Social and communicative functioning
John Oates, Kim Bard and Margaret Harris
It is widely acknowledged that the establishment of positive attachment relationships and communication with primary caregivers is an important outcome of social-emotional development in early childhood. Attachment security and communication abilities are also associated with key developmental achievements later in childhood, and indeed across the life-span. Research conducted with children with Down syndrome suggests that although differences in attention regulation and emotional responsivity may modify the developmental processes in some respects, the general patterns are similar to those in typically-developing children. It is known from research in this latter population that sensitivity and ‘mind-mindedness’ in caregiving are of key importance, as is the development of shared attentional focus. We argue that targeted research to identify the ways in which parents can most effectively support these core functions in the early development of children with Down syndrome should be a priority, as should involving parents as research partners in this endeavour.
Undoubtedly there are numerous research questions that remain unanswered regarding
the social and communicative abilities of infants, children and adults with Down
syndrome. For the purpose of this paper, which is to stimulate discussion regarding
urgent research priorities in these topic areas, we have chosen to consider the
idea of key questions from a developmental perspective. In part this is because
we believe that better understanding the development of these core abilities is
most likely to point to effective ways of supporting them. But also it is now much
clearer that the early stages of development, when brain functions are most plastic,
offer the best opportunities to overcome difficulties that may become much less
tractable if addressed later in development, when early difficulties in specific
areas may have subsequent wider-ranging effects on linked processes as the brain
becomes increasingly 'modularised' and specialised in function.
We have chosen to focus on a relatively high-level outcome of early development,
because this outcome, attachment to caregivers, is at the confluence of the many
components of social and communicative abilities. There is now solid evidence that
attachment security is a key achievement of the first year of life, and that it
represents the mutual effects of a range of environmental, genetic and constitutional
factors. It is of great significance for
subsequent development into later childhood and beyond, as evidenced by links into
emotional and cognitive development, and into the formation of later close relationships.
Thus it can be taken as a proxy for the many lines of early development that are
seen at more fractionated levels of analysis, encompassing attention, communication,
memory, executive functions, emotional sensitivity and expressiveness, along with
social skills and understandings such as mentalising capacities. It is also appropriate
to look at attachment in children with Down syndrome because of relative strengths
in social functioning. Indeed, strengths in
social domains differentiate Down syndrome from many other developmental disorders.
While there is general agreement that standard measures of attachment security,
notably Ainsworth's Strange Situation, can be carried out and meaningfully analysed
with children with Down syndrome, there have been concerns raised that the qualities
of attachment security and the form of organisation of attachment-related behaviours
that are seen in such measures may be different in children with Down syndrome. Thus the pathways to attachment may not necessarily
be equivalent to those for typically-developing children and, of equal importance,
the sequelae of attachment status may also be different for this population.
Research is currently uncovering more complex models of the development of attachment
in typically-developing populations than the simple environmentally-determined models
that have been current until recently, or the simple separate contributions models
for genes and environments. It is beginning
to be apparent that the pathways to attachment may involve more complex gene-environment
interactions, such that certain genotypes may work in one way in certain environments,
but in different ways in other environments[6,7].
At the same time, although the 'transmission gap' in attachment development (referring
to unexplained links in the intergenerational transmission of attachment) remains
to be filled, the caregiving conditions that favour secure attachment are becoming
more clearly defined. Also, the infant characteristics that interact with these
are also being delineated, for example aspects of temperament.
Again, though, it must be said that these new understandings are based almost entirely
on typically-developing populations, and it would be a mistake to extrapolate from
this body of research to development in Down syndrome without confirmatory evidence
from this target population.
Taking attachment security as a focus can also highlight those aspects of early
social communication that are especially important for psychological development,
hence offering the opportunity to investigate those components of caregiver behaviour
that are most likely to be worth supporting and enhancing.
These considerations suggest that longitudinal studies will offer particular promise
in clarifying the pathways in the development of children with Down syndrome that
are most amenable to positive intervention, and most likely to enhance developmental
It is important to recognise the significance of the individual developmental trajectories
followed by children with Down syndrome. It is a truism worth repeating that there
is at least as much variance within this population as there is within the typically-developing
population. Given the difficulties in recruiting large sample sizes in special populations,
we need to realise that treating our samples as homogeneous, and averaging data
in consequence, may not be the only and best way of analysing the research data
that we gather. Doing so may seriously compromise the identification of the unique
characteristics of each child's progress.
More value may be gained from a thoughtful mix of qualitative, idiographic approaches
with quantitative, nomothetic methods. We would like to highlight the importance,
within such a range of methods, of involving parents as research partners. Not only
do parents have ongoing regular experience with their children and hence they offer
opportunities for tapping into fine-grained and context-related aspects of their
children's development, but also parents may feel a benefit from involvement in
research and the positive nature of the enterprise.
Turning to psychological processes, attention and its regulation are increasingly
being seen as core components in early development, with implications across both
the cognitive and the social domains. Given the neuro-anatomical differences in
children with Down syndrome, specifically in the frontal cortical regions associated
with attention regulation and executive function that have been argued to affect
attention processes, clarifying the role of attention processes in early development
is a further potential research priority.
The use of brain-imaging techniques, along with other sensitive experimental methods,
is likely to prove fruitful here.
Moving up a level of analysis, the achievement of joint attention is a key outcome
of early development, with significance for social, communicative and cognitive
development. This process, which has been termed 'secondary intersubjectivity',
marks a progression from the dyadic relations established within the framework of
primary intersubjectivity, and makes possible the shared reference to external objects
and events that supports the social development of cognition. Studies of attention
in children with Down syndrome suggest that their ability to attend is in line with
their developmental level. However, children
with Down syndrome are less likely than typically developing (TD) children to protest
at maternal directivenessand they tend to
respond to direction by showing sustained attention.
This suggests that, as is the case for children who are born with severe/profound
hearing loss, the development of joint
attention in infants with Down syndrome may involve rather different dynamics from
those observed among typically developing children.
Because of the central role of joint attention, understanding the social processes
that support its emergence can be seen as an important research priority. This will
require fine-grained observational analysis of dyadic relations with children with
Down syndrome, again probably most fruitfully pursued within a longitudinal cohort
So far, this set of suggestions for further research has been concerned with early
development, with the key social processes of the first 1-2 yrs of life. However,
with the establishment of attachment, of joint attention (shared reference) and
the maturation of cortical functions associated with attention and executive functions,
in the succeeding stages of development, from 2-5 years of life, the development
of communication, social relations and cognitive growth play an important role,
especially in respect of preparation for participation in schooling.
Because the focus of this session in the conference is on social and communication
abilities, we must be mindful of the complementary role that the caregiver plays
in the development of these areas. The impact of the birth of a child with Down
syndrome into a family has effects on the parent(s) and any other siblings, and
more widely within any extended family.
The ways in which the primary caregiver(s), and other family members, respond to
the challenges faced depends in part on their own psychological characteristics
and in part on the specific profile of the individual child with Down syndrome.
In the early weeks and months after birth, dealing with medical issues is often
to the fore, along with adjustment to the birth. The complex interaction of these
factors and their effects on the emergent patterns of communication and caregiving
is deserving of further study, so that parents can be offered the most appropriate
support during this challenging period. Patterns of communication and care established
early on are important for the building of supportive relationships and the more
that can be known about how best to encourage these, the better.
Central in the endeavour to better understanding the development of these important
early relationships should be a recognition that attachment is not just a cognitive
process, but is essentially about emotional connectedness, about the sharing of
warmth, joy and affection, as well as supporting an infant's propensity to explore
the environment in positive ways. Attachment also serves to regulate distress, and
the sensitivity of caregivers to infant distress (which may be muted in some young
children with Down syndrome) should not be overlooked.
Finally, we would like to note that the importance for social learning of relations
beyond those with primary caregivers, such as relations with siblings and peers,
is increasingly being realised. The roles of emotional expression and sensitivity
to others' emotions in the development of empathy, and abilities to learn collaboratively
are worthy of more attention in the special context of children with Down syndrome.
With increasing concern around the risks of autism-like behaviours emerging in the
development of some children with Down syndrome, issues of relatedness with others
must surely be put high on the agenda for future research.
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John Oates is at the Centre for Childhood, Development and Learning, The Open University,
Kim Bard is at the Department of Psychology, University of Portsmouth, UK
Margaret Harris is at the Department of Psychology, Oxford Brookes University, UK
Correspondence to John Oates - e-mail:
Paper prepared from presentations and discussions at the Down Syndrome
Research Directions Symposium 2007, Portsmouth, UK. The symposium was
hosted by Down Syndrome Education International in association with the
Anna and John J Sie Foundation, Denver. Major sponsors also included the
Down Syndrome Foundation of Orange County, California and the National
Down Syndrome Society of the USA. Information about the symposium can be
Received: 4 October 2007; Accepted: 11 October 2007;
Published online: 2 July 2008
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RLI incorporates best practice in structured activities delivered in fast-paced daily teaching sessions. It was evaluated in a randomised controlled trial and found to improve rates of progress compared to ordinary teaching.
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