Review of Related Literature

Down syndrome (DS) is a genetic cause of intellectual disability resulting from the presence of a

third copy of chromosome 21. One of the associated cognitive changes in DS is altered memory

function. For example, many studies have found that although visuospatial working memory is

appropriate in relation to children’s mental age, verbal working memory is delayed, especially at

higher cognitive load levels (Lanfranchi et al., 2012). One of the most fundamental forms of

memory for day‐to‐day living is episodic memory, or children’s ability to recall specific life

episodes and the unique timing, place, and linked features of these memories. Episodic memory can

be a difficult memory domain to assess, especially in a population with impaired verbal abilities.

One task that has been used successfully to assess episodic memory in typical infants and toddlers,

as well as atypically developing individuals, is deferred imitation (Milojevich & Lukowski, 2016).1

According to the Edgin, J., et. al (2019) in their article "Differences in Memory Function across Age

in Down Syndrome" suggest that the function of episodic memory changes with age in people with

Down Syndrome (DS). In the young group of individuals with DS repeating information is

beneficial for people them and more likely to result in learning. While adults had higher levels of

floor performance at delay—suggesting memory is impaired overall—but when these individuals

did recall temporal order of actions this occurred most frequently in the condition with only two

exposures and a rest period. The finding that correlations with additional measures were overlapping

and that all episodic memory conditions were associated in the adult group suggests that cognition

becomes more uniform with age in DS. The uneven nature of cognition is more obvious in the

younger group, where the memory measures were inter‐correlated in adults. The results suggest

different patterns of memory performance in younger and older individuals with Down syndrome,

leading to some learning modifications which might support teaching strategies for new material. 1
But according to Dr. Ulrika Wester Oxelgren and Prof. Elisabeth Fernell (2019) in their article

"Intellectual disability in Down syndrome," discussed that the intellectual level was lower in the

older children and patients with+ Down syndrome need to be followed during childhood with regard

to their intellectual disability levels. In the population-based cohort of 60 children with Down

syndrome, they found a significantly lower level of ID in the teenage group compared to the

younger group. They suggest that most children with Down syndrome would benefit from a re-

evaluation of their cognitive function, in order to adapt their educational curriculum before entering

secondary school.

Because of intellectual delay, the child's communication may affect. Communication involves the

expression and sharing of information between people, via mediums such as speaking and gesture,

providing a means for people to connect. Shared intentionality and cooperation are fundamental to

human communication (Tomasello, 2010). Children who have developmental disabilities are often at

particular risk of experiencing communication difficulties, and specific communication profiles of

relative strengths and weaknesses tend to be associated with given populations (Geurts &

Embrechts, 2008; Laws & Bishop, 2003).

According to the International Journal of Experimental Educational Psychology, increasingly

children with Down Syndrome are attending mainstream schools, but evidence suggests that these

children are more prone to peer rejection and other problems when compared with their non‐

disabled counterparts. However, relatively little is known about children's attitudes toward their

peers with moderate to serious learning disabilities, including Down Syndrome. Their study assessed

the attitudes of non‐disabled primary school children (n = 118) in mainstream education toward their

peers with Down Syndrome. A secondary aim was to assess whether exposure to audiovisual

material promoting inclusion had any immediate effects on overall attitudes. A cross‐sectional,

questionnaire‐based survey was administered in four rural‐based schools. The results showed that
female participants over 10 were the most sociable. Overall attitudes toward inclusion were

consistently and statistically significantly more negative than those toward sociability. Other factors,

such as contact with peers with Down Syndrome, were not related to attitudes. Neither was there

any change in overall attitudes following exposure to the promotional material. Further work is

needed to identify factors underpinning the attitudes of non‐disabled children to their peers with

Down Syndrome and how best to promote inclusion in mainstream schools.

School is a very rich environment for the development of social skills, and it is noticeable that

children from well-structured school settings tend to be more sociable, show more developed social

interaction, play more advanced games with their peers, and exhibit more solid knowledge of social

rules (Bonome-Pontoglio & Marturano, 2010).

The significance of peer relations for psychological development and mental health was recognized

years ago by some eminent theorists. Piaget (1932) assigned a critical role to peer relations in his

theory of cognitive development. According to him, peer interaction exposes the child to diverse

viewpoints, including some that differ from those held by his or her parents. The cognitive conflict

induced by such exposure facilitates transition from one level of cognitive development to the next.

Furthermore, within the more egalitarian context of the peer system, it is easier for the child to

examine, analyze, and reflect on the nature and bases of social rules. It is such critical analysis and

reflection, Piaget hypothesized, that brings about the realization that social intercourse and order are

based on reciprocal exchanges between people.

Based on the study conducted by DSE Library, they investigated the popularity of children with

Down syndrome with their peers in mainstream classrooms using established sociometric

techniques. The classroom behavior of 16 children with Down syndrome aged 8 to 11 years were

assessed and the relationship between these behaviors and acceptance investigated. For comparison,

the relationship between classroom behavior and acceptance of 122 typically developing children
from the same classes was examined. The majority of the children with Down syndrome were found

to enjoy average levels of acceptance in the class. Although behavior problems were significantly

worse in the children with Down syndrome, poor behavior did not influence the other children to

reject them. There was a different picture for typically developing children where there was a strong

relationship between behavior and peer acceptance. Language skills were also assessed for the

children with Down syndrome. The children's language skills were not related to their popularity

with the other children. Neither problem behaviors nor language difficulties influenced friendships

in or out of the classroom for the children with Down syndrome.

Although children with DS present lower functional performance when compared to children with

typical development, that difference does not remain consistent throughout their development

because the child with DS, little by little, develops mobility skills that are gradually incorporated to

his/her daily repertoire, affecting his/her independent performance in several daily activities

(Mancini et al., 2003).

According to Soresi and Nota (2000), many studies have shown that people with mental retardation

have poor interaction with the others. The same authors, through a meta-analysis of different studies,

claimed that DS school children and those with developmental disorders (moderate or severe) poorly

adapt to school demands and, in general, experience difficulties achieving reasonable levels of

school performance. They especially have difficulties in two wide classes of behaviors which are

fundamental for school adaptation: relationship with peers and relationship with teachers. The latter

is related to the ability of meeting the teachers’ requests within school settings and the former is

related to the ability of participating in group dynamics, facing negotiation skills and start positive

relationships with schoolmates. Those difficulties decrease the quality and number of social

experiences, which potentially results in serious negative effects on their abilities to adapt to adult

life and on their social integration. That ability must be stimulated by the school environment for a
complete development of life aspects, both in DS children and in children with typical development.

Thus, inclusion is founded on the human and socio-cultural dimension which tries to enhance forms

of positive interaction, possibilities and support for difficulties, and meeting needs, all of which is

done by listening to students, parents, and school community.

Among other aspects, children with DS have been shown to present a deficit in social assertive

abilities, those that depend on a stronger initiative and to develop better passive social skills,

meaning those in which the influence of the environment is determinant (Anhão et al., 2010).

According to the article of Schwab, S., Gebhardt, M. & Huber, C. (2016) "Social acceptance of

students with Down syndrome and students without disability5" they've investigated the influence

of teacher feedback on the social acceptance of peers with intellectual disabilities and peers without

disabilities. Interventions fostering the social acceptance of students should thus not only focus on

the social competences or social behavior of the student, but they should also address the most

important factor for inclusion: the teacher. If interventions work one teacher could influence the

social acceptance of lots of peers over several years. So practice should train teachers stronger in

their interactions with disabled peers.

Down syndrome is also the most common genetic disorder associated with intellectual disability.

Despite the availability of sophisticated prenatal screening and diagnosis (Malone, et al., 2005), the

incidence of Down syndrome remains at approximately 1–800 live births (Patterson & Costa,

2005; Sherman, Allen, Bean, & Freeman, 2007). Knowledge of the genetic and neurobiological

mechanisms underlying this disorder has expanded dramatically in recent years (Patterson, 2007),

and research continues to refine what is now a well-established behavioral phenotype (Chapman &

Hesketh, 2000). Extensive behavioral work in particular has identified important cognitive

(Silverman, 2007) and language (Abbeduto, Warren, & Connors, 2007; Roberts, Price, & Malkin,
2007) profiles, and there is increasing interest with respect to the social development of children

with Down syndrome.

According to Fidler & Nadel, (2007) Available evidence suggests that, in comparison to many

aspects of cognition and language, the social development of children with Down syndrome appears

to be a relative strength. In general, these children exhibit a strong orientation to social aspects of

their environment and appear motivated to engage in social interactions. Certain developmental

characteristics of children with Down syndrome such as well-developed representational skills are

also compatible with involvement in social forms of play (Sigman & Ruskin, 1999). The perceptions

of parents and teachers of children with Down syndrome are consistent with this sociable profile and

with social development as a relative strength (Fidler, Hepburn, & Rogers, 2006; Gilmore,

Campbell, & Cuskally, 2003).

Moreover, parents of children with Down syndrome actively support their child’s participation in

settings containing typically developing peers during the early childhood and school years

(Guralnick, 2002). Because Down syndrome is so well known and increasingly accepted (Lenhard,

Breitenbach, Ebert, Schindelhauer-Deutscher, Zang, & Henn, 2007), lower levels of perceived

stigma may further encourage parents to actively foster their child’s participation in community-

based normative social activities. Taken together, these child characteristics along with parental and

societal factors may well combine to support the development of social relationships and to foster all

aspects of the social competence of children with Down syndrome.

However, recent research relevant to the social competence of children with Down syndrome

suggests vulnerabilities in precisely those processes closely associated with children’s peer-related

social competence ( Yeates, et al., 2007). Specifically, in studies employing various comparison

groups, including typically developing children matched on chronological age, mental age, or

language level, children with Down syndrome display substantial difficulties with respect to various

aspects of social understanding and associated socio-cognitive skills (Cebula & Wishart,
2008; Wishart, 2007; Wishart, Cebula, Willis, & Pitcairn, 2007). Related research also has revealed

difficulties with respect to emotion regulation abilities when faced with a frustrating situation, and

problems persisting when challenged with a difficult task. In fact, aspects of their sociability such as

high levels of approaching others may well be due to poor response inhibition. Chapman, (2003)

believed that other developmental characteristics common to children with Down syndrome, such as

unusual difficulties in expressive language may further place these children at risk for significant

peer competence problems.

Friends play a significant role in our daily lives especially in mental and physical health; however,

individuals with Down syndrome and other developmental disabilities, even those who are included

in general education programs, have not developed friendships as hoped.

According to D’Haem (2007), Making friends is one of the most intractable problems for children

with significant special needs - some do not have a single person who is their friend. Many research

studies have found that friends play a significant role in mental and physical health; however,

developing friendships remains a problem for those with Down syndrome and other developmental

disabilities. Peer relations are a critical aspect of a child’s life. Most importantly, in order for

individuals with developmental disabilities to live independent and full lives, friends in the

community are critical. The possibility of community friendships has been a major impetus for the

full inclusion of individuals with severe disabilities in local public schools. However, according to

Myra Madnick, the former Executive Director of the National Down Syndrome Society in New

York, “Despite all of the gains individuals with Down syndrome have made, loneliness is a major

problem.” Although students who are included have made great strides in language, behavior, social

development and academics this is not true for social inclusion.

Many schools established “circle of friends groups” in order to facilitate social acceptance and

friendships for children with disabilities and without; however, this relationships did note continue

outside the school. Once the target student entered secondary school friendship groups could not be
scheduled during the school day. Teachers were not willing to release students from their classes so

they could attend friendship group sessions and students were also concerned about missing

instruction. Although many students reported continued interest in the project and were willing to

meet with the target students they were not interested in meeting during lunch. These secondary

students do not have free periods during the day and most were active in sports and clubs after

school. After several months of attempts to schedule a mutually beneficial time to meet the in-school

friendship group meetings had to be abandoned. While older students may not be interested in

structured peer-support programs for students with developmental disabilities because they are

teacher directed. Intervention has been found to be more successful when peer ownership, and

problem solving were emphasized over teacher mediated strategies. D’Haem, (2007).
Citations
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3898700/
https://pdfs.semanticscholar.org/460a/3e3993cf4d200ce6f12a35e1d4c927cc7bd8.pdf