What is Down’s Syndrome?
Down’s syndrome (Down Syndrome) is a genetic disorder caused by abnormal cell division and the production of an extra full or partial copy of chromosome 21. This extra genetic material is responsible for the physical features and developmental differences associated with Down’s Syndrome. Though the physical features linked to Down’s Syndrome are well known, less is understood about the behavioral issues.
Having a better understanding of these facilitates early intervention, which can significantly enhance the quality of life of children who have this condition and enable them to live more fulfilling lives. In this article, we will cover Down’s Syndrome Behaviour Management to help you better understand how to discipline a child with Down’s Syndrome.
What are the Common Behavioral Issues in Down’s Syndrome?
Children with Down Syndrome are more likely to engage in challenging behavior (1 in 3). These behaviors may present many Down Syndrome behavior management problems within several settings, whether within the community, at leisure, or at school. In many instances, this behavior may prevent them from accessing these environments.
Some of these challenging types of behaviors include the following:
This presents a safety problem and requires good locks and door alarms at home or a written plan to the school that outlines what should happen if your child leaves the classroom or playground.
Stubborn or oppositional behavior
This type of non-compliant behavior may have been triggered by something specific. At times, this type of oppositional behavior may simply be your child’s way of communicating frustration or lack of understanding because of their communication/language problems.
If your child has Down Syndrome, he/she may have a short attention span. Their behavior can often be impulsive. In this case, their behavior is similar to children with anxiety disorders, language processing problems, and hearing loss.
These can range from simple to complex. For example, a simple manifestation of this problem could be your child always wanting to sit in the same chair. Sometimes, obsessive/compulsive behavior can be repetitive in a more subtle way, like always playing with something when they are not actively engaged.
This type of behavior is more commonly seen in younger children. When there is an increased level of restlessness and worry, however, a child may behave rigidly.
Autism Spectrum Disorder
Affects approximately 5-7% of kids with Down Syndrome. Their diagnosis is usually made around age 6-8 years old (which is a little later than in the general population).
Because of the difficulties that children with Down’s Syndrome have in controlling their impulses, relating to children and adults, communicating, and managing frustration, it is understandable that behavior problems and behavior management challenges are likely for many parents.
How Do I Discipline a Child with Down’s Syndrome?
Flexibility in discipline is essential. Children with Down Syndrome (along with typically developing children) will often misbehave simply for attention or to get a reaction, so it is vital to avoid this. Ignoring those insignificant improper behaviors is better than providing a reaction to them.
A reaction reinforces the very inappropriate behavior you want to stop. Above all, it is necessary to preserve the relationship with your child. Yelling at your child does not reinforce good behavior and may be more harmful than doing nothing at all.
Should a Child with Down’s Syndrome be on Medication?
Although children with Down’s Syndrome are 3-5 times more likely to have Attention Hyperactivity Disorder, the rate of prescribing medication is disproportionately low.
Drugs such as Ritalin, Rivastigmine, Galantamine, Memantine, and Donepezil are trial treatments for Down Syndrome.
They typically are recommended for use in children with intellectual disabilities and ADHD. Medications are cautioned against routine use possibly because of the uncertainty of an ADHD diagnosis.
Other causes of medication-based management is due to the lack of clinical trials examining the safety and efficacy of its use in children with Down’s Syndrome, and concerns over their cardiac safety, given the high incidence of congenital heart defects in the Down’s Syndrome population.
What are the Strategies to Manage Difficult Behaviors in Down’s Syndrome?
Downs Syndrome behavior management is a massive task that you may need help with. Parents should understand that not all strategies will be effective for every child, nor at all times.
Parental styles differ amongst children, age groups and even ethnic groups as well. What is important is to alway seek professional help when possible, as most behavioural strategies are based on anecdotal evidence collected and curated over many years by child psychology specialists.
The cooperation of the parents’ extended family is a welcome gesture to foster a sense of community-based support for difficult familial issues surrounding the raising of a special needs child.
Here are a few ways that you can use to improve your child’s behavior:
Keep a routine
Children with Down’s Syndrome often have difficulty receiving and remembering verbal instructions. Sticking with a system and talking them through in short statements of direction can greatly reduce negative behavior. Visual schedules are also recommended. Routine can be aided by prepping your child verbally or visually for the next thing they will need to do.
Positive reinforcement is a powerful motivator for children, especially those with Down’s Syndrome. Promising your child something they like (an activity or treat) can persuade your child to perform a particular required behavior.
A structured reward system can take the form of a simple chart with pictures of positive behavior, and the chart can be check-marked when that behavior is exhibited.
Additionally, give a reasonable reward to reinforce and encourage the behavior to continue. Simply praising good behavior can also have long-lasting effects. Immediately praising your child’s good behavior will give them a positive feeling they can associate with the behavior they just displayed.
Giving a high-five after something as simple as eating their vegetables can go a long way.
Children should be given a choice as often as possible and appropriate. Not only will this make them feel empowered, but it will also minimize negative behavior triggers. These can be simple choices, like choosing what shirt to wear to school.
Children with Down’s Syndrome often fall into the habit of sensory seeking (such as making loud noises or touching things) as a means of soothing themselves when they are stressed, frustrated, or unhappy. The best way to deal with sensory seeking is to find things to occupy the child’s free time, like coloring or reading.
Plan for difficult situations
You can help your child to prepare for upcoming events that may be difficult by using Social Stories. These are picture books that outline what they can expect, and they can help significantly to reduce anxiety and behavior problems.
This is crucial for behavior modification in relation to Down’s Syndrome behavior management. Children naturally want to test boundaries, and they make mental notes of how their behavior is dealt with and how it makes them feel.
It is imperative that you consistently encourage good behavior and discourage those that are bad (and not just focus on the bad behavior).
When Do You Need Expert Guidance for Your Child’s Wellbeing?
As the saying goes ‘it takes a village to raise a child’, this quote is especially apt for challenging situations such as raising children with special needs.
The parent should always be confident to approach their child’s pediatrician to raise questions, no matter how trivial, when it comes to best practice in childcare. From nutrition to emotional nourishment.
Expert medical guidance is best appreciated in the early years of an infant’s life, when the complex behavioural aspects of Down’s syndrome have yet to appear. At a young age, your child’s mental and emotional needs are still under your direct influence, therefore your informed parenting style (and disciplinary methods) can be practiced and tailored to your child as they grow up.
If your pediatrician is unable to spend time to educate you on possible methods of behavioural management, you may seek a second opinion from another appropriately skilled pediatrician for their feedback.
Another approach is to seek expert counsel from a child behavioural psychologist who may be best trained to assess your child’s unique mannerism, in real time.
Expert behavioral counselling can guide you to the personalized needs of your child specifically, in a way that is more practical for you according to the resources available.
Dr. Maria says,
When dealing with difficult behaviours in a child with Down’s syndrome, you should consider any underlying clinical isues that may be the cause….eg. such children are prone to inner ear problems (infections/deafness) which could be the cause for their discomfort…and they are expressing it their own way.
Can Telemedicine Help You Take Better Care of Your Special Needs Child?
TelePediatrics is a brand new approach to expert care using basic telecommunication technology, where parents no longer have the hassle of arranging an appointment weeks or months beforehand (in their city or out of state) nor do they have to arrange home childcare for their other children.
This convenient and inexpensive way to connect with a pediatric specialist or a behavioural psychologist who may be situated thousands of miles away, to actually observe your child at play in their most natural and comfortable surroundings i.e. their playroom, whilst interacting with you, is a great way to help you learn practical parenting tips.
Effective management of a child with Down’s syndrome requires frequent follow up with specific correlation to the child’s developmental milestones – best seen through a video chat to allow for timely intervention, changes in methods or even to alter a prescription.
Dr. Maria says,
Downs syndrome children are at higher risk of thryoid & celiac diseases – these diseases affect mood, eating habits, can cause insomnia and many other neurocognitive effects.
Parents should consider an annual well child visit which includes screening tests for such illnesses.
How Will a VIOS Provider Help Manage Special Behavioural Needs?
VIOS is a global specialist telemedicine gateway that allows parents like you to choose a skilled physician that you can personally judge, who would be the best choice for your child’s unique health needs.
Our extensively curated network of healthcare specialists are highly trained and certified in their fields, with dedicated expertise in specific health sector domains, such as pediatrics.
Through the VIOS Clinic, you can select your preferred provider by viewing their credentials and skill sets before you decide to book an online appointment, where you are.
Don’t have health insurance coverage? Do you live overseas?
Then we are the perfect solution for your family. With easy direct pay options, you can easily purchase a virtual consult token from our portal. Select the ideal timing that is convenient for you (from any timezone) and just click on the specific ZOOM (Zoom for Healthcare) link that will be emailed to you when you book the appointment.
Watch this testimonial from David who had used our global telemedicine platform to book an urgent priority appointment for his mother.
Will I have enough time to gain a valuable telemedicine consult?
Our Telemedicine Providers are more than willing to give you 30-40min of 1-to-1 video sessions, just to listen to your needs. We will provide a safe and convenient virtual care environment, in a relaxed and unhurried digital space.
Our Providers will give you expert consults, behavioural/lifestyle counselling with practical tips and second opinions to give you a better chance at making informed decisions, that you know is right for you alone.
Are you ready to seek expert counsel?
Dr. Ismail Sayeed
Dr. Sayeed is the Medical Director of ViOS, Inc. He is a deeply committed physician entrepreneur & medical blog writer. While building the global infrastructure of the VIOS Clinic, he is dedicated to educate people on the potential of specialist telemedicine for managing chronic diseases.
Read more about him in his author bio
Mayo Clinic. (n.d.). Down Syndrome.
Feely, K., Jones, E. (2008). Strategies to address challenging behavior in young children with Down syndrome. Down Syndrome Research and Practice, 12(2), 153-163.
National Down Syndrome Society. (n.d.). Managing Behavior.
Reisling, K. (2018, April 27). 5 Strategies for Dealing with Behavior Issues in Children with Down Syndrome. Down Syndrome Association of Wisconsin.
Anixt, J Dr, Epstein, J. Dr, Abbeduto, L Dr. (n.d.). Evaluating Assessment and Medication Treatment of ADHD in Children with Down Syndrome. Center for ADHD-Cincinnati Children’s.
Children’s Hospital Boston. (n.d.). BEHAVIOR AND DOWN SYNDROME: A PRACTICAL GUIDE FOR PARENTS [Brochure].