are 2 patterns of teeth grinding, occasional and regular biting. Bruxism can make annoying noise and cause tooth wear. Although, the issue is the problem that requires attention, but we should not pay too much attention.
Prevention of tooth damage may be done by the night guard which is usually recommended when the child has permanent teeth. However, children with Down syndrome are difficult to apply because they must agree to wear it.
When the baby bites teeth, what you should do is to find the cause which sometimes cannot find it. Causative treatment is provided like giving counseling on stress management, using biofeedback device during daytime, visiting occupational therapist, giving jaw muscles relaxant before bedtime.
Tips to help stop grinding teeth
Avoid foods and drinks that contain caffeine, such as cola, chocolate and coffee.
Avoid alcohol drinks.
Do not chew gum, pens and pencils.
Relax muscles around the jaw by training yourself during daytime.
When aware of the symptom, place the tip of the tongue in between the teeth.
At night, put a warm cloth around the earlobe.
Before using behavioral modification program in Down syndrome
Step 1: Check the following medical problems; hearing test, visual test, function of thyroid gland, screening of intestinal inflammation, sleep problems, anemia, pain or other physical discomforts such as gastroesophageal reflux, constipation and ear infections.
Step 2: Check mental health problems, for instance, behavior that is like symptom of anxiety, depression or other mental health problems by asking what was happening at home, some changes of situations or family facing stress.
Step 3: If the above medical and psychological problems are not found. Behavior modification program is then applied. What is needed for behavioral changing agent are knowledge, skills, time, patience, commitment, consistency and agility of decisions.
References
1. Buckley S. 2011,December 27. Teeth grinding. [Online].Available URL: http//www. Down syndrome.org/updates/2048/ 2. Patterson B. and Franer SM. 2006.Challenging behavior in Down Syndrome.National Association for Down Syndrome Conference .Workshop Handouts .2006 ,November 4. 3. Down Syndrome Behavior Issues.2012,May 10. [Online].Available
