The Results of the Use of Development Tools for Basic Writing Skills for Children with Down Syndrome

                    Writing skills are considered necessary for the children with Down syndrome since this group of children, currently, has more open opportunity in education through cooperative classes with normal children, parallel classes or a specific school for the children with intellectual disabilities. Regardless of the types of education provided the children with Down syndrome must possess writing skills as tools required for communication while learning. However, according to Noppawan Sriwongpanich (2002) their abnormal physical appearances such as broad and flat palms, short fingers, crooked little finger caused from short middle phalange, sharp cut of palm line, weak muscles as well as abnormalities in other body systems like cardiovascular system, endocrine gland and several others. Significantly, muscular system, Pueshel, 2001 cited that hypotonia/ low muscle tone causing muscle weaknesses poses difficulties in learning and developing movements in upright position. Because of this, the dominant impacts on reaching, picking and holding objects with difficulties in moving fingers were found. Besides, it also brings about lacking of skills of movement appropriate to stages of development that may result in muscle weaknesses and lack of daily living skills in children, for instance, eating, holding pencils for writing, etc. Thus, children with Down syndrome need to improve their writing skills more than normal kids. However, at present, teachers and related personnel still lack of knowledge relevant to writing skills development for children with Down syndrome. They solve this problem by holding their hands to write again and again thanks to lacking knowledge of basic writing components directly affecting their writing skills. Phakawan Sutthivongse (2008) investigated factors affecting basic skills in writing of children with Down syndrome and found that the agility of the use of hands was the most powerful element and the power of dominant hand fist, bilateral hand coordination, hand stability and sensory perception of hands and fingers were amongst the latter. All of the 5 factors influence the writing skills. This is new to therapists, teachers and personnel involved in the development of writing skills for children with Down syndrome.

Nowadays, there are no inventions of the tools for the purpose of development of basic skills in writing specifically for children with Down syndrome. From the vision of Rajanukul Institute to be a tertiary holistic service provider for child development, the research study on the development of basic skills in writing for children with Down syndrome was then, initiated with the objectives of being guidelines for reinforcing their basic skills in writing. A part from improving the service of the institute, the result of this study was also disseminated to benefit our personnel and all interested parties accordingly.

Pre-experimental method, one group pretest-posttest design, was used.

        8 samples of children with Down syndrome aged 5-6 years with the problem in basic skills in writing and at least 3 in 5 skills necessary for holding pencils which are 1) power of dominant hand fist,2) bilateral hand coordination 3) hand stability, 4) sensory perception of hands and fingers and 5) dexterity, were screened and evaluated by Developmental test of Visual-motor Integration (VMI)

The invented tool kit for improving basic skills in writing of children with Down syndrome was examined by specialists with IOC 0.96 in 2 parts. 1) The tool for developing basic skills in writing in 5 areas: power of dominant hand fist, bilateral hand coordination, hand stability, sensory perception of hands and fingers and dexterity and 2) plan for tool applications.

Subtest 1-12 was used to evaluate basic writing skills.

Comparative statistics of Wilcoxon Matched Pairs Signed Ranks Test with descriptive summary was applied.

Result of the Study: Table 1 showed the numbers of subjects, percent of age, gender and dominant hand (N= 8).

The objective of this study was to investigate the results of the use of the tool to improve basic skills in writing of 8 children with Down syndrome who received services at 3 service centers in Bangkok areas in the year 2010: 1) Rajanukul Institute, 2) Klongkum Development Center and 3) Muangkhae Development Center. The age group of the subjects ranged from 5-6 years with the average of 5.44 years, standard deviation of .39, 6 male accounting for 75% and 2 female or 25%. All of them were right-handed or 100%.

Table 2 explained the comparison of skills affecting basic skills in writing before and after manipulating tool.

Table 2 indicated that skills affecting basic skills in writing were hands and fingers’ sensation, bilateral hand coordination, dexterity and dominant hand strength. There was statistical significance at 0.05 after using supporting tools in all respects.

Table 3 illustrated the comparison of basic skills in writing before and after manipulating tool.

Table 3 indicated that basic skills in writing after manipulating tool were significantly higher at 0.05.

8 samples of children with Down syndrome with average age of 5.44 comprising 6 males or 75% and 2 females or 25% were screened. All were 100% right-handed. Skills affecting basic skills in writing were stability, hands and fingers’ sensation, bilateral hand coordination, dexterity and dominant hand strength. Basic skills in writing after manipulating tool were significantly higher at 0.05.

             The result of the study indicated that children with Down syndrome had means and standard deviation of hand stability before using tool was 2.29±2.60 while 3.99±4.58 after manipulating tool. The study also found that hand stability of the Children with Down syndrome after manipulating tool was significantly higher than before using tool at 0.05 (p-value = .036) Miller (1988) studied the hand stability of 1,204 subjects of normal children compared to this study’s children with Down syndrome with average age of 5.44 years, was significantly higher and also found that those of 5 years of age had scores ranging from 10-12 points. This was in accordance with Bruni (1998) who explained the difficulties of hand stability of Children with Down syndrome arising from their low tension of muscles. This caused children with Down syndrome difficulties controlling changes of the tension of muscles intentionally as well as maintaining steady level of shrink of muscles around joints in a certain period of time until the end of joints had shrunk in an opposite direction. This skill was vital for children to learn how to balance their hands and control carrying and releasing objects as well.

             Children with Down syndrome in this study had mean and standard deviation of hands and little finger’s sensation when using tool at .62±.52 and 2.37±.92 after using tool. In addition, this study also indicated that the sensation of hands and fingers of Children with Down syndrome after using tool was significantly higher than before using tool at 0.05 (p-value= .010) compared to the report of Miller (1988) who investigated the sensation of hands and fingers of 1,204 normal children and found that subjects aged 5 years had 3 points comparing to 2 of children with Down syndrome (male) had the same score as normal children. Bruni (1998) explained that the problem in sensation of hands and fingers was slow during sending and receiving messages to the brain. This affected the Children with Down syndrome with defects in sending messages, both in size and weight of objects, to the brain resulting in their lack of differentiation of objects as well as their difficulties in changing the patterns of movements of their hands and fingers in order to pick up different sizes of objects. As a result, they faced with too much energy applied in carrying objects. In addition, their sensory development also was rather slow noticing from longer time spending on surveying any object before taking it into their mouth. Consequently, learning through their hands to survey the surroundings was slow. This group of children needed to experience several touching models to improve their sensation. The 5 activities of hands and fingers’ stimulation were then applied in this investigation. These activities comprised 1) lotion massage, 2) squeezing plastic dolls with different surfaces, 3) opening various books with different surfaces, 4) drawing pictures by hands, and 5) coin feeling from foam box.

              Children with Down syndrome in this study had mean and standard deviation of bilateral hands coordination before using tool at 1.06±.42 and 2.25±.46 after manipulating tool. The result of the study on bilateral hand coordination showed significant difference before and after using tool at 0.05 (p-value = .016). The bilateral hand coordination of Children with Down syndrome after using tool was significantly higher than after using tool but not so high. Bruininks (1978) studied the bilateral hand coordination in 765 normal children and found that subjects aged 5 years had mean and standard deviation at 18.3±4.9. The bilateral hand coordination of Children with Down syndrome in this study was rather lower than normal children since children with Down syndrome had low tension of muscles reflecting balancing problems while sitting. They then used one hand to support themselves while using the other hand to do activities. Consequently, they lacked the chance to use both hands to do activities, grasp of objects to their body, exchange hands in gripping as well as developing their dominant hands to bilateral hand coordination skills (Bruni, 1998).

                        Subjects in this study had mean and standard deviation of agility before using tool at 4.87±1.36 and 8.37± 2.06 after manipulating tool. In addition, the study showed that hand dexterity of the Children with Down syndrome after using tool was significantly higher at 0.05 (p-value = .010). Comparing to Bruininks (1978) that investigated the dexterity of 765 normal children and found that subjects of 5 years of age had mean and standard deviation at 18.3±4.9, it was explained that the Children with Down syndrome had faced this problem thanks to the slow development of fingers which needed coordination while working freely. Gripping and intentional releasing of objects plus the short thumb with low tension and loose and hyper extending joints brought about difficulties in controlling the movement of the thumb to work with other fingers as to grip small items. Consequently, the dexterity of Children with Down syndrome was lower than that of normal children according to Bruni (1998).

              Down syndrome subjects had mean and standard deviation of the dominant hand’s strength before using tool at 14.62±5.94 and 24.67±5.78. The study indicated that the dominant hand’s vigor of children with Down syndrome after using tool was significantly higher than before using tool at 0.05 (p-value =.012). According to Nanthanee (2002) who investigated the prominent hand’s strength of 90 normal subjects aged 5 years and found that mean and standard deviation was 21.96±5.13 which was equal to the mean and standard deviation of children with Down syndrome after manipulating tool.

                Down syndrome subjects had mean and standard deviation before using tool at 3.50±2.51 and 11.50±.93 after applying tool. In addition, it was found that the basic skills in writing after using tool was significantly higher than before using tool at 0.05(p-value =.011). This meant that mean and standard deviation after using tool was higher than before using tool. According to Beery (1997) who conducted the study of basic skills in writing on 2,614 normal children aged 5 years found the score was in the range of 11-12. It was evident that the writing ability of Children with Down syndrome after using tool was equal to normal children. This was in accordance with Phakawan (2008) who investigated the factors affecting basic skills in writing in the children with Down syndrome. The study showed that the factor affecting basic skills in writing in the children with Down syndrome most was dexterity and dominant hand fist’s vigor, bilateral coordination, stability and sensation of hands and fingers were the latter. The concept supporting each of the factors affecting basic skills in writing was that of Bruni (1998)’s building fundamental skills required for early intervention of visual motor integration skills for improving basic skills in writing. Those skills consisted of stability, sensation of hands and fingers, bilateral coordination, sensation of hands and fingers and dexterity. Besides, Saunder’s concept (2001) put the emphasis on the development or preparedness of hands in the areas of strength, dexterity, stability, bilateral coordination and abilities of integration of touching sensory skill, motor skill, and location of joints together with visual ability in order to be able to control motions or change the patterns of hands in gripping and writing effectively. This was the early intervention of basic skills in writing of pre-school children.

May I express my sincere thanks to Associate Professor Dr. Nunthanee Sathiensakpong, Chief of department of occupational therapy, Chiang Mai University, Mrs. Pussadee Photharam, an occupational therapy academic level 6 of Chulalongkorn hospital, Mr. Niponthorn Saengthongsri, an occupational therapist of Queen Sirikit National Institute of Child Health, Ms. Nichapat Srinaruewan, an academic on occupational therapy of Child Ability Development Center, Smart Kids for being an expert on her kind examination of tool and consultancy until the study was completed and my special thank to the director of Rajanukul Institute for her great support.

Noppawan Sriwongpanich (2002). Children with Down Syndrome. Bangkok: Kurusapa Ladprao Printing Press.

Nanthanee Sathiensakpong (2002). Factors Affecting the Writing Ability of Pre-school Normal Children, Department of Occupational Therapy, Faculty of Technical Medicine, Chiang Mai University.

Nanthanee Sathiensakpong (2006). Evaluation Test of Pre-school Children of Miller’s "Screening of Development and Tests of Abnormality in Children", Department of Occupational Therapy, Faculty of Technical Medicine, Chiang Mai University.

Pakawan Sutthiwong (2008). Factors Affecting the Writing Ability of Children with Down Syndrome. M. Sc. in Occupatinal Therapy, Graduate School, Chiang Mai University

Sukritta Piriyakulathorn (2005). Early Childhood Children’s Drawings Associated with Strength of Hand, Fingers and How to Hold Pencil. M. Sc. in Human Development, Mahidol University.

Issariyaporn Vanichpipat (2006). Applications of a Set of Activities Used to Develop Hand-Eye Coordination for Children with Intellectual Disabilities. M. Ed. in Elementary Education, Chaing Mai University.