OTHER LINES OF RESEARCH IN BUSINESS

ORGANIZATION
COOPERATION AGREEMENTS IN RESEARCH AND DEVELOPMENT

Master in business Organization

Early Intervention for Mentally Disabled Children Due to Genetic Etiology

Rey Juan Carlos University

Master of business Organization

PROFESSOR: JOSÉ LUIS MONTES BOTELLA

Prepared BY: AYOUB MALLA

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Table of Contents
ABSTRACT...................................................................................................................................................3
INTRODUCTION........................................................................................................................................3
LITERATURE REVIEW............................................................................................................................4
METHODS....................................................................................................................................................5
PARTICIPANTS..............................................................................................................................6
INSTRUMENTS..............................................................................................................................6
BACKGROUND TO THE STUDY.....................................................................................................7
RESULTS......................................................................................................................................................7
SELF-HELP...................................................................................................................................7
COGNITION...................................................................................................................................8
MOTOR.........................................................................................................................................9
LANGUAGE.................................................................................................................................10
CORRELATION OF LABORATORY FINDINGS WITH DEVELOPMENTAL FIELDS:..........................11
DISCUSSION..............................................................................................................................................15
REFERENCES...........................................................................................................................................19
APPENDIX ‘A’...........................................................................................................................................20
Table (9): ............................................................................................................................................20
Table (12):...........................................................................................................................................21
Table (13):...........................................................................................................................................22
Table (14):...........................................................................................................................................23
Table (15):...........................................................................................................................................24
Table (16):...........................................................................................................................................25

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Abstract: As part of the research work required for OTHER LINES OF RESEARCH
IN BUSINESS ORGANIZATION module, the objective of the study is to study degrees
of response to early intervention among intellectually disabled children due to different
genetic etiologies and estimating a possible underlying molecular genetics that could
serve to modulate the degree of response to early intervention among children of
different genetic causes and children of the same genetic cause. The research will
employ a quantitative approach with statistical analysis. Finally, I would end my paper
with an overall summary.
Keywords: SPSS, Statistics, Syndromes, Children

Introduction

The study reported herein is inclusive of 100 cases involving individuals with mental
disabilities due to different genetic causes including those of Down syndrome, Prader-
Willi syndrome & Silver-Russell Syndrome in addition to controls matched for age (6M-
4Y) and sex.
Each case was subjected to: (1) comprehensive history including family history
and specifically maternal and paternal ages at birth in each case, similar conditions in the
family, jobs and exposure to drugs or x-rays; (2) pedigree construction and analysis; (3)
evaluation of social status of the family whether it be high-, middle-, or low-
socioeconomic status; (4) clinical examination of all body systems with special emphasis
on any anomaly; (5) investigations according to each individual case including such as
echocardiography, hearing tests (ABR), fundus examination, brain C-T scan, EEG, as
well as others; (6) early intervention; and (7) preliminary (pre-test) evaluation of
developmental (DA) of all developmental fields including infant-stimulation, cognition,
motor, social maturation, and language through use of the Portage developmental charts;
and (7) a comprehensive clinic and house-centered Portage program for early
intervention and education of the mentally disabled children and their care givers.

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Literature Review

The work of Connolly, Morgan, Russell, and Richardson entitled “Early Intervention
with Down Syndrome Children” states findings that intervention during infancy in
children with DS “has a positive effect upon development of adaptive and intellectual
skills in children with Down syndrome. Further, the findings suggest that intervention
facilitates acquisition of early developmental skills.” (1980, p.1407)
The work of Mahoney and Fewell (2001) reports a field-based investigation of
the effects of two motor intervention approaches on children with DS including
neurodevelopmental treatment and developmental skills. It is reported that motor
functioning was examined at the beginning of the study and following 1 year of motor
intervention services. Pre-post comparisons indicated that children made significant
changes in their motor development age and quality of movement over the course of
intervention. However, it is reported that there was no evidence that motor invention
accelerated development or improved quality of movement beyond what could be
expected on the basis of maturation. In addition, no differential intervention effects were
associated either with children’s diagnosis or treatment model. The work of Crombie
and Gunn (1998) reports developmental assessments for two cohorts of children with DS
and report that cognitive function was strongly associated with adaptive behaviors.
Conclusions of the study state that early intervention studies should investigate “social
disadvantages and biological impairment not only as separate issues but as a
combination of the two.” The work of Hines and Bennett (1996) states that positive
changes were noted in a study of the development of children with DS who were
exposed to early intervention programs. Connolly, Morgan, Russell and Fulliton (1993)
report that the long-term motor, cognitive and adaptive functioning of a sampling of
adolescents with Down Syndrome who were involved in an early intervention program
when compared to a group who did not experience an early intervention program
showed that the group that had experienced the intervention program “had significantly
higher scores on measures of intellectual and adaptive functioning than did the children
in the comparison group. The EI group subjects did not show the decline typically seen
with age in adaptive functioning in individuals with Down syndrome. The work of
Fewell and Oelwein (1991) reports a study involving preschool children with DS who
were enrolled in the Model Preschool Program for Children and state findings that there
were significantly higher rates of development during interventions than when the
children entered the program. Gibson and Harris (1988) report pooled findings from 21
early intervention demonstration studies for Down’s syndrome infants and children “…
yield consistency of short-term benefits in the growth of finer motor skills, simple social
repertoire and DQ/IQ scores, but conflicting evidence in support or not of benefits in the
gross motor, linguistic and cognitive/academic domains. Support for the tenacity of
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gains, on follow-up to the early years of primary schooling, is disappointing. It is
recommended that: (1) intervention programmers view the key working assumptions and
ideological positions governing present practices more critically; (2) intervention
curricula reflect the unique biological and behavioral properties of the syndrome, taking
into account individual differences which are independent of etiological label; and (3)
care delivery systems be based more fully on multidisciplinary collaboration, especially
between the health sciences and education fields.” The work of Connolly, Morgan and
Russell (1984) report having examined the long-term effects of an early intervention
program on the motor, cognitive and adaptive functioning of children with Down
syndrome. The study compared the group of children with a group of DS children who
did not participate in an early intervention program. The children were assessed and
findings show that children in the early intervention program “…earned significantly
higher scores (p less than .0005, p less than .05) on the measures of intellectual and
adaptive functioning than did the children of comparable age who did not participate in
an EIP. The children in the EIP did not show the decline typically seen with age in
intellectual and adaptive functioning in children with Down syndrome. The children in
the EIP were below expected age levels in gross (77.7%) and fine motor skills (58.3%)
but had mean fine motor skill levels that exceeded their mean gross motor skill levels
(50%). Based on the results, EIPs for children with Down syndrome appear to provide a
foundation for subsequent learning and development.
Because Down syndrome children lack muscle tone, a condition termed
hypotonia physiotherapy is critical for these individuals in the form of early
interventions. Without physiotherapy the Down syndrome child will be “left with
weaknesses, odd behaviors, and disfigurements that need not have happened.” (Hudson,
2010) Psychological assessments for Down Syndrome children are important for
assessing cognitive abilities, adaptive skills and behavior. Functional skills include
communication and motor skills as well as self-help skills and socialization skills.
(Cicchette and Beeghly, 1990, paraphrased).

Methods

This program is primarily focused on training of the studied children in their local
environment and specifically in the house. The main program idea reverses the emphasis
of the mother in the home. This program was implemented in the form of bi-weekly
interventional sessions (30-40 minutes for each session) in addition to 3 monthly
evaluation sessions. Throughout the early intervention program (2 years), children have
been taking brain function stimulants and enhancers in the form of calculated mega
doses of multi-vitamins, antioxidants, omega 3 polyunsaturated fatty acids, and essential
amino acids.

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 The treatment and care provided to mentally retarded individuals has
experienced change and expansion in recent years. Families prior to the 1800s kept
children with mental disabilities at home and hidden from the view of the public. After
that time state governments built large institutions to house children with mental
disabilities and parents were advised by physicians to institutionalize retarded children
resulting in few children with mental disabilities having the opportunity to receive
education and training.

Participants
This study involved thirty cases with mental disability and 30 controls matching for age
and sex. The thirty individuals studied were divided into twenty (20) cases with Down
Syndrome (DS) and ten cases with Prader-Willi syndrome (PWS). The Down Syndrome
cases were further subdivided according to cytogenetic analysis into 3 subgroups as
follows:
(1) group1 – the non-disjunction (regular) DS cases (n-10);
(2) group2 – translocation DS cases (n=5); and group3 – mosaic DS cases (n=5).
The ages of all patients ranged from 6 months to five years. Patients were obtained
through referral to outpatient clinics of Children with Special Needs Department and
Clinical Genetics Department, National Research Centre (N.R.C.) from 2000-2002.
Each case was subjected to the following:
(1) comprehensive history taking;
(2) pedigree construction and analysis;
(3) evaluation of social status of the family;
(4) clinical examination of all body systems;
(5) investigations according to individual case; and
(6) laboratory investigations.

Instruments
Prader-Willi cases were subjected to thorough molecular cytogenetic diagnostic
approach such as: FISH using SNRPN or other probe in the common deletion region,
along with a centromeric probe, and methylation analysis would detect both UPD and
imprinting mutations. Diagnosed cases were subjected to:

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(1) preliminary (pre-test) evaluation of developmental age (DA) of all developmental
fields (i.e. infant-stimulation, self-help, cognition, motor, social maturation, and
language), using the Portage developmental charts;
(2) a comprehensive clinic and house centered program for early intervention and
education of the mentally disabled child and their care givers; and
(3) a final (post-test) evaluation of DA of all developmental fields using the Portage
developmental charts.

Background to the Study

It is now recognized by experts that children with mild mental retardation are many
times able to develop new skills over time through early intervention and educational
services resulting in their ability to function normally in life and to no longer warranting
a diagnosis of retardation. All individuals except those who are most profoundly
retarded can generally develop their full potential through living in the community as
most individuals with mental retardation have the capacity for learning enabling them to
advance intellectually and to develop job skills as well as social skills enabling them to
fully participate in society. Individuals with mild mental retardation marry, have families
and are basically unable to be distinguished from normal individuals in society however,
if these individuals are to achieve their full potential as children these individuals require
special education and training beginning in infancy and continuing until they establish
an adult role in life.

Results

Self-Help
Mean post-test Self-Help field values of total DS cases and groups 2&3, showed a non-
significant statistical (P>0.01) increase compared with mean pretest Self-Help field
values (P=0.4, 0.86, respectively). On the other hand, mean post-test Self-Help field
value of group 1 DS cases, showed a non-significant statistical (P>0.01) difference,
compared with that of pretest Self-Help field (Table 13).
Pearson correlations among the mean pretest developmental fields values showed that
Self-Help had a statistically highly significant positive correlation with Social
(P=0.000), Motor (P=0.000) and Language (P=0.007) fields, and a statistically
significant positive correlation with Cognitive (P=.021) field (Table 14).
Mean pretest Self-Help field values showed a statistically highly significant (P=0.000)
positive correlation with those of post-test Cognitive field, and a statistically significant
positive correlation with post-test Self-Help (P=.031) and Language (P=.042) fields.

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Meanwhile, there was a statistically non-significant (P>0.05) correlation between Self-
Help field and both Social and Motor fields (Table 15).
Pearson correlations among the mean post-test developmental fields values of DS cases
showed that Self-Help had a statistically highly significant (P=.001) positive correlation
with Motor field, and a statistically significant (P=.040) positive correlation with
Language. Otherwise, there was a statistically non-significant (P>0.05) correlation
between post-test Self-Help and both post-test Social and Cognitive fields.
Regarding the sex of DS cases, there was a statistically non-significant (P>0.01) increase
of mean pretest Self-Help field value of female cases, compared with that of males
(Tables 9). Meanwhile, there was a statistically non-significant (P>0.01) decrease of
mean post-test Self-Help f2ield value of male cases, compared with that of females
(Table 11).
According to social class, there was a statistically non-significant (P>0.01) decrease of
mean pretest value Self-Help developmental field of high (n=7) class DS cases,
compared with that of middle- and low-class cases. Meanwhile, there was a statistically
non-significant (P>0.01) increase of mean pretest Self-Help value of low-class cases,
compared with that of middle-class ones (Table 10). The post-test means Self-Help field
of high class (n=7) DS cases, showed a statistically non-significant (P>0.01) decrease,
compared with that of middle class (n=9) and low class (n=4) cases. On the other hand,
there was a statistically non-significant (P>0.01) decrease of post-test mean middle class
Self-Help field value, compared with that of the low class (Table 12).
There was a statistically non-significant (P>0.05) correlation between the mean of ages,
maternal and paternal ages of DS cases, compared with both pretest and post-test Self-
Help developmental field values.

Cognition
Mean post-test Cognitive field value of total DS cases, showed a highly significant
statistical (P=0.001) increase, compared with that of mean pretest Cognitive field.
Meanwhile, mean post-test Cognitive field value of group 2 DS cases, showed a
significant (P=0.009) statistical increase, compared with that of mean pretest Cognitive
field. On the other hand, mean post-test Cognitive field values of groups 1&3 of DS
cases, showed a non-significant statistical (P=0.27, 0.19, respectively) increase,
compared with those of mean pretest Cognitive field (Table 13).
Pearson correlations between mean pretest Cognitive field values and those of the other
pretest developmental fields, showed a statistically significant positive correlation with
Social (P=.045) and self-help (P.021) fields, otherwise, there was a statistically non-
significant (P>0.05) correlation with other pretest developmental fields (Table 14).
Mean pretest Cognitive field values had a statistically highly significant positive
correlation with those of post-test Cognitive (P=.000) field, and a statistically significant
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negative correlation with mean post-test Social (P=.019) field value. Meanwhile, there
otherwise, there was a statistically non-significant (P>0.05) correlation with other post-
test developmental fields (Table 15).
Mean post-test Cognitive field value showed a statistically non-significant (P>0.05)
positive correlation with those of the other post-test developmental fields.
Regarding the sex of the studied DS cases, there was a statistically non-significant
(P>0.01) increase of mean pretest Cognitive field values of female cases, compared with
that of males (Tables 9). On the other hand, there was a statistically non-significant
(P>0.01) decrease of mean post-test Cognitive field values of female cases, compared
with that of males (Table 11).
According to social class, there was a statistically non-significant (P>0.01) decrease of
mean pretest Cognitive developmental field of high (n=7) class DS cases, compared with
that of middle- and low-class cases. Meanwhile, there was a statistically non-significant
(P>0.01) difference between the mean of pretest Cognitive value of low-class cases,
compared with that of middle-class ones (Table 10). There was a statistically non-
significant (P>0.01) increase of post-test mean high class Cognitive field value,
compared with those of middle and low classes. On the other hand, there was a
statistically non-significant (P>0.01) difference between the post-test mean of Cognitive
value of middle-class cases, compared with that of low class (Table 12).
There was a statistically non-significant (P>0.05) correlation between the mean of ages,
maternal and paternal ages of DS cases, compared with both pretest and post-test
Cognitive developmental field values.

Motor
Mean post-test Motor field value of total DS cases, showed a significant statistical
(P<0.01) increase, compared with that of mean pretest Cognitive field. Meanwhile, there
was a statistically non-significant increase of mean post-test Motor field values of
groups 1,2&3 of DS cases (P=0.56, 0.09, 0.43, respectively), compared with those of
pretest Cognitive field (Table 13).
Pearson correlations between mean pretest Motor developmental field values and those
of the other pretest developmental fields, showed a statistically highly significant
positive correlation with Social (P=.002), Self-Help (P=.000), and Language (P=.005)
fields. On the other hand, there was a statistically non-significant (P>0.05) correlation
with Cognition (Table 14).
Mean pretest Motor developmental field values showed a statistically highly significant
positive correlation with post-test Motor (P=.004) field. Meanwhile, pretest Motor
developmental field values had a statistically significant positive correlation with post-
test Self-Help (P=.033) and Cognitive (P=.012) fields, and a statistically non-significant
negative correlation with Social field (Table 15).
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Pearson correlations among the mean post-test developmental fields values of DS cases
showed that mean post-test Motor field value had a highly significant (P=0.001)
correlation with Self-Help field. Otherwise, there was a statistically non-significant
(P>0.05) correlation between Motor field and Social, Cognition and Language
developmental fields.
Regarding the sex of the studied DS cases, there was a statistically non-significant
(P>0.01) decrease of mean pretest and post-test Motor field values of female cases,
compared with those of males (Tables 9,11).
According to social class, there was a statistically non-significant (P>0.01) decrease of
mean pretest Motor developmental field of high (n=7) class DS cases, compared with
those of middle- and low-class cases. Meanwhile, there was a statistically non-
significant (P>0.01) increase of mean pretest Motor value of low-class cases, compared
with that of middle-class ones (Table 10). There was a statistically non-significant
(P>0.01) decrease of mean post-test high class Motor field value, compared with those
of middle and low classes. On the other hand, there was a statistically non-significant
(P>0.01) increase of the mean post-test Motor field value of middle-class cases,
compared with that of low-class ones (Table 12).
There was a statistically non-significant (P>0.05) correlation between the mean of ages,
maternal and paternal ages of DS cases, compared with both pretest and post-test Motor
field.

Language
Mean post-test Language field values of total and groups 1&2 DS cases, showed a non-
significant statistical (P=0.37, 0.26, respectively) increase, compared with those of
pretest Language field. Meanwhile, there was a statistically non-significant (P=0.83)
difference between mean post-test Language field value and pretest of group 3 DS cases
(Table 13).
Pearson correlations between mean pretest Language developmental field values and
those of the other pretest developmental fields, showed that showed a statistically highly
significant positive correlation with Self-Help (P=.007) and Motor (P.005) fields, and a
statistically significant (P=.033) positive correlation with Social developmental field.
Meanwhile, there was a statistically non-significant (P>0.05) correlation between
Language field and cognition (Table 14).
Mean pretest Language developmental field value showed a statistically significant
(P=.011) positive correlation with post-test Cognitive field, otherwise, there was a
statistically non-significant (P>0.05) correlation between pretest Language field and
post-test Social, Self-Help, Motor, and Language fields (Table 15).
Pearson correlations among the mean post-test developmental fields values of DS cases
showed that mean post-test Language field value had a significant correlation with Self-
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Help (P=.040) and Motor (P=0.027). On the other hand, there was a statistically non-
significant (P>0.05) correlation between Language with both Social and Cognitive
developmental fields.
Regarding the sex of DS cases, there was a statistically non-significant (P>0.01) increase
of pretest mean Language field value of female cases, compared with that of males
(Tables 9). On the other hand, there was a statistically non-significant (P>0.01) increase
of post-test mean Language field value of male cases, compared with that of females
(Tables 11).
According to social class, there was a statistically non-significant (P>0.01) increase of
pretest mean Language developmental field of high (n=7) class DS cases, compared with
that of middle-class cases. Meanwhile, there was a statistically non-significant (P>0.01)
difference between pretest mean Language value of high-class cases, compared with that
of low-class ones. On the other hand, there was a statistically non-significant (P>0.01)
increase of pretest mean Language developmental field of low-class cases, compared
with middle class ones (Table 10). There was a statistically non-significant (P>0.01)
increase of post-test mean Motor field value of high and low classes cases, compared
with that of middle class. On the other hand, there was a statistically non-significant
(P>0.01) difference the post-test mean Motor field value of high-class cases, compared
with that of low-class ones. (Table 12).
There was a statistically non-significant (P>0.05) correlation between the mean of ages,
maternal and paternal ages of DS cases, compared with both pretest and post-test
Language field.

Correlation of Laboratory findings with developmental fields:

By correlating the different laboratory findings of studied DS cases and their pretest
developmental fields values. It was found that Erythrocyte SOD values of DS patients
showed a statistically significant negative correlation with the pretest Social field values
(P=.023), otherwise, there were no significant (P>.05) correlations between the other
different laboratory values and the other pretest developmental fields values of DS
patients (Table 16)
1. Patients with Prader-Willi syndrome:
 Chromosomal analysis
Molecular genetic analysis for cases with PWS showed that 9 cases (90%) had
interstitial deletion of 15q11-13 on chromosome 15 by FISH technique, and one case
(10%) had no deletion.

 Pedigree analysis

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They were six (60%) female and seven (40%) male patients. Positive parental
consanguinity was found in six cases (30%). Their maternal ages ranged from 23 to 32
years with a mean of 27+4 year, and paternal ages from 30 to 39 years with a mean of
34.6+3.4 year.

 Socio-economic classification
Socio-economic classification of families of families with PWS patients, using our
social status sheet (Fig. 3), showed that two cases (20%) were classified as high level,
four (40%) as middle, and four (40) as low.

 The results of “Portage” EIP

a) Socialization
There was a statistically non-significant (P=0.18) increase of mean post-test Social
developmental field value (70.2+4.98), compared with that of pretest (61.9+18) value
(Table 16).

Pearson correlations among the mean pretest developmental fields of PWS cases showed
that there was statistically non-significant (P>0.05) correlation between the mean pretest
Social field value and the mean Self-Help, Cognition, Motor, and Language (P=0.421,
0.765, 0.410,0.771, respectively) fields .
Pearson correlations between pretest Social field and the post-test fields of PWS cases
showed that there was a statistically non-significant (P>0.05) correlation between the
mean pretest Social field and the post-test Social, Self-Help, Cognition, Motor, and
Language fields (P=-0.370, 0.122, 0.175, 0.946,09.449, respectively) fields .
There was a statistically non-significant (P>0.05) correlation between mean post-test
Social developmental field value and the post-test Self-Help, Cognition, Motor, and
Language (P=0.119, 0.818, 0.282, 0.257, respectively) fields.

b) Self-Help
There was a statistically non-significant (P=0.14) increase of mean post-test Self-Help
developmental field value (56.8+5.25), compared with that of pretest (52.5+72.1) value
(Table 16).

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Pearson correlations among the mean pretest developmental fields values showed that
Self-Help had a statistically non-significant (P P>0.05) correlation with Social,
Cognition, Motor, and Language () fields.

Mean pretest Self-Help field value showed a statistically non-significant (P>0.05)

correlation with those of post-test Social, Self-Help, Cognition, Motor, and Language
(P=0.370, 0.122, 0.175, 0.946, 0.449, respectively) fields.

Pearson correlations among the mean post-test developmental fields values of PWS
cases showed that Self-Help had a statistically non-significant (P>0.05) correlation with
Social, Cognition, Motor, and Language (P=0.119, 0.577, 0.557, 0.256, respectively)
fields.
c) Cognition
There was a statistically non-significant (P=0.54) increase of mean post-test Cognitive
developmental field value (50.8+6.8), compared with that of pretest (48.8+7.6) value.

Pearson correlations between mean pretest Cognitive field values and those of the other
pretest developmental fields, showed a statistically non-significant (P>0.05) correlation
with Social, Self-Help, Motor, and Language (P=0.765, 0.250, 0.932, 0.226) fields.

Mean pretest Cognitive field value had a statistically non-significant (P>0.05)

correlation with those of post-test Social, Self-Help, Cognition, Motor, and Language
(P=0.427, 0.446, 0.137, 0.730, 0.590, respectively) fields.

Mean post-test Cognitive field value showed a statistically non-significant (P>0.05)

positive correlation with those of post-test Social, Self-Help, Motor, and Language
(P=0.818, 0.577, 0.953 0.893, respectively) fields.

d) Motor
There was a statistically highly significant (P=1.92003E-05) increase of mean post-test
Motor developmental field value (74.9+11.94), compared with that of pretest
(49.6+7.18) value (Table 16).

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Pearson correlations between mean pretest Motor developmental field values and those
of the other pretest developmental fields, showed a statistically non-significant (P>0.05)
correlation with Social, Self-Help, Cognition,and Language (P=0.410, 0.243, 0.932,
0.374, respectively) fields.

Mean pretest Motor developmental field values showed a statistically non-significant

(P>0.05) correlation with those of post-test Social, Self-Help, Cognition, Motor, and
Language (P=0.407, 0.180, 0.561, 0.397, 0.326, respectively) fields.
Pearson correlations among the mean post-test developmental fields values of PWS
cases showed that there was a statistically non-significant (P>0.05) correlation between
Motor field and Social, Self-Help, Cognition, and Language (P=0.282, 0.557, 0.953,
930, respectively) developmental fields.

e) Language
There was a statistically non-significant (P=0.79) increase of mean post-test Language
developmental field value (40.7+20.22), compared with that of pretest (43.6+21.52)
value (Table 16).
Pearson correlations among mean pretest developmental fields values showed that there
was a statistically non-significant correlation between Language and Social, Self-Help,
Cognition, and Motor (P=0.771, 0.123, 0.226, 0.374, respectively) fields.
Mean pretest Language developmental field value showed a statistically highly
significant (P=0.006) correlation with that of the post-test Language field. Meanwhile,
there was a statistically non-significant (P>0.05) correlation between pretest Language
and Social, Self-Help, Cognition, and Motor (P=0.446, 0.581, 0.527, 0.456,
respectively) fields.
Pearson correlations among the mean post-test developmental fields values of PWS
cases showed that there were non-significant (P>0.05) correlations between Language
and Social, Self-Help, Cognition, and Motor (P=0.257, 0.256, 0.893, 0.630,
respectively) fields.

Discussion

14
This study analyzed the socioenvironmental data of the studied DS cases following
implementation of the Portage Early Intervention Program, DS cases showed marked
increases and improvements in the different five developmental areas of:
(1) social development;
(2) self-help development;
(3) cognition development;
(4) motor development; and
(5) language development.
DS children studied demonstrated a more focused attention style while in the play alone
with toys situation, these children smiled less and rejected the toys more often. The self-
help developmental field demonstrates considerable increase in most DS cases including
progression of self-care skills with the implementation of intervention sittings. Down
Syndrome children experienced difficulty in making stage-to-stage transitions even
when taking their slower developmental pace into account. The Down Syndrome
children showed differential performance patterns over a series of trials which suggests
that their object conceptual knowledge was not consolidated well. Some Down
Syndrome cases did not learn the contingency, although some individual infants did
learn the contingency and better performance was shown to be associated with higher
Portage cognitive field values. There was marked improvement in almost all the studies
of Down Syndrome individuals as well as progress in attaining the usual stages of motor
development through the use of physiotherapies and psychomotor exercises and
specifically the use of attractive colorful objects with sounds. Down Syndrome
individuals in the study showed deficit language-production skills relative to language
comprehension and cognitive skills.
Approximately 50% of Down Syndrome cases showed delayed language production
during the first year of intervention. With the progress of portage sittings, practically all
Down Syndrome cases exhibited productive language deficits relative to mental age
progress after 2 years of intervention. Deficits in language production were more
pronounced in syntactic skills compared with vocabulary development. While 50% of
studied Down Syndrome, cases exhibited deficits in vocabulary development, the
remainder appeared to be developing vocabulary consistent with their cognitive
progression. There were significant developmental field correlations due to the
intersection of developed social maturation with self-help, motor, and language and
cognition as the master key of information processing and learning for all developmental
tasks. PWS, showed non-significant improvements of Social, Self-Help, and Cognition
fields that could be attributed to the fact that these cases had older range of ages (3-5
years) and the gap between the expected and the actual developmental and mental ages

15
is wider than that of DS cases, with frequent tantrums, outbursts, obsession convulsive
neurosis, autistic behaviors, maladaptive behaviors, and sociopaths.
PWS showed significant improvements of motor developmental skills despite the
overfeeding and excessive weight problems, due to the successful implementation of a
restricted diet regimen rich in protein and vitamins and poor in fat. Specific results of the
‘Portage’ EIP in the area of socialization show mean post-test value of Social field for
the total DS cases, showed a significant statistical (P<0.01) increase when compared
with their mean pretest values of ‘social’ field. Group 2 DS cases showed the highly
significant (P=0.001) statistical increase of mean post-test ‘social’ field value, compared
with that of pretest ‘social’ field. Pearson correlations among pretest developmental
fields values of Down Syndrome cases showed that ‘social’ field had a highly significant
positive correlation with ‘self-help’ (P=.000) and ‘motor’ (P=.003) fields, and a
significant positive correlation with ‘cognition’ (P=.045) and ‘language’ (P=.033) fields.
(Table 14) Pearson correlations between pretest ‘social’ field and the post-test fields of
DS Cases showed that there was a statistically highly significant positive correlation
between pretest ‘social’ field and post-test ‘cognition’ (P=.000) and ‘motor’ (P=.004)
fields and a statistically significant (P=.031) positive correlation with post-test ‘self-
help’. Meanwhile, there was a statistically non-significant (P.0.05) correlation between
the mean pretest ‘social’ field and the post-test ‘social’ and ‘language’ fields. (Table 15)
There is reported to have been a statically non-significant (P>0.05) correlation between
mean post-test ‘Social’ developmental field value and the other mean post-test
developmental fields. (Table 16) In regard to the sex of studied DS cases, there was a
statistically non-significant (P>0.01) increase of mean pretest ‘social’ field value of male
cases, compared with that of females. (Table 9) Meanwhile there was a statistically non-
significant (P.0.01) difference between mean post-test ‘social’ field values of male cases
compared with that of females. (Table 11).
The comparison between pre- and post-test developmental field values in the different
socials classes showed in the mean pretest ‘social’ field of high class (n+7) DS cases a
statistically non-significant (P>0.01) decrease when compared with that of middle class
(n=9) and low-class (n=4) cases. There was a statistically non-significant (P>0.01)
increase of mean pretest middle class ‘social’ field value, compared with that of the low
class. (Table 10). Meanwhile, the mean post-test ‘social’ field of high class (n=7) DS
cases showed a statistically non-significant (P.0.01) decrease, compared with that of
middle class (n=9) and low class (n=4) cases. On the other hand, there was a statistically
non-significant (P>0.01) decrease of mean middle class pretest Social field value,
compared with that of the low class (Table 12). Finally, there was a statistically non-
significant P>0.05) correlation between the mean of ages, maternal and paternal ages of
DS cases, compared with both mean pretest and post-test Social developmental field
values.

16
The findings in the present study reported herein are stated to include several factors that
are shown to be positively correlated with one another. First the ‘Self-Help’ field in the
study through conduction of Pearson correlations found that mean pre-test
developmental field values demonstrated that ‘Self-Help’ had a “statistically highly
significant positive correlation with Social, Motor, and Language fields, a statistically
significant positive correlation with Cognitive Field, and a statistically significant
positive correlation with post-test ‘Self-Help, and Language fields. Pearson correlations
among the mean post-test developmental field values of Down Syndrome demonstrated
that ‘Self-Help’ had a statistically highly significant positive correlation with Motor field
and a statistically positive correlation with Language fields.
Pearson correlations between mean pretest Cognitive field values and the other pretest
developmental fields are reported to have shown a statistically significant positive
correlation with Social and Self-Help fields. (see Table 14) In addition, “Mean pretest
Cognitive field values had a statistically highly significant positive correlation with those
of post-test Cognitive (P=.000) field, and a statistically significant negative correlation
with mean post-test Social (P=.019) field value. Meanwhile, there otherwise, there was a
statistically non-significant (P>0.05) correlation with other post-test developmental
fields (see Table 15).
In the mean post-test motor field value of total Down Syndrome cases it was
shown that a significant statistical increase occurred when compared with that of mean
pretest Cognitive field. Pearson correlations between mean pretest Motor developmental
field values and those of the other pretest developmental fields, showed a statistically
highly significant positive correlation with Social, Self-Help, and Language fields. (See
Table 13) Furthermore, mean pretest motor developmental field values showed a
statistically highly significant positive correlation with Social, Self-Help, and Language
fields. (See Table 14) Meanwhile, pretest Motor developmental field values had a
statistically significant positive correlation with post-test Self-Help (P=.033) and
Cognitive (P=.012) fields, and a statistically non-significant negative correlation with
Social field (See Table 15). Finally, Pearson correlations among the mean post-test
developmental fields values of Down Syndrome cases shows that mean post-test
Language field value had a significant correlation with Self-Help \and Motor. On the
other hand, there was a statistically non-significant correlation between Language with
both Social and Cognitive developmental fields.
Comparison of mean pretest and post-test developmental field values of DS and PWS
cases shows a statistically significant increase of mean pretest Social field value of total
DS cases compared with that of PWS cases. Additionally, there was a statistically highly
significant increase of mean post-test social field value of group 2 DS cases compared
with that of PWS cases. In addition, total and group 3 DS cases showed a statistically
significant increase of mean post-test Social field values compared with that of PWS

17
cases. There was a statistically significant increase of mean pretest Self-Help field value
of groups 1 and 2 DS cases compared with that of PWS cases.
Results show as well that there was a significant increase of mean pretest Self-
Help field values of DS groups 1 and 2 compare with PWS cases and a highly
significant increase of mean post-test Self-Help field values of total and groups 1 and 2
DS cases compared with PWS cases.
Also shown in the study results is a highly significant increase of mean post-test
Cognitive field value of group 2 DS cases compared with PWS cases and total DS cases
shows a significant increase of mean post-test Cognitive field value when compared
with PWS cases.
Results in the language field value of group 3 DS cases when compared with that of
PWS cases, and a significant increase of mean post-test Language field value of group 2
DS cases when compared with that of PWS cases.

References
Nilholm, C. (1996) Early intervention with children with Down syndrome - Past and future
issues. Down Syndrome Research and Practice. 1996;4(2);51-58. Online available at:
http://www.down-syndrome.org/reviews/62/
Mahoney, G., Robinson, C. and Fewell, RR (2001) The effects of early motor intervention on
children with Down syndrome or cerebral palsy: a field-based study.
J Dev Behav Pediatr 22 (3): 153-62 (2001 Jun)

18
Crombie, M. and Gunn, P. (1998) Early Intervention, Families, and Adolescents with Down
Syndrome International Journal of Disability, Development and Education 45 (3): 253-281
(1998)
Hines, S. and Bennett, F. (1996) Effectiveness of Early Intervention for Children with Down
Syndrome. Mental Retardations and Developmental Disabilities 2 (2): 96-101 (1996)
Connolly, B.H., Morgan, S.B., Russell, F.F. and Fulliton, W.L. (1993) A longitudinal study of
children with Down syndrome who experienced early intervention programming. Phys Ther 73
(3): 170-179 (1993 Mar)
Fewell, R.R. and Oelwein, P.L. (1991) Effective Early Intervention: Results from the Model
Preschool Program for Children with Down Syndrome and Other Developmental Delays. Topics
In Early Childhood Special Education 11 (1): 56-68 (1991 Spr)
Gibson, D. and Harris, A. (1988) Aggregated early intervention effects for Down's syndrome
persons: patterning and longevity of benefits. Journal of Mental Deficiency Research 32: 1-17
(1988 Jan).
Hudson C. (2010) The Importance of Early Physiotherapy in Down Syndrome Cases, 2010,
Articles Base. Online available at: http://www.articlesbase.com/health-articles/the-importance-
of-early-physiotherapy-in-down-syndrome-cases-1926220.html)
Connolly BH, Morgan S, Russell FF (1984) Evaluation of children with Down syndrome who
participated in an early intervention program. Second follow-up study. Phys Ther 10 (64): 1515-
1519 (1984 Oct)
Cicchette, D., & Beeghly, M. (Eds.). (1990). Children with Down syndrome: A developmental
perspective Cambridge: Cambridge University Press. Nadel, L. (Ed.). (1988). The psychobiology
of Down syndrome. Cambridge: MIT Press. Thomas, A., & Chess, S. (1977). Temperament and
development. New York: Brunner/Mazel. 

Appendix ‘A’

Table (9): Comparison between Mean Pretest Developmental Fields Values of DS Cases
(N=20) According to Sex

19
 SOCIAL SELF-HELP COGNITION MOTOR LANGUAGE

F (n=7) 67.14+19.48 69.86+22.47 52.16+33.7 53.54+30.45 45.27+25.68

M (n-13) 69.39+17.35 78.58+22.58 42.69+19.76 59.78+25.69 41.12+22.1

P value 0.10557 0.108088 0.07514 0.156869 0.31137

Significance NS NS NS NS NS

NS statistically non-significant difference (P>0.01)

Table (10): Comparison between Mean Pretest Developmental Fields Values of DS Cases
(N=20) According to Social Class

SOCIAL SELF-HELP COGNITION MOTOR LANGUAGE

High
60.09+17.2 72.24+23.48 39.19+23.2 54.66+23.64 45.9+25.47
(n=7)

Middle
76.6+16.19 73.62+23.88 49.13+24.06 55.27+33.75 38.54+26.39
(n=9)

Low
65.53+17.52 85.58+19.26 50.9+34.32 67.98+14.74 45.8+7.5
(n=4)

Table (11): Comparison between Mean Post-test Developmental Fields Values of DS Cases
(N=20) According to Sex

SOCIAL SELF-HELP COGNITION MOTOR LANGUAGE

F 83.6+13.41 72.829+19.85 64.47+18.58 74.26+18.08 44.11+17.59

M 83.23+20.57 81+18.22 68.78+25.95 75.21+21.56 56.58+20.64

P value 0.102845 0.475567 0.095027 0.063238 0.5

Significance NS NS NS NS NS

NS statistically non-significant difference (P>0.01).

20
 Table (12): Comparison between Mean Post-test Developmental Fields Values of DS Cases
(N=20) According to Social Class

SOCIAL SELF-HELP COGNITION MOTOR LANGUAGE

High
76.73+28.53 72.2+24.54 69.47+31.37 71.9+26.09 53.27+23.12
(n=7)

Middle
85.8+7.86 79.72+16.78 66.01+18.5 73.19+17.95 49.82+18.87
(9)

Low
89.48+9.53 84.98+10.47 66.25+22.67 83.88+12.52 55.78+22.42
(n=4)

Table (13): Comparison between Mean Pretest & Post-test Developmental Fields Values of
DS (N=20) Cases

PRETEST POST-TEST
Se Se
lf- lf-
Cogni Mo Langu Soc Cogni Mo Langu
Social H H
tion tor age ial tion tor age
el el

p p

Grou
p1
71.68 78. 49.85 60.7 38.56 80.5 77. 60.72 72.0 49.73
Mea 49 1 9 69 1
17.97 19.48 14.99 24.09 20.24
n

21
SD 23. 18.6 18. 21.9
23.0
24 7 25 8

Grou
81. 91. 87.3
p2 56.3 92.2
32 04 2
Mea 58.08 43.34 6 47.3 8** 85.46* 67
20. 13. 13.5
n 12.92 6 35.35 33.9 29.36 8.29 45 20.34 2 21.44

SD

Grou
p3
63. 79.9 66.
Mea 82 52.6 8 14 68.1
n 72.98 40.98 45.86 62.18 6 42.42
22. 37.7 12.1 18.
SD 19.98 32 28.21 3 32.0 5 55 16.9 18.6 11.33

Total
DS
75. 78. 74.8
57.6 83.3
Mea 68.61 53 46 42.57 14 67.27** 8* 52.22
6*
n 26.8
17.64 22. 25.03 22.82 18. 23.21 19.9 20.1
1 18
SD 35 71 3

* indicates statistically significant difference (P<0.01).

** indicates statistically highly significant difference (P<0.001).

Table (14): Pearson Correlations among Pretest Developmental Fields Values of DS Cases
(N=20)

SOCIA SELF- COGNITI MOTO LANGUA

L HELP ON R GE

22
 Social

Correlation 1.000 .854** .453* .661** .478*

Self-Help

Correlation .854** 1.000 .511* .824** .587**

Cognition

Correlation .453* .511* 1.000 .224 .429

Motor

Correlation .661** .824** .224 1.000 .607**

Language

Correlation .478* .587** .429 .607** 1.000

** Correlation is significant at the 0.01 level (2-tailed).

* Correlation is significant at the 0.05 level (2-tailed).

Table (15): Pearson Correlations between Pretest and Post-test Developmental Fields Values
of DS Cases (N=20)
POST-TEST
SOCIA SELF- COGNITI MOTO LANGUA
L HELP ON R GE
PRETEST
23
 Social

Correlation -.288 .482* .710** .619** .335

Self-Help

Correlation -.166 .482* .793** .412 .458*

Cognition

Correlation -.521* .029 .710** -.362 .059

Motor

Correlation -.211 .478* .551* .619** .529*

Language

Correlation -.325 .350 .556* .374 .335

* Correlation is significant at the 0.05 level (2-tailed).

** Correlation is significant at the 0.01 level (2-tailed).

Table (16): Comparison between Mean Pretest & Post-test Developmental Values of PWS
(N=10) Cases
PRETEST POST-TEST
Se Se
So lf- So lf-
Cogni Mo Langu Cogni Languag
cia H cia H Motor
tion tor age tion e
l el l el
p p
24
Mean 61. 52 49. 70. 56
48.8 43.2 50.8 74.9** 40.7
9 .5 6 2 .8
SD 7. 7.1 4.9 5.
18 7.6 21.52 6.8 11.94 20.22
21 8 8 25
P value 0.1 0. 1.9200
0.54 0.79
8 14 3E-05
Signific N
NS NS HS NS
ance S

NS statistically non-significant difference (P>0.05).

25