Social development for individuals with Down syndrome - An overview

Sue Buckley, Gillian Bird and Ben Sacks

Social development includes social interactive skills with children and adults, social understanding and empathy, friendships, play and leisure skills, personal and social independence and socially appropriate behaviour. Each of these areas of development is discussed, drawing on the available research literature. Social understanding, empathy and social interactive skills are strengths for children and adults with Down syndrome, which can be built on throughout life to enhance their social inclusion and quality of life. The opportunity to establish friendships may be affected by social independence and by speech and language and cognitive delay. Parents and teachers need to think about ways of increasing the friendship opportunities of children during primary school and teenage years. The importance of friendships with both typically developing peers and peers with similar disabilities is stressed, as is the need to develop play, leisure and independence skills. Most children and teenagers with Down syndrome have age-appropriate social behaviour, but some children do develop difficult behaviours which cause family stress and affect social and educational inclusion. Information on the types of behaviour which may cause concern is included and attention is drawn to the high incidence of sleep difficulties as they influence day time behaviour. Strategies for encouraging age-appropriate behaviour are discussed and ways of preventing and changing difficult behaviours are outlined.

Buckley SJ, Bird G, Sacks B. Social development for individuals with Down syndrome - An overview. Down Syndrome Issues and Information. 2002.

doi:10.3104/9781903806210


Introduction

Social development, as discussed in this module, includes the development of interpersonal social skills, friendships, play and leisure skills, independence and self-help skills, and socially acceptable behaviour. It can be argued that social development is fundamentally important to any individual's well-being since the ability to socialise, to make friends and to take care of one's self, affects all aspects of daily life. In fact, social confidence and competence may be more important than academic skills for becoming independent, finding work, having friends and being independent in the community as an adult.

Most aspects of social development involve social interaction or social activity with other people and, therefore, the ability to understand the behaviour, emotions and feelings of others is important for success in social relationships. The ability to communicate effectively with others is equally important in developing social relationships and managing daily life.

For children and adults with Down syndrome, social understanding is usually a strength, beginning in infancy. Many of the cues which indicate how someone is feeling are non-verbal, for example, tone of voice, facial expression and body posture, so that even when a child or adult does not understand all the spoken language being used in a social situation they are still able to pick up the main messages about feelings and behave in an appropriate way, despite the delays in their development of spoken language skills. This has led a number of authors to emphasise the good social skills, empathy and social competence of most children and adults with Down syndrome. [1-9] They tend to have better social understanding and social behaviour than other children with similar levels of cognitive and communication delay[10-14] and this can help them to be successful in community activities and in inclusive education. However, in the authors' experience, good social understanding of the behaviour of others can also enable children with Down syndrome to be skilled at being naughty as they know exactly how to provoke the reactions they want! We will return to this issue in the section on behaviour below.

It is important to stress that children with Down syndrome are all individuals and differ widely in their social skills, communication abilities and understanding. In addition, like all children, the social development of infants and children with Down syndrome will be influenced by their temperament, experiences in the family, school and community and by the way they are treated by others.[4, 15-18] The behaviour of a child is almost always very different in an environment where he/she feels safe and understands what is expected of him/her compared with the same child's behaviour when sensing negative emotions or when unable to explain a difficulty.

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A small number of children with Down syndrome also have other conditions such as neurodevelopmental disorders, including autistic spectrum disorders, and these children will have social difficulties and will not show the good social understanding that is typical of most children with Down syndrome.

Influences on social development

Influences on social development

  • Temperament and personality
  • Language and cognitive abilities
  • Family environments
  • Expectations and management
  • Specific difficulties such as autism, hyperactivity or obsessional disorders

Social development begins from the earliest days of babies' lives and is strongly influenced by their experiences with their parents and caregivers. Parents and care givers, in turn, are influenced by the temperament and behaviour of infants from the earliest days. Some babies are more difficult than others and some parents will be able to cope with difficult babies with more confidence than others. In other words, development is a dynamic and interactive process in which the behaviours of children and parents influence each other, and the children's ongoing experiences influence their development in addition to their biological makeup. In this section, four main influences on social development are highlighted briefly - temperament and personality, language and cognitive abilities, family environments, and expectations and management. The evidence of their influence on outcomes for children with Down syndrome will be returned to later in each section when discussing the different aspects of social development.

Temperament and personality

Children's behaviour and social development is influenced by temperament and personality. Some children are anxious in temperament, others placid and calm. Some children are outgoing and sociable, others are shy and find it less easy to make friends. Research studies indicate that the range of temperamental and personality characteristics among children with Down syndrome is the same as the range observed in typically developing children. There is little evidence to support the stereotype which suggests that all children with Down syndrome are invariably placid and happy. [3,4,16,19-22]

Temperament is used to describe the basic behavioural style of children.[23] It is characterised in infants by collecting information on their activity level, regularity in biological functions such as hunger, sleep and bowel movements, readiness to accept new people and new situations, adaptability to changes in routine, sensitivity to noise, bright lights and other stimuli, whether a child's mood leans towards cheerfulness or unhappiness most of the time, intensity of responses, distractibility and degree of persistence. Based on these characteristics, different types of temperament have been identified by researchers studying typically developing infants and young children, including 'easy', 'difficult', 'slow to warm', and 'intermediate'.[23-25] Studies of children with Down syndrome indicate that the proportion of children classified in each type is similar to the proportions for typically developing children. For example, in a study of 12-36 month old infants with Down syndrome, 42% were classified as 'easy', 16% as difficult, 13% as 'slow to warm', and 29% as 'intermediate'.[26] This compares with a study of typically developing infants in which 38% were classified as 'easy', 12% as 'difficult', 6% as 'slow to warm' and 44% as 'intermediate'. [27]

These figures illustrate that the range of temperaments seen in the infants with Down syndrome was the same as the range seen in the typically developing children. The figures also illustrate the range of individual differences in the temperaments of the infants with Down syndrome, making clear that the stereotypes which suggest that all the children are the same are not supported by the evidence. This information also indicates that, like typically developing children, some children with Down syndrome will be more difficult to manage than others and that some will have more social difficulties than others, as a result of temperamental differences.

Some children and teenagers with Down syndrome, like other children, will have additional difficulties such as autism spectrum disorders (ASD), attention deficit hyperactivity disorders (ADHD), obsessional compulsive disorders (OCD), anxiety or depression, which should be diagnosed and treated appropriately. Any of these additional difficulties will affect their social functioning.

Language and cognitive abilities

Children's social development is influenced by their understanding of the world around them and the behaviour of others, therefore children with delayed cognitive (mental) development are likely to have more difficulty in becoming socially competent and in controlling or self-regulating their behaviour. They will be older before they understand the reason why certain behaviours may be dangerous for example.

Children's rate of progress with language development will also influence all aspects of their social development. As children's understanding of language develops, it is possible to reason with them and explain why certain behaviours are desirable and others are not (though this can also be effectively communicated in non-verbal ways, with actions and gestures, in most situations). As their language and communication skills develop, children experience less frustration and can explain how they feel or ask for what they want. In addition, in typical development, language is also important in self-regulation as children use silent or private speech to control their own behaviour and this also seems to be true for children and teenagers with Down syndrome.[28,29]

It is likely, therefore, that those children with Down syndrome who progress more slowly than most in language and cognitive development will be more at risk for behaviour and social difficulties and will be more demanding to manage for longer periods of time during childhood. For almost all children with Down syndrome, their social competence and behaviour steadily improves with increasing age.[4,5,18]

Family environments

All children are influenced by their experiences within their families and the relationships within families, the personalities and the interpersonal communication within families vary a great deal. Children need to feel loved, wanted and emotionally secure as well as having their basic needs for warmth, food and care met. Some families experience more difficulties than others in establishing a supportive emotional climate as well as good communication between members of the family. In these families, the task of bringing up children will be more difficult than in cohesive and emotionally stable families and children in these families are likely to have more social and behavioural difficulties and to do less well in school.

Some families have many more social disadvantages than others, such as unemployment, one parent coping alone, poor housing, or poverty. Parents who are disadvantaged in any of these ways will find parenting more difficult and their children will tend to be more at risk for developmental difficulties.

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The research indicates that these family differences have the same effects on the progress of children with Down syndrome as they do for other children.[15-18] In addition, some families find it more difficult to adapt to becoming parents of a child with a disability and the way that parents do adapt and make use of support systems outside the family influences the progress of their children with Down syndrome.[15-18]

Expectations and management

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Bringing up children is a difficult task and the progress of all children is influenced by the expectations in the family and by parents' management skills. All children respond to the social feedback that they receive about themselves, their behaviour and the way in which they are expected to behave. Parents have different expectations for the behaviour of a two year old compared with their expectations for the behaviour of a five year old. Parents vary in their requirements for good behaviour and in their ability to manage difficult behaviour. These variations in behaviour expectations and management skills influence the social development of children in all families.

When a child has a disability, it is often much more difficult for parents to know what expectations and demands for good behaviour are appropriate. Do they judge these on the basis of the child's developmental skills or on the child's chronological age? It is easy to 'baby' a child with a disability - that is, to treat them as if they are younger than they are - and the child may then behave in immature ways for longer than is necessary.

The delays in cognitive and language development experienced by most children with Down syndrome may make them more difficult to manage in some ways. Routines and quite clear behaviour expectations help the child to understand the rules more easily. [16] In other words, there may be less room for more flexible attitudes to behaviour and parents may benefit from support and guidelines on the need for good behaviour management from the first year of the child's life.

Teachers and other carers also need to be encouraged to expect and reward good behaviour. In preschool and school, children with Down syndrome should be expected to behave in socially age-appropriate ways and to conform to the school routines. In the authors' experience over many years, behaviour difficulties arising in school or in community settings are most often the result of inappropriate management.

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However, children with Down syndrome can be quite challenging, often in naughty ways, as they often see how far they can push the boundaries in a new situation. Some of these behaviours may be learning and exploratory behaviours. Children with Down syndrome often use their good understanding of the behaviour of others to get the reactions that they want, for example running away, which usually results in being chased, and a variety of other behaviours such as touching other children's work or making a noise in class to gain the teacher's attention.

For some children, behaviour is not easy to change and if a child is persistently difficult in school and at home, parents and teachers will have to work together to develop common strategies in order to change the behaviour.