to the Developmental Medicine Center at Children’s Hospital Boston, “One in ten
children has behavioral problems that are serious enough to be diagnosed by a
professional…One in three children with Down Syndrome has behavior problems
that are serious enough to be diagnosed by a professional.” Diagnosed behavior problems are much more
common in children with Down Syndrome. There are also children with Down Syndrome
whose actions cause issues for their family but are not serious enough to be
diagnosed. Managing the troubles these children face can be challenging. The
discipline process begins with identifying common behavior concerns. Down
syndrome individuals share many of the same behavior concerns that typically
developed children also face. There is, too, a list of reasons Down Syndrome
children may face these issues. For example, trouble relating well with other
children and adults, trouble controlling impulses, trouble communicating, and
trouble dealing with frustration (CHB). These troubles coupled with triggers
and reinforcing factors make behavior issues especially more common. By
understanding the underlying cause of many of the actions of children with Down
Syndrome, one can appropriately apply disciplinary action. Undesired behavior
in children with Down Syndrome can be managed by understanding common behaviors
and triggers, following the discipline process, and encouraging positive
Sometimes the behavior of a child with Down Syndrome may be quite
difficult for parents and supervising adults to manage. Understanding the
necessity for structure and positive discipline is crucial for success. One
must also remember that this child is developmentally delayed and will struggle
more with discipline than the typical child. Down Syndrome effects everyone
differently, so each child’s needs should be met appropriately.
step to understanding the concerning behavior of a child is to evaluate the
child as a whole. Chronic or acute medical problems can be an underlying cause
for these behavior changes. Examples of medical problems that may be associated
with this conduct are issues such as: anemia, sleep apnea, constipation, vision
or hearing deficits, Thyroid function, celiac disease, gastroesophageal reflux,
depression, anxiety, etc. (Patterson). An important component of the initial
work-up for behavior problems in children with Down Syndrome begins with an
evaluation by the child’s primary care physician.
typically developing child’s behavior concerns are usually not that different
from those seen with Down Syndrome. Although they have very similar actions,
they may last longer and occur at different ages. An example of this would be the
way a two or three-year-old throws a temper tantrum, compared to a child with
Down Syndrome, which may begin around age three or four (CHB).Children with
Down Syndrome need to be understood in context of their developmental age
rather than their chronological age. Expressive and receptive language skills
also need to be considered. Many issues can be related to frustration in
communication. By finding ways to help the individual communicate more
effectively, some of these behaviors can be corrected.
From the earliest interaction with a child
who has Down Syndrome, one must focus on positive reinforcement. Children with
these special needs respond well to encouragement and positive discipline
rather than scolding and physical action (Philadelphia). These negative ways of
control are damaging to the child and present no advancement in managing their
behavior. Approaching the situation with a positive attitude, minimal anger,
and patience is key to consistently encouraging the child to behave in an acceptable
manner. An angry outburst from an authority figure is likely to upset the child
even further, which is difficult to control.
is a form of communication. A child’s behavior, even the worst, can send a
message that he or she may not have a skill needed, is physically
uncomfortable, frustrated, or countless other messages. One should also
consider emotional stress factors at home or in school that may have an
indirect impact on his or her reaction. It is crucial to recognize reinforcing
factors and triggers that cause an undesired behavior from the child.
Remembering that behavior is a message of an underlying cause can help manage
the problem and prevent future episodes from occurring.
discipline includes providing nurturance while also maintaining structure.
Nurturance fuels the child’s mental and emotional health by practicing love and
acceptance. Structure defines the rules, routines, and consequences set for the
child’s behavior to guide his or her growth. Balancing the two will set a
foundation for the child to grow into a caring, competent, responsible adult.
When the child is misbehaving, try to intervene early in the process while one
can still practice positivity and patience rather than letting their own
emotions and frustrations get in the way of proper discipline.
By thinking ahead, monitoring the child and
supervising his or her environment, many undesired outbursts can be prevented.
One approach to plan for upcoming difficult events is called Social Stories (Swiezy).
By using picture books that sometimes contain words, a child with Down Syndrome
can become more familiar with what will happen in a future event. These Social
Stories help with difficult situations such as blood drawing, a birthday party,
or a vacation where the child may feel overwhelmed by the environment.
giving directions, it is best to have a distraction-free environment. Ask the
child to step away from his or her toys and the television to ensure the
instructions are understood. It is best to practice speaking in a firm, yet
positive voice and maintaining eye contact when giving instructions. Children
with Down Syndrome often struggle with language (CHB). If your speech is more
complicated, the child is less likely to follow through with your request.
Directions should be simple, clear, and contain as few steps as possible. For
example, try, “Brush your teeth, please.” instead of, “Please go upstairs to
brush your teeth before you go to bed.” Speaking with a Speech-Language
Pathologist or a private provider for other options such as sign language or a
picture exchange system may benefit certain children with special needs.
with Down Syndrome tend to rely on positive contact with others to maintain
good behavior (Swiezy). It is important to have positive, fun interactions with
the child even when events take a turn for the worst. Try to spend quality time
each day doing activities such as playing a game, reading a favorite book,
drawing, or even cooking something fun. This will help maintain positive vibes
in the environment, encouraging desirable behavior. Parents and siblings can
also help encourage the child by setting an example. Model behavior works very
well for children with Down Syndrome (Patterson). For example, siblings can
specifically ask permission before going out the door or leaving an area. This
can help prevent the child’s impulse to run off by knowing he or she must ask
permission before leaving. Encouraging siblings to set examples of desirable
behavior is an excellent strategy to begin managing performance.
desirable behavior is established, a parent or supervising adult must continue
to track compliance. If the child seems to be making progress, be sure to
reward success. This could be anything from buying a new book or a day at the
park. Along with rewards, one must also remember to establish consequences.
When the child is behaving in an unacceptable manner, discipline him or her
with the appropriate action. Behaviors can change quickly, but assuring they
stay appropriate requires consistency.
children with Down Syndrome are different than the typically developed child.
Therefore, their needs are also different and must be addressed properly. By
understanding common behaviors and triggers, following the discipline process,
and encouraging positive behavior one can manage these undesired behaviors. The
key to beginning to control this poor performance is understanding the child
and the factors that trigger these behaviors. Once one can identify specific behaviors
and their causes, he or she can properly discipline the child. Positive
discipline is one of the necessary components to changing behaviors. Behavior
can change quickly but applying consistency will help assure they remain
corrected in the future. Providing nurturance while also maintaining structure
to a child with Down Syndrome will help he or she grow into a caring,
competent, responsible adult.