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CASE REPORT OF DOWN SYNDROME CHILD

Bio Data

Name Abdullah

Gender Boy

Chronological Age 6 Years

Clinical Diagnosis Down Syndrome

REASON FOR REFERRAL

Abdullah’s teacher had concerns for him regarding his act of tongue protrusion,
communication and social skills, academic performance and development of fine motor
skills.

PERSONAL HISTORY

Birth and Early Childhood

Abdullah was a fullterm baby and delivery was normal. There is history of neonatal
jaundice. After birth, Abdullah started neck holding at about 4 months, was sitting at 7
months and was able to walk at 1.6 yrs. of age. He began to utter words at about 3 years
after birth and spoke in sentences by 5 years of age. His toilet training started at 4 years
of age.

Social and Emotional History

Social skills of child are good. He has friendly interaction with class mates, family
members and other relatives. Apart of good socialization, he is a bit naughty, quite active
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and has average adaptability level. He has a bit of labile temperament. He may get
annoyed with others on trivial matters but rarely displays his emotion of anger. He
prefers to sit alone when his mood is off.

Educational History

Child started his schooling at the age of 4 years and 6 months. Schooling was in a local
private special education school. He spent almost a year there but he did not show any
progress. Later, Abdullah’s mother got him admitted to Govt. Special Education Centre,
Ferozwala, for better outcomes. During his stay in this center, child has a consistently
good attendance record. He has no unexplained absences or discipline problems. At
present, no previous academic record is available.

Class Room Observation

Abdullah has been observed during his routine class timings. He shows calm, quiet and
on seat behavior. He has good interaction with his class mates. He appears comfortable in
the group but at times gets distracted. Sometimes he, being a bit naughty, needs
prompting to be stopped. He has good instructional following. Regarding answers to
questions, almost fifty percent of his responses are accurate.

Interests and Hobbies

Child likes jumping, running and climbing. He is also fond of listening pop music. He
loves to eat bread as compared to rice.

Medical History

General health of Abdullah is good. There is no history of previous surgeries or any

noteworthy illness. Moreover, his vision and hearing are adequate. There is no history of
addiction.

Behavior Pattern

Abdullah has some unusual behavior patterns. Child has his tongue protruding out of his
mouth. The protruding tongue is hurting the peri-lips area. He often shows mild level of
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temper tantrums at home. For example, may take belongings of others without their
permission. Hitting behavior is also present. Child has mild level of distractibility and
poor attention span as well.

FAMILY HISTORY

Abdullah belongs to a lower middle class family and has four people at home. His father
is a 35 years old man. His education is up to matriculation and runs a shop. Father
displays a caring attitude towardsall his children but he is more attentive towards his
target child. The mother of Abdullah is 30 years old educated house wife. Mother’s
attitude towards target child is overprotective and she loves the child a lot. The parents
are unrelated, have satisfactory relationship and maintain a nuclear family system.Though
the family has limited financial resources but parents try to fulfill all their obligations
involved in taking care of their children. Child Abdullah has one eight years old brother
and a five years old younger sister. Child has close, friendly and affectionate
relationships with his siblings. Both siblings involve Abdullah in their play time. Child
sleeps with his brother.

There is no physical and psychiatric history in child’s family. Child’s siblings are well
developed children and do not have any developmental delays. However, history of
mentally challenged children is present in the relatives. Over all child belongs to a happy
and contended family.

ASSESSMENTS

Abdullah was assessed by using Carolina Curriculum for Pre-schoolers with Special
Needs (CCPSN) (Johnson- Martin, Attermeir, & Hacker, 1990) and informal
observations at the beginning of the program, in order to establish a baseline level of
performance. A series of observations were conducted with the help of psychologists,
class teacher and speech therapist to determine child’s strengths and weaknesses in
different domains of curriculum.

Following are the results of assessments;-

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Cognition

When child cognition domain was assessed on CCPSN, it was determined that child
could follow simple instructions and directions including in, out, up and down. He
showed good imitations of block train and block building. Despite these strengths, child
was not able to sort objects by name, colors, and shapes. He also had a difficulty in
identifying soft and hard objects, basic colors and shapes.

Communication

Abdullah’s strengths in communication include better receptive language. He is able to

identify familiar objects and to tell 2 -3 body parts. Child’s one step command following
is also good. In area of speech he is capable to deliver 1 -2 words speech. However the
child’s oral motor is not in good condition. He has poor dentition, open mouth closure
and drooling problem as well. Moreover, child has limited vocabulary and unintelligible
speech to some extent.

Social Adaptation

The child’s social adaptation was relatively good. He greets familiar persons
spontaneously. He shares his food and toys with siblings and friends. He enjoys
inside/outside play with mates. He helps his seniors in picking up, dusting and wiping
table. He can eat independently with spoon and fork, drinks from a small glass with
single hands and swallows food in mouth before taking into another bite. Child was able
to put on simple clothing. Personal grooming of the child is also better as he can wash his
hands and face independently, can brush teeth and blowing nose with assistance.
However, child is unable to express his feelings like complaint and excitement. He was
not able to dress and undress, undoes large button and unfasten pants’ hook.

Motor Skills (Gross and Fine motors)

In the area of motor skills, child can play with messy material like clay. He can screw and
unscrew caps from small bottle, transfers material with a spoon. He can handle objects
with better control. He is able to built tower of three blocks and can hold pencil, chalk
and crayons with fist. However, his fine motors are not refining as he could not hold
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pencil, crayons with thumb and fingers, he cannot string beads. He had poor control with
lines and unable to built towers of eight blocks.

MANAGEMENT PLAN

Short Term Goals

1. To improve attention span, concept formation, memory and visual perception skills.
2. Enhance ability to improve communications pattern in three words sentences and
understand objects with 60% accuracy.
3. To enhance social adaptations including self concept, interpersonal skills, self help and
personal grooming.
4. To decrease unusual behavior patterns.
5. To achieve bilateral motor skills in gross and fine motor areas.

Long Term Goals

To prepare the child to live and work as independently as possible and being able to
function and behave appropriately in a typical world while using his maximum inherit
potentials.

PROGRAM INTERVENTIONS

Based on the case formulation, a multi-pronged modalities and techniques were designed.
The intervention program started with motivational interviewing in order to develop
rapport with the parents and targeted child to get involved in the intervention cum
Individualized Educational Program. To enhance the child’s cognitive skills, teacher was
guided to use one-on-one or small group instructions, use of pair pictures, cues and
concrete material (‘Hands on”) for teaching purpose. Group activities and group
competitions were also arranged in order to motivate child in academics. To increase
child’s attention and concentration, different prompts, cues, multi-colored background
for work along with calm and quite seating environment was assured. To improve
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communication and language skills, the Oral Motor Management (OMM), tongue
exercises, drooling exercises were used by the speech therapist. To enhance
communication, child was taught names of daily usage things, different people and
objects with the help of flash cards, picture books, original model and work sheets. To
increase social adaptation skills, role playing, role rehearsal and chaining of tasks were
used. Chaining is a behavioral technique to teach a behavior by breaking it down in small
steps either in forward (first to last step) or backward (last to first step) chaining process.
While applying these techniques focus was given on the process rather than the end result
(i.e., “wow! You did it better! Let’s do it again! rather “you failed”). Home work
assignments were given to strengthen the learned tasks at school. As child had tongue
protruding, to reduce it, on spot verbal prompts were used by concerned staff members.
Mother was also guided regarding medication and cleanliness of peri-lips area. Verbal
reprimands and reminders were also used to decrease unwanted behaviors like taking out
others objects without permission. To reduce child’s temper tantrum, time out and
ignorance strategies were applied. To increase pencil holding and pencil control, chaining
and task analysis were used. In addition, hand exercise, verbal and physical prompts were
also used. In nut shell, different mode of strategies was applied according to situation and
demand of behavior by psychologist, class teacher and speech therapist.

SUMMARY OF OUTCOMES

The intervention program was a worthwhile experience for Abdullah and rest of the team
attached to it. Based on trimester assessment and routine observation in his underlying
skills and functional skills, intervention program appears to have had a positive impact.
Abdullah showed a significant improvement in his academics like he started to sort
objects by name, colors and shapes to some extent. He has begun to differentiate between
soft and hard, red and yellow color, and concept of up and down with prompts.
Considerable changes were observed in interpersonal skills. He is struggling in mastering
of self-help skills, dressing and personal grooming with little assistance. Child is able to
put off simple cloths, opening and closing front zip of his jacket. He is able to assist and
guide his friend in group activities on very basic level. His parents graded his
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performance as an average compared to last three months. Since the implementation of

management plan, changes have been obvious in her gross motor skills but fine motor is
yet required to work on though he tries to scribble on paper, pencil holding with thumb
and finger. Likewise his speech and language also required more practice. He has started
to point things by taking their name such as pencil, copy, chair, lunch etc. The overall
management plan proved prolific in child’s dealing with his different domains of
curriculum.

Reference

Johnson-Martin, N. M., Hacker, B. J., & Attermeier, S. M. (1990). The carolina

curriculum for pre-schooler with special needs (CCPSN) assessment log and

developmental progress chart (1st ed.). U.S.A: Brooker Publishing.