In David Stein’s Supporting Positive Behavior in Children and Teens with Down Syndrome, he explores behavior management approaches that work best with the Down Syndrome population. To begin, here are the functional strengths and limitations of individuals with Down Syndrome. These understandings should guide treatment interventions.
STRENGTHS
Social responsiveness (noticing tone of voice and attention directed their way)
Visual learning (posters, social stories, etc.. with them as the subject)
Receptive language (comprehension of spoken words)
Learning through repetition and routine
LIMITATIONS
Executive functioning
Expressive language/ syntax (articulately expressing thoughts/opinions through well formed sentences)
Common behavioral problems that children or teens with Down Syndrome might demonstrate include task refusal, running/bolting, physical aggression, stimming behaviors, rigidity, and problems understanding boundaries. Providers can target undesirable or unsafe behaviors proactively by setting up systems that limit the opportunity for behaviors to occur, or responsively by intervening once the behavior occurs.
PROACTIVE MANAGEMENT STRATEGIES
Rewards systems (token economies)
Visual schedules (“If/Then” or “First/Then” posters)
EX– “IF *insert picture of client at school* Monday-Friday, THEN *insert picture of family playing client’s favorite game together*”
Social stories
Keep them simple; the client should be able to explain the story to you
Immediate reinforcement for positive behaviors
EX– Attention, validation, encouragement, and LOTS of charismatic emotionality
Proactive management strategies produce the best probability of curbing undesirable and unsafe behaviors. If you know a behavior of concern (for example, bolting) you can proactively change the environment to minimize bolting opportunities (for example, by using door locks only reachable by adults, putting alarms on your doors and windows, and placing visual aid posters on the doors).
Be mindful of building positive behavioral momentum. If you notice the good behaviors and validate them regularly, then your child/adolescent is more likely to follow behavioral directives that come next because they are feeling good about themselves!
REACTIVE MANAGEMENT STRATEGIES
Ignore bothersome, but not unsafe behaviors
Redirect the individual to a positive and preferred behavior
Intervene on unsafe and highly undesirable behaviors
Drain your emotions
Use short directives (EX– “No hit.”) – Keep your voice calm
Redirect the individual to a positive and preferred behavior
If you know that you will soon be encountering an unfamiliar situation or environment (for example, going to the dentist), you can be proactive by making a social story with pictures, a few words, and rewards written in. Keep your social stories simple; the person reading it should be able to explain it to you. Read them together, often, before the event. Example below:
Working with this population can be extraordinarily rewarding and heart warming! This group of individuals are generally easy-going, eager to please, charismatic, insightful, and cheerful. These individuals are fiercely loyal and will THRIVE working with a mentor that they feel bonded with. If given patience and understanding, these clients will offer unique insights that create a very special and rewarding working relationship.