ABA Therapy

The following paper has been provided by Down Syndrome Education International www.downsed.org

Addressing challenging behaviour in children with Down syndrome: The use of applied behaviour analysis for assessment and intervention

By Kathleen M. Feeley and Emily A. Jones
C.W. Post Campus of Long Island University, USA

Abstract – Children with Down syndrome are at an increased risk for engaging in challenging behaviour that may be part of a behavioural phenotype characteristic of Down syndrome. The methodology of applied behaviour analysis has been demonstrated effective with a wide range of challenging behaviours, across various disabilities. Applications to children with Down syndrome and the examination of behaviourally based strategies to specifically address the unique characteristics of children with Down syndrome are limited. However, there are several studies in which a subset of the participants did have Down syndrome. A handful of these studies are reviewed within the context of functional behaviour assessment and Positive Behavioural Supports. Drawing from these studies and the behavioural literature, as well as the authors' clinical experience and research, suggestions regarding early intervention for challenging behaviour with children with Down syndrome are provided.

Keywords: applied behaviour analysis, functional behaviour assessment, Positive Behaviour Support,behavioural phenotype, proactive strategies, setting events, antecedent strategies, skill replacement, reinforcement systems, consequence strategies.

 Children with Down syndrome have a propensity to engage in behaviours that can be particularly problematic for family members and caregivers, as well as professionals who work with them. Such behaviour, referred to by Doss and Reichle (1991) as challenging behaviour, is defined as that which results "...in self-injury or injury of others, causes damage to the physical environment, interferes with the acquisition of new skills, and/or socially isolates the learner" (p. 215). The presence of challenging behaviour, along with characterisations such as "stubborn," have long been noted in the literature(Gibson, 1978). More recently, parent and teacher ratings indicate that children with Down syndrome show higher rates (than typically developing children) of attention problems, social withdrawal, noncompliance, and compulsions (such as arranging objects and repeating certain actions) (e.g., Coe et al., 1999; Evans & Gray, 2000) and high rates of self-talk (Glenn & Cunningham, 2000). Additionally, behaviours associated with anxiety, depression, and withdrawal, have been noted to increase with age (Dykens & Kasari, 1997).

There are specific physical characteristics of Down syndrome (e.g., those associated with sleep disorders) (Richdale, Francis, Gavidia-Payne & Cotton, 2000; Stores,1993) as well as a higher incidence of illness (Roizen, 1996) that may significantly impact the behavioural repertoires, including increasing the likelihood of challenging behaviour, in children with Down syndrome. Researchers have also demonstrated that challenging behaviour, particularly avoidance behaviour, appears consistently in very young infants with Down syndrome (Wishart, 1993a, 1993b). Specifically, when presented with task demands just slightly above their current level of ability, children with Down syndrome demonstrate a unique pattern of behaviour involving opting out of learning opportunities and misusing social behaviours. It appears that the presence of the extra chromosome associated with Down syndrome affects the likelihood of challenging behaviour beginning in infancy. In turn, these behaviours can have catastrophic effects; interfering with learning in children with Down syndrome, not only at the foundational level during infancy, but throughout life.

These characteristics that impact the behaviour repertoire reflect a unique pattern of strengths and weaknesses evident in individuals with Down syndrome and have been described as a distinct cluster of behaviours termed a behavioural phenotype. Dykens (1995) defined behavioural phenotype as "...the heightened probability or likelihood that peopl e with a given syndrome will exhibit certain behavioural and developmental sequela relative to those without the syndrome" (p. 523). This does not mean that all children with Down syndrome will demonstrate all of the characteristic behaviours; rather, there will be in an increased likelihood.

 Click here to read the full paper 326.31 Kb