Trainee teachers' attitudes to inclusive education for children with Down's syndrome

Functional Analysis of Contextually Inappropriate Social Behavior in Children With Down Syndrome

BACKGROUND

Children with Down syndrome often engage in contextually inappropriate social behavior, which researchers suggest may function to escape from difficult activities to preferred social interactions. Caregivers may reinforce the behavior, perceiving it only as evidence of the child's social strength, when, in fact, the pattern may also prevent or slow the development of critical skills. Unlike overt forms of challenging behavior, contextually inappropriate social behavior had never been subjected to experimental analysis.

AIMS

The purpose of the current study was to identify and demonstrate functional control of contextually inappropriate social behavior to caregiver-informed contingencies.

METHOD AND PROCEDURES

We interviewed caregivers and subjected contextually inappropriate social behavior to functional analyses for nine young children with Down syndrome.

OUTCOMES AND RESULTS

We found sensitivity to the caregiver-informed contingencies for all nine participants with strong functional control and large effect sizes for most.

CONCLUSIONS AND IMPLICATIONS

Caregivers may not perceive contextually inappropriate social behavior as problematic, yet patterns of contextually inappropriate and other problem behaviors suggest decreased engagement and poor task persistence. Assessments that lead to intervention decisions may be more informative when they include questions about social topographies of behavior not typically considered as problematic. Once caregivers are aware of the pattern, they may be better prepared to intervene.

Interventions for acceptance and inclusion of people with intellectual disability: A systematic review

BACKGROUND

The inclusion of people with intellectual disabilities is limited due to a high prevalence of prejudice towards this population. We reviewed studies to identify the most effective intervention methods that focus on acceptance of people with intellectual disabilities.

METHOD

A literature review was conducted using several databases-EBSCO, Web of Science, Google Scholar. The search resulted in 6728 articles, of which 26 met the inclusion criteria.

RESULTS

Studies were largely consistent in reporting positive changes after interventions. Although there is no obvious pattern to determine the efficacy of an, long interventions or those involving direct contact may have the most beneficial effects on the relationships between people with and those without intellectual disabilities.

CONCLUSION

The evidence suggests that several types of interventions impact the knowledge, change in the attitudes, behaviour and self-related constructs that lead to the acceptance of people with intellectual disability.

Non-invasive prenatal screening for trisomy 21: Consumers' perspectives

Non-invasive prenatal screening (NIPS) has the potential to dramatically increase the prenatal detection rate of Down syndrome because of improvements in safety and accuracy over existing tests. There is concern that NIPS could lead to more negative attitudes towards Down syndrome and less support for individuals with Down syndrome. To assess the impact of NIPS on support for prenatal testing, decision-making about testing, and beliefs or attitudes about Down syndrome, we performed an Internet-based experiment using adults (N = 1,789) recruited through Amazon Mechanical Turk. Participants were randomly assigned to read a mock news article about NIPS, a mock news article about amniocentesis, or no article. The content in the two articles varied only in their descriptions of the test characteristics. Participants then answered questions about their support for testing, hypothetical testing decision, and beliefs and attitudes about Down syndrome. Reading the mock NIPS news article predicted increased hypothetical test uptake. In addition, the NIPS article group also agreed more strongly that pregnant women, in general, should utilize prenatal testing. We also found that the more strongly participants supported prenatal testing for pregnant women, the less favorable their attitudes towards individuals with Down syndrome; providing some evidence that NIPS may indirectly result in more negative perceptions of individuals with this diagnosis.

Interventions aimed at increasing knowledge and improving attitudes towards people with intellectual disabilities among lay people

Despite policies aimed at ensuring equal rights and maximising respect and social inclusion for people with intellectual disabilities, in their daily lives many continue to face negative attitudes and discrimination within society. Misconceptions about what it means to have an intellectual disability and about the capabilities of people with intellectual disabilities appear widespread, and may contribute to prejudice and discrimination. This review provides a summary and evaluation of empirical interventions aimed at increasing knowledge and targeting negative attitudes towards this population among lay people of working age. An electronic search using PsycINFO, Web of Science and PubMed identified 22 English language studies published between 1990 and early 2014 that reported a specific intervention with a lay population sample. The majority of studies reported promising outcomes, particularly those aimed at increasing knowledge of intellectual disability through education. Support for the positive influence of contact with people with intellectual disabilities was demonstrated across several interventions. Interventions delivered at least partly by individuals with intellectual disabilities, and educational interventions appear to hold the most promise. The evidence is limited though by the weaknesses of measurement tools employed.

Tracking subtle stereotypes of children with trisomy 21: from facial-feature-based to implicit stereotyping

BACKGROUND

Stigmatization is one of the greatest obstacles to the successful integration of people with Trisomy 21 (T21 or Down syndrome), the most frequent genetic disorder associated with intellectual disability. Research on attitudes and stereotypes toward these people still focuses on explicit measures subjected to social-desirability biases, and neglects how variability in facial stigmata influences attitudes and stereotyping.

METHODOLOGY/PRINCIPAL FINDINGS

The participants were 165 adults including 55 young adult students, 55 non-student adults, and 55 professional caregivers working with intellectually disabled persons. They were faced with implicit association tests (IAT), a well-known technique whereby response latency is used to capture the relative strength with which some groups of people--here photographed faces of typically developing children and children with T21--are automatically (without conscious awareness) associated with positive versus negative attributes in memory. Each participant also rated the same photographed faces (consciously accessible evaluations). We provide the first evidence that the positive bias typically found in explicit judgments of children with T21 is smaller for those whose facial features are highly characteristic of this disorder, compared to their counterparts with less distinctive features and to typically developing children. We also show that this bias can coexist with negative evaluations at the implicit level (with large effect sizes), even among professional caregivers.

CONCLUSION

These findings support recent models of feature-based stereotyping, and more importantly show how crucial it is to go beyond explicit evaluations to estimate the true extent of stigmatization of intellectually disabled people.

Neurological phenotypes for Down syndrome across the life span

This chapter reviews the neurological phenotype of Down syndrome (DS) in early development, childhood, and aging. Neuroanatomic abnormalities in DS are manifested as aberrations in gross brain structure as well as characteristic microdysgenetic changes. As the result of these morphological abnormalities, brain circuitry is impaired. While an intellectual disability is ubiquitous in DS, there is a wide range of variation in cognitive performance and a growing understanding between aberrant brain circuitry and the cognitive phenotype. Hypotonia is most marked at birth, affecting gait and ligamentous laxity. Seizures are bimodal in presentation with infantile spasms common in infancy and generalized seizures associated with cognitive decline observed in later years. While all individuals have the characteristic neuropathology of Alzheimer's disease (AD) by age 40 years, the prevalence of dementia is not universal. The tendency to develop AD is related, in part, to several genes on chromosome 21 that are overexpressed in DS. Intraneuronal accumulation of β-amyloid appears to trigger a cascade of neurodegeneration resulting in the neuropathological and clinical manifestations of dementia. Functional brain imaging has elucidated the temporal sequence of amyloid deposition and glucose metabolic rate in the development of dementia in DS. Mitochondrial abnormalities contribute to oxidative stress which is part of AD pathogenesis in DS as well as AD in the general population. A variety of medical comorbidities threaten cognitive performance including sleep apnea, abnormalities in thyroid metabolism, and behavioral disturbances. Mouse models for DS are providing a platform for the formulation of clinical trials with intervention targeted to synaptic plasticity, brain biochemistry, and morphological brain alterations.

Public awareness, attitudes and beliefs regarding intellectual disability: a systematic review

The general public's responses to people with intellectual disabilities influence the likely success or failure of policies aimed at increasing their social inclusion. The present paper provides a review of general population based research into awareness, attitudes and beliefs regarding intellectual disability published in English between 1990 and mid-2011. An electronic search using PsycINFO and Web of Science plus a hand search of the literature was completed. Most of the 75 studies identified consisted of descriptive surveys of attitudes. They tend to conclude that age, educational attainment and prior contact with someone with an intellectual disability predict attitudes, while the effect of gender is inconsistent. Eight studies examined lay knowledge about intellectual disability and beliefs about its causation in a range of cultural contexts. The impact of interventions designed to improve attitudes or awareness was examined by 12 studies. The evidence is limited by the fact that it is mostly based on relatively small unrepresentative samples and cross-sectional designs. It is concluded that overall, high quality research into general population attitudes to intellectual disability is limited. Public knowledge of intellectual disability and causal beliefs are particularly under-researched areas. There is a notable absence of well designed evaluations of efforts to reduce misconceptions about intellectual disability and tackle negative attitudes. Areas for future research are noted, including the need for well designed studies that consider awareness, attitudes and beliefs in relation to stigma theory.

Social cognition in children with Down's syndrome: challenges to research and theory building

Characterising how socio-cognitive abilities develop has been crucial to understanding the wider development of typically developing children. It is equally central to understanding developmental pathways in children with intellectual disabilities such as Down's syndrome. While the process of acquisition of socio-cognitive abilities in typical development and in autism has received considerable attention, socio-cognitive development in Down's syndrome has received far less scrutiny. Initial work in the 1970s and 1980s provided important insights into the emergence of socio-cognitive abilities in the children's early years, and recently there has been a marked revival of interest in this area, with research focusing both on a broader range of abilities and on a wider age range. This annotation reviews some of these more recent findings, identifies outstanding gaps in current understanding, and stresses the importance of the development of theory in advancing research and knowledge in this field. Barriers to theory building are discussed and the potential utility of adopting a transactional approach to theory building illustrated with reference to a model of early socio-cognitive development in Down's syndrome. The need for a more extensive model of social cognition is emphasised, as is the need for larger-scale, finer-grained, longitudinal work which recognises the within-individual and within-group variability which characterises this population. The value of drawing on new technologies and of adapting innovative research paradigms from other areas of typical and atypical child psychology is also highlighted.

Socio-cognitive understanding: a strength or weakness in Down's syndrome?

BACKGROUND

Social understanding is often thought to be relatively 'protected' in children with Down's syndrome (DS) and to underlie the outgoing personality characteristically attributed to them. This paper draws together findings from our studies of behaviours during object concept testing, generally considered a theoretically 'pure' measure of early cognitive ability, and from more recent work focusing on two key socio-cognitive skills: recognising facial expressions of emotion and collaborative learning. Age range of children studied was 4 months to 18 years.

METHODS

Using standardised hiding tasks, object concept ability was assessed cross-sectionally and longitudinally in children with DS and in age- or stage-matched typically developing (TD) children. Stability of cognitive advances was assessed and similarities/differences in developmental pathways explored. In the emotion recognition studies, the ability to distinguish six primary emotions was measured, with performance compared with that of developmentally-matched TD children and age-matched children with intellectual disabilities of similar severity but differing aetiology [non-specific intellectual disability (NSID) or fragile X syndrome (FXS)]. In the collaborative learning study, the impact on sorting skills of working with a peer on a conceptually related task was measured, with outcomes compared in DS, NSID and TD child pairings.

RESULTS

Evidence of counterproductive, socially-based strategies being inappropriately applied by children with DS in learning contexts was found in both the object concept and collaborative learning studies, along with inefficient use of current cognitive and linguistic abilities. Emotion recognition weaknesses were also identified, although deficits were relative rather than absolute and individual variability was marked.

CONCLUSIONS

In line with emerging evidence from other research teams, findings suggest possible difficulties in some core aspects of interpersonal functioning in DS, with both qualitative and quantitative differences in how social cognition develops and is applied in learning contexts. Implications for development and for behavioural phenotype theory are briefly discussed.