Setting Up for Success

By Riley Rosebush RSLP and Jillian Baldwin RSLP, with Glen Hoos

Reprinted from 3.21: Canada’s Down Syndrome Magazine (Issue #16: Back to School). Click here to download the full magazine.

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Everyone agrees that an inclusive approach to educating students with Down syndrome is ideal. But what does it look like in practice?

Inclusion means exactly what it sounds like: including students in all aspects and activities related to school life. Part of our job as educators is to identify and remove barriers to full participation for all students, including those with Down syndrome.

When a student has a disability, they may experience restrictions (seen and unseen) that limit them from participating in certain situations. Here, we present strategies to help you identify and mitigate those factors at both the individual student level and the classroom level. Success in school can look different for everyone, but supporting students to be fully included can help everyone achieve their personal goals throughout their school career.

When designing an inclusion plan, the goal is to remove barriers to learning and respond to each student’s unique needs. This requires understanding each student on an individual level. To learn more about your student’s strengths and needs, we recommend communicating with their caregivers and community support team, including their speech and language pathologist (SLP), occupational therapist, physical therapist, behaviour consultant, and any other professionals who might have information about the student’s learning and developmental needs. It’s a team effort!

Below are some of the most important factors to consider.

Health Issues

Health issues and complications can limit one’s ability to attend to what’s around them, participate in learning activities, and gain life experiences. Simply put, when a student doesn’t feel well, they have less energy to pay attention and take part. Even one poor night’s sleep can significantly deplete their resources for the day.

Keep in mind that individuals with Down syndrome tend to have more health issues, but also have a harder time identifying and expressing internal feelings, such as pain and sickness. This means that communicating with caregivers and keeping an eye on a student’s health symptoms is essential. They might not be able to tell you when something is wrong.

Health-related factors that can greatly influence a child’s day-to-day success include:

• Sleep: People with Down syndrome are more likely to experience sleep disturbances, such as obstructive sleep apnea that can affect mood, memory, and attention.
• Nutrition: People with Down syndrome are more likely to have gastrointestinal issues, allergies, and sensitivities, or other issues with eating and drinking that impact the quality of nutrition and hydration they receive.
• Physical Activity: Low muscle tone makes it easier for students to fatigue during activities. Too much or too little physical activity can impact a student’s readiness to learn and join in. Most students with Down syndrome benefit from movement breaks and rest periods throughout the day.
• Mood: Like all of us, students with Down syndrome are susceptible to mood changes. However, they may have fewer strategies and communication skills with which to appropriately express their feelings. Mental health issues such as anxiety can also affect people with Down syndrome, but may be expressed and perceived differently than in neurotypical people.
• Differences in Motivation: Research suggests that some people with Down syndrome have an overall lower level of internal or intrinsic motivation to take on challenging tasks. This means they are less likely to want to do something ‘just because’ everyone else is doing it. This is especially true for new, more difficult, or less preferred activities. We need to consider how we can make the activity more motivating, perhaps by adding some rewards, changing the level of challenge, or incorporating their preferences and interests. Ask and consider what the student does find motivating, and focus on their personal strengths to help them learn in a way that’s meaningful to them.

Perceptual and Sensory Skills

Individuals with Down syndrome may also have perceptual or sensory challenges which cause difficulty taking in, tolerating, processing, and interpreting what they see, hear, smell, and feel. Students may exhibit certain behaviours to try to calm themselves and make sense of their environment. These behaviours are often their way of staying regulated in a world that can be overwhelming.

People with Down syndrome can often remember and understand things better if they can see them, rather than just hear them. This is because visual processing tends to be a relative strength compared to auditory, or sound, processing. Consequently, adding visuals can support memory and learning.

Hearing impairment is very common among people with Down syndrome, and families are encouraged to have a hearing and ear health check done at least once a year. If a student has difficulty with hearing, they may react less or more intensely to sounds than other children, and may have additional difficulty developing clear speech, paying attention, and understanding what is said.

Fine and Gross Motor Skills

We also must keep in mind a student’s gross and fine motor skills, which are likely to be delayed in Down syndrome. Low muscle tone, lax joints, and sensory differences all contribute to motor learning difficulties. Movement difficulties can be a major restriction in participating in school activities, such as walking from classroom to classroom, writing their name, or opening their lunch kit independently. And if you really think about it, activities with motor demands are presented to a student constantly throughout the school day. Sometimes it might look like a student is refusing to do an activity, but the activity is really too difficult within the time constraints at hand. We need to recognize where motor challenges are limiting a student’s ability to participate, and see if we can add supports or modify the task accordingly.

Cognitive Skills

Cognitive skills enable us to process, analyze, and understand information. Some of these skills that tend to be relatively weaker in Down syndrome include:

• attention processes
• remembering the words you hear and want to use
• reasoning and problem-solving
• abstract thinking
• sequencing and organizing information
• generalizing skills to new situations

These skills may be required at any given moment in the classroom. For example, students are often expected to pay attention and carry out a teacher’s instructions. Imagine a student given instructions to, “Take off your coat and shoes, put them in your locker, and then find your seat and get out your homework.” Instead, the student goes to the art area and appears to ignore her teacher.

Ignoring or refusing is one interpretation of the behaviour, but think about how we could modify our instructions if we took one of these interpretations instead:

• Perhaps the student’s reduced attention span made her easily distracted by the vibrant art area.
• Perhaps her verbal short-term memory and limited vocabulary led her to forget the multi-step instructions after hearing  them.
• Maybe she was unable to sequence and organize the task, so initiating and carrying out an appropriate response was overwhelming.
• Or, a combination of the above factors impeded her response, but the student did not have the communication or problem-solving skills to tell her teacher she needed help.

Communication Skills

It’s important to consider the student’s level of both understanding and expressing words, symbols, and full messages. Keep in mind that individuals with Down syndrome tend to understand more than they are able to express – so, do not underestimate their understanding, but also do not assume they understand everything you say, either. We’ll have much more to say below about supporting the student’s communication.

As educators, we need to be aware of opportunities to include students as fully as possible, but also be sensitive to challenging demands that can tax our students’ abilities. Each student has finite resources that can be depleted by individual and environmental demands. For each task, consider: what is the ultimate goal, and how can I preserve the student’s resources in other areas? Now let’s think about the external or environmental factors in the classroom. Proactively modifying environmental factors can help students learn and more fully take part in the classroom.

Below are four tactics to establish a classroom conducive to the success of all students.

Create a Sensory-Friendly Environment

When it comes to sensory and perceptual challenges in the environment, we want to address anything that can inhibit a student’s ability to focus and learn. This can include:

• reducing visual distractions (e.g., clutter, movement)
• reducing auditory distractions (e.g., people talking, chairs scraping the floor, clocks ticking)
• mitigating aversive tactile stimulation (e.g., itchy clothing tags)
• being attentive to vestibular or proprioceptive input needs (e.g., adding heavy work or movement breaks to calm or alert the sensory system)
• including listening equipment such as F.M. systems when needed
• considering preferential seating needs as required

Consult with your student’s occupational therapist, hearing resource teacher, or other professionals to find out more about their sensory processing needs, and to strategize ways to make the classroom environment a more sensory-friendly place.

Implement Appropriate Program Modifications

Program modifications are usually determined when developing your student’s individualized education plan (IEP). IEP meetings should involve parents, resource teachers or learning support teachers, classroom teachers, educational assistants, and specialists who know the student well.

Program modifications should enable the student to learn and be successful in school activities, while also keeping in mind the development of skills that are important for friendship, future employability, and independence.

Utilize Adaptive Equipment

Occupational therapists, physical therapists, and SLPs can help determine what kind of adaptive equipment your student needs to do their best in school. Equipment can support a variety of skills that tend to be challenging to individuals with Down syndrome. For example:

• Perceptual Skills: Equipment could include eyeglasses or enlarged text for vision issues, or hearing aids and FM systems for hearing issues.
• Sensory Skills: Ball chairs, weighted items, swings, and so on, can provide appropriate sensory input that will increase or decrease activity level as needed.
• Motor Skills: Items for fine motor tasks (e.g., pencil grips and supportive seating), and for gross motor tasks (e.g., specialized playground equipment) can ease demands on a student’s finite capacity so that more resources are available to tackle a job. For example, if students don’t have to spend energy trying to support their posture and sit upright, they’ll have more energy left for tasks like talking, writing, and eating.
• Cognitive and Communication Skills: Low and high technology options, from visuals of the day’s schedule to the use of electronic communication devices, can build predictability, support understanding, and encourage expression throughout the day.

Let’s further explore the use of visuals. You may think a student no longer needs visuals once they are talking. However, visuals can further enrich a student’s expression of their ideas, as well as support their ability to understand and remember incoming information. Keep in mind that students with Down syndrome tend to have relatively weaker memory for what they hear, so we can capitalize on the relative strength of their visual processing skills to support what we say to them. Plus, we all use visuals every day to learn and remember things, from diagrams and written notes, to our cell phones and planners!

Visuals include anything the student can see that is meaningful and supports understanding, such as:

• demonstrations and videos
• objects
• photos
• picture symbols or drawings
• writing

Visuals, however, are not one size fits all. We must consider a student’s ability to see and make sense of items when deciding how big/small, complex/simple, and abstract/concrete materials must be.

As tasks or lessons become more advanced, you might start to incorporate more complex visual learning tools, such as peer or video modeling, social scripting, and social stories. If these tools are new to you, speak with a colleague or SLP who has training and experience in implementing these strategies.

When you create and use visuals for your students with Down syndrome, you may find that they are useful for the whole class! First-then boards, choice boards, visual schedules, and task breakdowns can make your classroom run more smoothly for all learners.

Some students have augmentative and alternative communication (AAC) as part of their support plan. Higher-tech AAC devices can support a student’s expression if their speech is difficult to understand or if they struggle to remember words and build sentences. This can reduce current frustration while continuing progress in overall communication, language and concept development.

You might have seen students with an iPad equipped with a communication app such as Touch Chat, LAMP, Proloquo2Go, or a PODD system. Use it! Request brief training from your school’s SLP, and then give it a shot with your student. Find out who is in charge of programming the vocabulary and suggest adding key words or concepts to facilitate class participation. Your input and ideas about what language is relevant in the classroom is vital to implementing practical communication supports.

The most common augmentative communication system for children with Down syndrome is a total communication approach. Total communication combines all communication methods at a student’s disposal. Use speech, sign language, gestures, pictures, or technology, depending on what supports communication in a given situation. This can help students to express their ideas more clearly and efficiently. As speech develops and children learn new spoken words, speech may gradually overtake sign language or AAC, or people may use their AAC to repair communication breakdowns, support literacy growth, or express more complex ideas than they might be able to verbally. Students with communication impairments deserve to access a communication method that works for them now, so we recommend not waiting to introduce AAC if your student is struggling to communicate clearly.

Provide Personal Support

Teachers, educational assistants, therapists, and peers who interact with students with Down syndrome all have an important role to play in facilitating communication. Below are some helpful guidelines to optimize exchanges with the student.

Supporting Comprehension

Communicate in ways that facilitate the student’s comprehension. The following strategies are based on the relative challenges more commonly seen in Down syndrome with regards to attention, verbal short-term memory, abstract thinking, and organization:

• Keep your sentences short and simple, delivering one key piece of information at a time. Emphasize key words with your voice too.
• Speak at a slower pace – but keep it natural.
• Use concrete, specific words.
• Augment what you say with visual supports, demonstrations, and hands-on activities.
• Repeat, repeat, repeat! Pre-teach new concepts, repeat key points often, and review regularly.

Monitor your student to determine whether you need to adjust your delivery style. The student likely understood what you said if they respond meaningfully, accurately, and consistently to similar directions or requests. Responding incorrectly, repeating the last thing you said, smiling and nodding, or ignoring you are signs that your message didn’t go through, and you need to adjust your delivery.

Supporting Expression

We also need to help our students express their needs and ideas in the classroom. The following ideas may help:

• The #1 tip is to WAIT! Give time for students with Down syndrome to process their responses. Challenge yourself to count to ten before talking again, and encourage classmates and other staff to do the same.
• When a student doesn’t answer your question right away, it can be tempting to ask it again, or shower them with more questions. Think about only asking questions your student can answer, and keep in mind that some types of questions are easier than others. For example, when and why questions tend to be more abstract than concrete who, what, and where questions. The easiest type of question to answer is a choice question; students just need to recognize and repeat their choice using the words you just modeled.
• If the student makes errors in their sentences, simply repeat their sentence with emphasis on corrections – you are modeling the correct way to say it, but not forcing them to repeat you.
• If there is a routine activity that involves using similar words or phrases every time, such as show and tell or calendar, consider providing visual supports to help your student express more complete ideas. You might write down a sentence or a script (with or without picture symbols) to remind them of what to say when it’s their turn.
• Finally, it is very important to positively reinforce any attempts to communicate and take part meaningfully. Reward effort, not accuracy, with attention and praise, and acknowledge and follow through on requests when possible.

Sometimes you may struggle to understand your student’s speech. We must appreciate how frustrating this can be for the student with Down syndrome. Show that you feel relaxed, interested in what they are saying, and will try to work with them to figure it out.

You will learn which strategies work best for your individual student to repair unintelligible words. Try politely asking the student to:

• slowly repeat their message
• show you or take you to what they mean
• tell you the first sound or letter
• try another mode, such as AAC, sign language, gesture, or writing
• answer a yes/no question or choice question to narrow down the topic

If all else fails, respectfully ask if they want to try again later and consider asking someone who might have more context clues to share. Make sure to honour that agreement!

Supporting Social Communication

Social communication, or pragmatics, involves the many nuanced skills required to keep up a conversation, such as making eye contact, reading body language, taking turns talking, maintaining a topic, and asking partner-directed questions. While these unspoken rules tend to be absorbed automatically, students with Down syndrome likely need us to teach these hidden rules explicitly and clearly.

Pragmatics are one of the most important aspects of communication for success in school and with peers. Even if a student has limited expressive language, strong social communication can help students with important social skills such as taking turns, waiting in line, sharing toys, greeting friends and staff, and expressing interest in other people. As children grow from elementary school to adulthood, pragmatics are the skills that evolve into the characteristics you want to see in a good employee, friend, or partner.

School personnel are in a particularly good position to teach and reinforce pragmatic skills; compared to parents, you get to see children in a rich social environment and support daily interaction with classmates and staff. Effectively teaching and supporting positive social skills is one of the most important things you can do for a child in your school.

You can do this through:

• Modeling: Show exactly what to do in a given situation.
• Scripts: Create scripts for common interactions to teach the student what they can say and do.
• Role Play: Practice and rehearse scripts in advance.
• Visuals: Include visuals of rules and scripts to support the student’s understanding, learning, and memory.
• Prompting: Cue the student to use the skills they have practiced in the appropriate moment.
• Feedback: Provide specific feedback immediately after the student’s attempt; focus on what they did well to increase the chances they will do it again in the future.

By understanding our students on an individual basis and designing a classroom environment that plays to their strengths and supports them through challenges, we set our students up for success – this school year and far beyond!

This article is adapted from the video Supporting Individuals in the Classroom: