Down+Syndrome

=__Down Syndrome__=  Down syndrome is named after the physician John Langdon Down, who first identified the syndrome. Down syndrome has been used as a synonym, and has been closely related to: Mosaic 21 Syndrome, Translocation 21 Syndrome, Trisomy 21, Trisomy 21 Syndrome, Trisomy G, and Trisomy G Syndrome. Down syndrome occurs in 1 of every 800 live births in all races and ethnic groups. The actual definition of Down syndrome, as stated in The 2002 Official Parent’s Sourcebook on Down syndrome is: “it is a chromosomal disorder caused by an error in cell division that results in the presence of an additional third chromosome 21 or ‘trisomy 21’” (Parker & Parker, 2002, p.10). A person with Down syndrome is easily identified by their facial features. The typical characteristics include slightly slanted eyes with small skin folds at the inner corner of the eye, a flattened nasal bridge, a short neck, a tongue that tends to protrude and small hands (Girod, 2001, p.9). The health problems that are typically associated with Down syndrome include heart defects that affect 40 percent of those with the disorder, poor muscle tone and a proneness to respiratory infections and leukemia (Girod, 2001, p.9). Mental retardation is the most significant symptom of Down syndrome. A person with Down syndrome can range in mental retardation from mild to moderate. As a result, the person’s cognitive, social, language, and motor development is affected (Girod, 2001, p.9).
 * DEFINITION**
 * CHARACTERISTICS**

The cause of Down syndrome is unknown. The disorder is not inherited, meaning that the parents do not pass it on (Girod, 2001, p.9). However, the reason behind why the disorder occurs is known. Cells of the human body usually contain 23 pairs of chromosomes, half coming from each parent. The sperm cell and the ovum each contain 23 individual chromosomes. Pairs only form during the fertilization process. If the fertilized egg that is developing is female, it will contain pairs numbered 1 to 22, and the XX pair; whereas if it develops into a male, it contains pairs 1 to 22 and the XY pair. Down syndrome results when the fertilized egg contains extra material from chromosome number 21. When the embryo is developing, the extra material from chromosome 21 is repeated in every cell. This is how the term //Trisomy 21// was developed, //tri// meaning three and //somy// meaning chromosome (Girod, 2001, p.18-19).
 * CAUSES**

There are three different variations that can cause Down syndrome. Each variation is described in detailed throughout Parker and Parker’s 2002 Official Parent’s Sourcebook on Down Syndrome: //1) 92% of the time, DS is caused by the presence of an extra chromosome 21 in all cells of the individual (as described above) –called trisomy 21 ////2) 2-4% of cases, DS due to mosaic trisomy 21 // //-similar to above, but extra chromosome 21 is present in some, but not all cells of the individual // //-in this situation, the range of the physical problems may vary, depending on the proportion of cells that carry the additional chromosome 21 // //3) 3-4% of individuals with DS have cells containing 46 chromosomes but still have features associated with DS. // //-material from one chromosome 21 gets stuck or translocated onto another chromosome, either prior to or at conception // //-individuals may have cells with 2 normal chromosomes 21, but have additional chromosome 21 material on the translocated chromosome // //-the individual with this type of DS is said to have translocation trisomy 21 //(Parker & Parker, 2002, p.12)
 * GENETIC VARIATIONS**

Most often Down syndrome forms due to a random event during reproductive cell fertilization. Research has not been able to show that Down syndrome is attributable to any behavioural activity of the parents or any environmental factors (Parker & Parker, 2002, p.12). If parents give birth to a child with Down syndrome, the possibility that in a subsequent pregnancy the child will have Down syndrome is about 1%. An interesting fact of Down syndrome is that 88% of all cases, the extra chromosome is derived from the mother, and 8% of the time it is from the father. Only 2% of all Down syndrome cases is the extra chromosome due to “mitotic errors” (Parker & Parker, 2002, p.13). The most common risk factor for having a child with Down syndrome is maternal age. Over the years, doctor’s have seen an increase in the rate of Down syndrome births to mothers who are 35 years of age or older. There is no confirmed reason why this rate is so high. However, it is believed that the risk is increased in older women because of the abnormalities in their eggs (Girod, 2001, p.32). However, 75% of all babies born with Down syndrome are from women aged 35 years old or younger, and they are having more babies than women over 35 years of age. Only 9% of all pregnancies occur in women over 35 years of age, but 25% of those babies are born with Down syndrome. Research shows that maternal age plays a part in the role of Down syndrome, but “using maternal age will not detect over 75% of pregnancies that will result in Down syndrome” (Parker & Parker, 2002, p.14). The risk of having a baby with Down syndrome is 1 in 400 births for women over the age of thirty-five. At age twenty, the risk is only 1 in 1600 births. Once a parent has a child with Down syndrome there is only a 1% chance that any future children will have the disorder (Girod, 2001, p.33). The best known research being conducted is the Human Genome Project. The goal of the project is to name the genes on all 23 chromosome pairs and to determine what characteristic each gene is responsible for. By doing so, this may lead researchers toward treatments for Down syndrome (Girod, 2001, p.73).
 * OCCURENCE**
 * TRENDS**

__Mother’s Age __<span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA"> __Incidence of Down Syndrome__ <span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">Under 30- less than 1 in 1000 <span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">30- 1 in 900 <span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">35- 1 in 400 <span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">36 - 1 in 300 <span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">37- 1 in 230 <span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">38- 1 in 180 <span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">39- 1 in 135 <span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">40- 1 in 105 <span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">42- 1 in 60 <span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">44- 1 in 35 <span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">46- 1 in 20 <span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">48- 1 in 16 <span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">49- 1 in 12 <span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">(Table retrieved from “The 2002 Official Parent’s Sourcebook on Down Syndrome”, Parker, J.N., & Parker P.M., 2002, p.14) A controversial pre-screening procedure has been the topic of debate for many years. The debate is focused on the value and quality of life of persons with Down syndrome. Expecting parents can choose such a test to determine if their baby will be born with Down syndrome. Some parents choose to abort the pregnancy if the results show that their baby has Down syndrome. Others use the time during pregnancy to become prepared and knowledgeable about the challenges and joy that lie ahead (Girod, 2001, p.32). Until the 1970’s, it was common practice for parents to place their newborn child with Down syndrome in mental institutions. The families would keep this secret from the rest of the world and sometimes even tell people that their child had died at birth (Girod, 2001, p.8). A great work of fiction that deals with this subject is “The Memory Keeper’s Daughter” written by Kim Edwards. During the 1970’s, attitudes started to change about people with Down syndrome. A law was passed to protect the educational rights of children with Down syndrome who were now allowed to attend school. In fact, the 1990’s had the greatest number of independent and semi-independent educated, working adults with Down syndrome to date (Girod, 2001, p.10).
 * //<span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">Relationship of Down Syndrome Incidence to Mother’s Age //**
 * ISSUES**

<span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">There are procedures available that are non-invasive, only involving a drop of the mother’s blood, and the test determines if there is an increased probability for Down syndrome. Although these tests do not show a definitive sign for Down syndrome, they do suggest that the individual being tested may want to undergo further tests after discussion with professionals and loved ones. The support received from loved ones is very comforting, and extremely important. Parents often deal with feelings of depression and guilt, so support becomes very important. Parker & Parker (2002) explain 3 different tests that are used to diagnose for Down syndrome. Each test carries its own pros and cons. The three tests are as follows: //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">__Amniocentesis:__ // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">-the removal and analysis of a small sample of fetal cells from the amniotic fluid // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">-cannot be done until the 14-18th week of pregnancy // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">-lower risk of miscarriage that chorionic villus sampling // //__<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">Chorionic Villus Sampling (CVS): __// //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">-extraction of a tiny amount of fetal tissue at 9 to 11 weeks of pregnancy // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">-the tissue is tested for the presence of extra material from chromosome 21 // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">-carries a 1-2% risk of miscarriage // <span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA"> //__<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">Percutaneous Umbilical Blood Sampling (PUBS) __// //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">-most accurate method used to confirm the results of CVS or amniocentesis // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">-the tissue is tested for the presence of extra material from chromosome 21 // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">-PUBS cannot be done until the 18-22nd week // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">-carries the greatest risk of miscarriage // <span style="FONT-SIZE: 9pt; LINE-HEIGHT: 115%; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA; mso-ansi-language: EN-CA; mso-bidi-language: AR-SA">(Parker & Parker, 2002, p.15-16) <span style="FONT-SIZE: 10pt; LINE-HEIGHT: 115%; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA; mso-ansi-language: EN-CA; mso-bidi-language: AR-SA">If a baby is born and suspected of having Down syndrome (physical characteristics check), a blood test called karyotype is usually performed. The test involves “growing” cells from the baby’s blood for about 2 weeks, and using a microscope, the chromosomes are visually inspected for any extra material from chromosome 21 (Parker & Parker, 2002, p.16-17). <span style="FONT-SIZE: 10pt; LINE-HEIGHT: 115%; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA; mso-ansi-language: EN-CA; mso-bidi-language: AR-SA">Often people with Down syndrome have medical disorders that are associated with Down syndrome. Congenital hypothyroidism is a disorder that causes the thyroid gland to enlarge, reduces basal metabolism, and disturbs the autonomic nervous system. Other medical disorders include hearing loss, vision disorders, and congenital heart disease. Every person with Down syndrome is unique, and although these medical disorders are associated with Down syndrome, not everyone will develop all of these disorders (Parker & Parker, 2002, p.17-18).
 * PRENATAL ASSESSMENT**
 * DIAGNOSIS**
 * ASSOCIATED MEDICAL DISORDERS**

**__CONNECTION TO LEARNING__**
Students with Down syndrome have characteristics that challenge their development and learning capabilities. For example, there are many health factors that could affect development and learning, however, it is important to note that not all individuals that have Down syndrome have all of the following characteristics.
 * IMPACT ON DEVELOPMENT AND LEARNING**

People with Down syndrome often have hypotonia, also know as low muscle tone which ultimately affects fine and gross motor skills. Students with Down syndrome also have delays in the development of fine motor skills and struggle with eye-hand-coordination, therefore, manipulating objects is more difficult. In math, for example, Dr. Horstmeier (2004) states that students with Down syndrome: “have less energy to devote to understanding number relationships if they are struggling with just writing and lining up the numbers in a math problem.”(p. 13) Therefore, the mere effort of using a pencil for long periods of time can prove to be a challenge. With regular exercise, however, this condition usually will lessen and improve. (Horstmeier, 2004, p. 13; PREP, 1999, p.6)

Many individuals with Down syndrome are born with congenital heart abnormalities and teachers should be aware of this, even though most problems have been dealt with before schooling. However, this condition could impact learning in cases where certain activities are restricted to the student. (PREP, 1999, p.6)

Often students with Down syndrome will have some problems with vision and most will need glasses. (PREP, 1999, p. 6)

Another health concern that will impact development and learning is hearing loss. Due to having a smaller than average sized middle ear and narrow Eustachian tubes, children with Down syndrome are prone to ear infections that can cause temporary or even permanent hearing loss. Ultimately, hearing loss can affect language comprehension, learning abilities and also speech development. (PREP, 1999, p.7)

Other related health concerns are Sinusitis and Upper Respiratory Infections which suppresses health and therefore can affect learning. (PREP, 1999, p. 7)

Some individuals with Down syndrome may develop during the course of their life a condition known as Atlantoaxial Instability (AAI) which is “increased flexibility between the first and second vertebrae of the neck that increases the risk of spinal injury.”(PREP, 1999, p.7) Therefore, activities such as gymnastics, diving, somersaulting, high jump, soccer and football, could put strain on the neck and should be avoided. (PREP, 1999, p. 7)

There are many dental factors that affect the development and learning of individuals with Down syndrome. For example, once teeth begin to develop, low muscle tone, known as hypotonia, affects the amount of pressure that the lip and tongue muscles can put on those teeth. Also, the oral cavity is often smaller than normal, therefore the tongue and the smaller cavity cause an open bite in individuals with Down syndrome. These characteristics can cause jaw misalignment, malpositioned or even missing teeth and therefore articulating sound becomes very difficult. Another impact on development and learning is that most students who have Down syndrome “have significant delays in speech and vocal expressive language – that is, with communicating their own thoughts in words.”(Horstmeier, 2004, p. 13) Children with Down syndrome struggle with the mechanics of their mouth due to hypotonia and a high, narrow roof of the mouth. Therefore, students with Down syndrome may be difficult to understand, however, studies show that their comprehension of language is usually better than their ability to speak clearly. (Horstmeier, 2004, p.14)(Horstmeier, 2004, p. 13-14; PREP, 1999, p.8)

Another possible impact on development and learning is that many students with Down syndrome may suffer from Obstructive Sleep Apnea (OSA) which is when breathing becomes interrupted during sleeping periods. This is believed to be caused by hypotonia, enlarged adenoids and tonsils accompanied with a narrow throat area. Obstructive Sleep Apnea can cause fatigue which ultimately affects learning in the classroom and overall participation. (PREP, 1999, p.8)

Development and learning may also be affected by the struggle with weight gain. Unfortunately, the combination of dental complications, hypersensitivity in the mouth, digestive problems, and the possibility of hypothyroidism all contribute to weight gain. Therefore, it is very important that students with Down syndrome participate in gym class and are taught to practice healthy eating and lifestyle habits. (PREP, 1999, p. 8)

A non-health factor that creates challenges in the development and learning of individuals with Down syndrome is that many students struggle with short-term and working memory. Since students with Down syndrome struggle with short-term memory, placing information into long-term memory can prove to be a challenge. Dr. Horstmeier (2004) states: “When information is not of interest to them (such as math facts) or has little emotional impact, they may seem to remember it one day and forget it the next. This is not willful forgetting on the child’s part – instead, it just means that the information was never properly stored in her memory to begin with." (Horstmeier, p.13) (Horstmeier, 2004, p.13)

Students with Down syndrome also struggle with receiving language, therefore oral instructions can be very complicated and should be broken down into smaller steps for easier processing. (Horstmeier, 2004, p. 14)

On top of this, a child with Down syndrome may also have difficulty in processing oral information. This is often the result of hearing loss, however, students without hearing loss also struggle with processing oral information. Dr. Horstmeier (2004) states: “Although children with Down syndrome can understand much of what they hear, they seem to process speech slowly and tend to miss details and information that is given sequentially, as in directions.”(p. 14) Therefore, it is suggested that students with Down syndrome learn more visually and kinesthetically. (Horstmeier, 2004, p. 14-15)

A student that has Down syndrome will undergo the stages of development more slowly than his/or her peers. Dr. Horstmeier (2004) uses Piaget’s theory to explain the cognitive development of children with Down syndrome, and suggests that many believe that people with Down syndrome do not surpass the concrete operational level and therefore abstract concept are usually too complicated. (p.15) This explains the reason for which students with Down syndrome work better using manipulatives and other concrete materials. (Horstmeier, 2004, p. 15-16)

Ultimately, frustration often impedes motivation. As we have mentioned above, there are many factors that can cause frustration on the learning of individuals with Down syndrome and ultimately discourage learning. (Horstmeier, 2004, p.16)

There are many teaching strategies that are available to educators in order to teach individuals who have Down syndrome. The most obvious strategies are to ensure that a student that has Down syndrome should be seated where he or she can best see and hear the teacher. ([|Canadian Down Syndrome Society [CDSS]], p.3)
 * STRATEGIES**

Another strategy is to emphasize visual learning and hands-on learning because most students with Down syndrome learn more efficiently by using these teaching strategies. The Canadian Down Syndrome Society ([|CDSS]) suggests using concrete materials to ease the process of making correlations of abstract activities to real life experiences.(p.4) Providing learning experiences that are relevant to the real world and real life situations such as incorporating math in grocery shopping is essential. The CDSS also suggest using verbal cues and visual supports to enhance learning. Even the usage of visual cues, however, must be simple and there must not be too much information in one visual frame. While using visual information, a teacher should also slow their instruction rate and provide lengthened and repeated processing time for comprehension. It is also important to note that questions, reading materials, testing, assessment, homework and activities should always be at the level the student with Down syndrome is currently at during that point in time. ([|CDSS], p.4; Horstmeier, 2004, p.20, 22; PREP, 1999, p12)

Another essential strategy is to ensure success very early on in the lesson in order to heighten motivation and self-esteem. Dr. Horstmeier (2004) mentions including a “success step” in every lesson, which is a “relatively easy activity related to the new skill for the student to complete at the beginning of the lesson.”(p. 27) This will provide motivation for students when dealing with difficult tasks. Other motivational suggestions are using tangible positive reinforcement. Only once the subject content is comprehensible for the student and worth their interest can there truly be success for learning. (Horstmeier, 2004, p.27; PREP, 1999, p.13)

To ease processing oral instructions, a teacher should break down the task into simple steps and compensate with visual and tactile cues, teaching aids and manipulatives. In order to ease the communication difficulties a student with Down syndrome might have, teaching strategies should include providing verbal prompts such as “slow down”, “try again”, and prompt replies such as providing the beginning of the response sentence. Another useful suggestion is to allow alternative response methods that a child may use such as selecting multiple choice responses or drawing out their responses. ([|CDSS], p. 5; PREP, 1999, p.12)

Another teaching strategy is to establish a definite teaching routine, ensuring that a child with Down syndrome is taught how to follow that routine, and that child should be allowed time to practice that routine. Designing lessons that provide structured learning and building in flexibility help as students with Down syndrome usually do well with structure and schedules. In order to ease any sensory and motor difficulties such as processing multiple instructions from multiple sources, a teacher will need to be certain that a student with Down syndrome focuses on only one task at a time and only one sense at a time.([|CDSS], p. 4-5; Horstmeier, 2004, p.21-22)

In order to ensure that the student with Down syndrome is able to focus on the lesson, a teacher must make certain their lesson is in-tune with the interest of the student, is at the level of language of the student, and that the steps are made into even smaller and simpler steps. (Horstmeier, 2004, p. 22)

Another suggestion is to minimize any motor demands that a student may have to do because their hands may tire due to low muscle tone and therefore a student might grow uninterested in the lesson because they cannot participate in the lesson as long as their peers can.(Horstmeier, 2004, p. 24)

As a result of having difficulty participating in activities that demand a lot of fine and gross motor skills, a child with Down syndrome might struggle participating in the phys-ed classroom. Modifying equipment, however, can ensure success in the classroom. For example, a school should provide larger bats or rackets, etc., and softer or larger balls. Students that have Down syndrome should participate in gym class, however, teachers should be aware of any health concerns. As previously mentioned, students with Down syndrome need to be careful and not participate in activities that put too much pressure on the neck, for the risk of atlantoaxial instability. As a result, a teacher should check with parents before allowing participation in activities that could injure the neck. The benefits, however, of participating in gym class such as exercise for endurance, improving coordination, building strength, and learning how to play and follow rules are important and essential in the development and learning for students that have Down syndrome. (PREP, 1999, 47-48)

The Canadian Down Syndrome Society (CDSS) provides an information package for teachers on possible factors that will affect learning, meanwhile providing strategies for teachers. This information package provided some strategies used in this report. Please see their website, or click the provided link below to find the particular Information series that was used. Also note, that their website provides other information series packages regarding Down syndrome that are very useful for educators. http://www.cdss.ca/site/resources/down_syndrome/information_series/Teaching%20Students%20With%20Down%20Syndrome.doc

<span style="FONT-SIZE: 10pt; LINE-HEIGHT: 115%; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA; mso-ansi-language: EN-CA; mso-bidi-language: AR-SA">It is recognized that children with Down syndrome develop movement patterns and motor skill proficiency quite slowly (Jobling, Virji-Babul, Nichols, 2006, p.34). Motor milestones are generally delayed, and children with Down syndrome are often seen as having a “lack of finesse”, and are sometimes described as being “clumsy” (Jobling, et al., 2006, p.34). Feelings of frustration are sometimes evident due to awkward forms of movement, and the delayed developmental process. Movements are jerky and hesitant due to lack of fluency, and children with Down syndrome are known to have poor postural stability and balance. <span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">One of the latest ideas is the implementation of a dance program for students with Down syndrome (with full inclusion of all students). The overall benefits are to improve motor behaviour, as well to enhance learning. A great aspect of a dance program is children with Down syndrome will “improve motor skill proficiency by progressing from simple skills to more complex skills” (Jobling, et al., 2006, p.35). The dance program is also a different opportunity for children with Down syndrome to progress their motor skills in movements and actions that may not have ever been done with them before. This opportunity has also been suggested to provide appropriate and effective ways to improve form and quality of movement patterns of children with Down syndrome (Jobling, et al., 2006, p.35). Along with motor skill development, the “inherent practice and rehearsal effects could remediate deficits in postural control and make practicing a motivating and rewarding experience for children” (Jobling, et al., 2006, p.35). Along with these benefits, balance skills of children with Down syndrome are shown to improve with dance, more than a traditional gross motor program. Dance has always been seen as an interactive and creative environment. These characteristics of dance provide all students with the sense of community participation and involvement. The creative expression in dance allows the opportunity for children with Down syndrome to express feelings and ideas through movement, and at the same time, providing opportunities to develop motor skill proficiency. In the article by Jobling et al. (2006), they state that there are four concepts that should be involved in such dance programs. Including these four concepts in the dance program will allow for improvements in movement quality and form, as well helping develop proper posture and good balance. The four concepts are as follows: //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">1) Development of an awareness of their bodies in 3 ways: body, space, and effort awareness // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">-body awareness: knowing what the body does, how limbs function in movement, and introducing body parts during a circle time // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">-space awareness: explores the body in relationship to space, and other people and objects in the environment; actions at various levels (high/low, near/far…) // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">-effort awareness: refers to the feeling and the pace of the movement (speed, accuracy, and the sustaining of the movement) // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">2) Movement vocabulary // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">-make sure the dance experience is described, talked about, and enjoyed by all // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">-knowing the language of movement and using it appropriately in verbal self-talk, may also assist those with DS to plan their movements and coordinate them with others // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">3) Individuals with DS may require much more time for the kind of exploration necessary to understand the task and build the confidence in the environment ////<span style="FONT-SIZE: 9pt; FONT-FAMILY: Wingdings; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA; mso-bidi-font-family: Arial; mso-ascii-font-family: Arial; mso-hansi-font-family: Arial; mso-char-type: symbol; mso-symbol-font-family: Wingdings"> à ////<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA"> this need can be addressed in the dance program where the movement and dance opportunities offer continual exploration and practice without the boredom of structured repetition // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">-so as knowledge and understanding grows, confidence is built, frustration is decreased, and the children discover the joy of moving // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">4) Allow for creativity // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">- give children with the opportunity to expand their creative skills as they grow to know and understand their bodies, and the ways it can move together with others // //<span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">-they can use their “movement language” to communicate with others and formulate their ideas // <span style="FONT-SIZE: 9pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA">(From Jobling, Virji-Babul, Nichols, 2006, p.36-38) <span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-CA"> Although a dance program is not specifically outlined in the article by Jobling et al., teachers and other professionals can implement various dance styles and programs, taking into account the core concepts and benefits outlined above. Implementing these concepts will provide various opportunities for motor skill development, language development, and the opportunity to interact with other children. With all the great benefits provided through this program, the main objective is inclusion for all. There are many services and supports available to teachers to increase awareness of Down syndrome and strategies on how to teach students with Down syndrome. In Manitoba, there is the Manitoba Down Syndrome Society that provides support not only to families, but to educators as well. This organization provides a workshop every year available to the teachers and other educational professionals that are on the team of educating a student with Down syndrome. This workshop provides support, advice, and teaching strategies and is called “See me Beautiful.”
 * IMPACTS ON PHYSICAL ACTIVITY**
 * A NEW STRATEGY FOR PHYSICAL EDUCATION**
 * SERVICES AND SUPPORTS**

As mentioned above, the Canadian Down Syndrome Society (CDSS) provides an information package for teachers on possible factors that will affect learning, meanwhile providing strategies for teachers. There are many other support organizations that are available, however, these are good starting points that can forward you to many more resources.

Another useful resource is the organization PREP (Pride Respect Empowerment Program) based in Alberta. Resources can be ordered on-line through their website. Please click the below link to find their website. [|www.prepprog.org]

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