Search

Purpose: Children with Down syndrome often present with a communication disability, and families require information to support their child's communication. Effective provision of information by professionals is an important part of family-centred practice. However, we currently do not know the specific communication information needs of families of children with Down syndrome. This study aimed to (1) explore families' experiences of communication information provision and (2) identify families' preferences regarding when, what and how they would like to receive information about communication., Method: A qualitative descriptive approach was used to explore the experiences and information needs of nine family members of children with Down syndrome aged 0-15 years. Data from semistructured, in-depth interviews were analysed using thematic analysis., Results: Three core themes were identified: (1) We want more information about communication to be provided by professionals now and into the future so we can be "self-help people." (2) We want general information resources that help us support our child's communication. (3) We want to have a two-way partnership with professionals so we can share and receive specific information about our child's communication., Conclusion: Ineffective information provision restricts families' capacity to be self-help people in supporting communication development. Ongoing provision of both general and specific information about communication is needed in different formats. This study informs the development of resources to better meet families' information needs., (© 2019 John Wiley & Sons Ltd.)

Background: Setting goals for treatment is often the core of the rehabilitation process. The quality of the set goals has however rarely been evaluated. The aims of this study were therefore to assess the quality of goals set in clinical practice of pediatric rehabilitation using SMART criteria (Specific, Measurable, Achievable, Relevant, and Timed) and to assess if the goals were considered relevant from both a client perspective and expertise perspective., Methods: In a retrospective multicase study, a total of 161 goals from 42 children with disabilities (cerebral palsy, n = 22; Down syndrome, n = 16; and developmental disability, n = 4) were assessed. The children were 1.5-5.5 years and had previously participated in goal-directed, activity-focused therapy at four pediatric rehabilitation centers. Collaborative goal setting had been used to define the desired treatment outcome. The quality of the goals was assessed using defined SMART criteria., Results: Specific: All goals could be reliably linked to International Classification of Functioning, Disability and Health-Children and Youth version chapters within the Activity/Participation domain. Measurable: A total of 75% of the goals were rated as having a well-defined scaling; in 20%, the scaling was less clear, and in 5%, a scaling could not be determined. Achievable: A total of 80% of the goals were attained. Relevant: All goals were set in collaboration with the family and could therefore be considered relevant from a client perspective. Relevancy judged from a professional perspective was strengthened by the fact that age, baseline status, and diagnosis had an influence on the choice of goals. Timed: All goals were set within a specific time frame., Conclusions: The goals set in clinical practice showed high quality with respect to the SMART criteria. The most difficult part was the construction of the goal attainment scale. The goals settled in clinical practice were considered relevant from both a client perspective and expertise perspective., (© 2018 John Wiley & Sons Ltd.)

Aim: The purpose of this integrative literature review was to understand the experiences of East Asian families of children with Down syndrome and identify factors affecting their adaptation in the Resiliency Model of Family Stress, Adjustment and Adaptation., Background: Socio-cultural factors influence how well families adapt following the birth of a child with Down syndrome. Existing literature in this area has focused primarily on families from Western cultures. This is problematic because nurses care for families from all over the world. Therefore, the focus of this review is on families of children with Down syndrome living in East Asia, where Confucianism is dominant., Design: Integrative literature review., Data Sources: Online databases (i.e. PubMed, CINAHL and PsycINFO) and a public search engine (i.e. Google Scholar) were used along with manual searches of reference lists and major journals. Studies were limited to original publications written in English and published between 1990-2014., Review Methods: Two authors independently performed integrative review processes proposed by Whittemore and Knafl and a quality assessment using the Mixed Methods Appraisal Tool., Results: Like families in Western cultures, some East Asian families of children with Down syndrome adapted well and even thrived while others struggled. Various socio-cultural factors, including some associated with Confucianism, played a role in how individuals, dyads and families adapted., Conclusion: An understanding of socio-cultural influences can help nurses implement culturally sensitive family-centred interventions with families of children with Down syndrome. It may also facilitate policy changes concerning resources for these families., (© 2016 John Wiley & Sons Ltd.)

Background: As individuals with Down syndrome are living longer and more socially connected lives, early access to supports and services for their parents will ensure an optimal start and improved outcomes. The family's journey begins at the child's diagnosis, and cumulative experiences throughout infancy and childhood set the tone for a lifetime of decisions made by the family regarding services, supports and activities., Methods: This study utilized focus groups and interviews with seven nurses, five therapists, 25 service co-ordinators, and 10 English- and three Spanish-speaking parents to better understand family experiences and perceptions on accessing Down syndrome-related perinatal, infant and childhood services and supports., Results: Parents and providers reflected on key early life issues for children with Down syndrome and their families in five areas: prenatal diagnosis; perinatal care; medical and developmental services; care co-ordination and services; and social and community support., Conclusions: Systems of care are not consistently prepared to provide appropriate family-centred services to individuals with Down syndrome and their families. Individuals with disabilities require formal and informal supports from birth to achieve and maintain a high quality of life., (© 2014 John Wiley & Sons Ltd.)

Objective: Parents and health professionals believe that recurrent respiratory tract infections (RRTI) have a large impact on children with Down syndrome (DS). We studied the relation between parent-reported RRTI and development, behaviour and health-related quality of life (HRQoL) in 8-year-old children with DS., Method: During a 3-year period, 325 children with DS were recruited for inclusion in this observational study. Parents were asked to fill in the Child Behavior Checklist and TNO-AZL Children's Quality of Life Parent Form. A psychological assistant administrated the McCarthy Scales of Children's Abilities. The children were divided into a group with presence of RRTI (RRTI (+) ) and a group without RRTI (RRTI (-) ), on the basis of parental report. Linear regression analyses were performed to assess the effect of RRTI, while correcting for the influence of confounders., Results: Compared with RRTI (-) children (n = 176), RRTI (+) children (n = 149, 46%) showed decreased mental and motor development (mean developmental age 3.67 vs. 4.08 years), more behavioural problems and lower scores on most HRQoL scales (P < 0.05). Moreover, school enrolment is less favourable in RRTI (+) children., Conclusion: In 8-year-olds with DS, the children with parent-reported RRTI show more delayed development, more behavioural problems and lower HRQoL compared with the children without RRTI. Although this association does not prove a causal relationship, further studies should focus on this, because RRTI are potentially preventable., (© 2012 John Wiley & Sons Ltd.)

Aims and Objectives: To determine awareness, use and attitudes of Turkish women towards prenatal screening tests (PST) for Down syndrome (DS)., Background: The technology of screening and diagnosing congenital diseases and abnormalities of foetuses has rapidly developed in the past few decades and prenatal screening for DS in early pregnancy is a valued component representing a cost-effective public health intervention in modern developed countries., Design: Cross-sectional and descriptive study., Methods: The study was carried out in 518 women in the early postpartum period at the Maternity and Children's Hospital between 1 September 2010 and 1 March 2011 using a questionnaire developed by the researchers., Results: Awareness about the first- and second-trimester PST [nuchal translucency (NT), triple test] was 21·6 and 59·7%, whereas use of them was 13·7 and 44·8%, respectively. Women who had lower education, were unemployed, had a patriarchal family type, had a low income status, were unmarried, had consanguineous marriage and did not have a private doctor were less aware and had less use of NT and/or triple test. Women who did not have a genetic disease in their family, were multiparous, had an unplanned pregnancy and did not receive antenatal care were less aware and had less use of the triple test. In case, the foetus was diagnosed as DS, women made the following decisions: continuing the pregnancy, terminating the pregnancy, leaving the decision to the doctor and being not sure 34·9, 12·0, 29·9 and 23·2%, respectively., Conclusion: Women's knowledge about and attitudes towards PST are important. This study shows that Turkish women have limited knowledge about and use of PST. Therefore, health professionals play a significant role in improving patients' information about PST. They should dedicate more time to discussions with women, provide appropriate and understandable information tailored to women's socio-economical level and should emphasise the indications, purposes and limitations of PST., Relevance to Clinical Practice: Discovering women's opinions and knowledge about PST will help healthcare providers determine their information needs., (© 2012 Blackwell Publishing Ltd.)

Background: International research in recent years has begun to focus on the medical problems of individuals with intellectual disabilities and on family stress in accessing health services for persons with developmental disabilities. Less is known about the needs of individuals in different diagnostic groups, or about their experiences of systems of care. Therefore, we report the results of focus groups with parents of children or adults with fragile X syndrome, autism or Down syndrome., Methods: Semi-structured group interviews with parents of children, youth or adults from each of three diagnostic groups probed perceptions of challenges and successes in obtaining and negotiating healthcare services in Ontario, Canada., Results: Parents described diverse barriers to care, the need for advocacy in securing services, perceptions of service delivery and the role of healthcare professionals in regulating access to a wide range of services. Diagnostic services represented one area of central concern to parents from all three groups., Discussion: Focus group data yielded a wide range of concerns. Suggestions for enhancing the system included expanding syndrome-specific education for medical students and health professionals and creating a centre that could offer service-related information for parents.

Background: There have been few reports of the world views, values and priorities of families of children with autism or Down syndrome, despite the fact that family belief systems are considered to be among the most important factors affecting the adaptation and resilience of families., Methods: Transcripts from three focus groups involving 19 key informants (15 parents of children with autism or Down syndrome, and 4 service providers) were analysed using qualitative methods., Results: The themes indicated that raising a child with a disability can be a life-changing experience that spurs families to examine their belief systems. Parents can come to gain a sense of coherence and control through changes in their world views, values and priorities that involve different ways of thinking about their child, their parenting role, and the role of the family. Although parents may grapple with lost dreams, over time positive adaptations can occur in the form of changed world views concerning life and disability, and an appreciation of the positive contributions made by children to family members and society as a whole. Parents' experiences indicate the importance of hope and of seeing possibilities that lie ahead., Conclusions: The information from this study may be used to provide families with an advance understanding of the changes in beliefs that they might undergo, and assists service providers in providing individualized and family-centred services and supports to families.

The health services often struggle in their attempts to engage and support fathers. This paper describes the piloting of a small group for the fathers of children with a disability, in this case Down Syndrome. The group is described from conception to conclusion and limitations of the study are discussed. The group approach meets a need for a proportion of fathers who prove able to explore their experiences and feelings.

Three studies were undertaken of two cohorts of young people with Down's syndrome. One cohort, of 52 people, was born in the 1960s and they were seen in their teens and again in their mid-20s. The other cohort, of 26 people, was born in the 1970s and they were seen in their teens. The studies show that while carers in both cohorts paid lip service to the rights of young people with learning disabilities to have sexual experiences and to marry, they did not necessarily feel that this applied to their own youngsters. Carers of the 1970s cohort at teenage were more permissive than carers of the 1960s cohort at adulthood. How carers controlled the sexuality of their young people is discussed. Carers in both cohorts were rarely in favour of parenthood for people with learning disabilities and over half the carers thought that sterilization might be appropriate, in some circumstances. At teenage, about two-thirds of carers in both cohorts thought that their youngsters needed sex education. By adulthood, in the 1960s cohort, only one-third of the same group of carers continued to hold the same view. According to carers, more young people knew about events that they were unlikely to experience themselves, namely pregnancy and birth, than knew about the most likely event, sexual intercourse. So, in spite of holding permissive views on sexual expression for people with learning disabilities, carers left their own young people ill-prepared for such experiences. Few young people were given the education or freedoms necessary to encourage sexual relationships. Reasons for this discrepancy are discussed.

The emotional impact upon the family following the diagnosis of a child's disability is significant although parents feel that their needs are not specifically addressed by professionals. A series of groups for the parents of pre-school children with severe disabilities are described. The groups are designed to provide parents with an opportunity to discuss in depth the impact of their childs' disability upon themselves, their partners and their families. Feedback from group members is reported and the practical issues in providing such groups discussed.

Patients with Down's syndrome are particularly vulnerable to the development of both hypothyroidism and Alzheimer's disease. Both hypothyroidism and Alzheimer's disease may be associated with elevated serum concentrations of thyroid stimulating hormone. In a group of institutionalized Down's syndrome patients with normal thyroid function, global scores of ability were higher than in a group of patients with elevated thyroid stimulating hormone levels in the presence of normal T3 and T4. The actual concentrations of thyroid stimulating hormone were shown to be significantly and inversely correlated with scores of global abilities. If these findings are reproducible, the authors believe that thyroid stimulating hormone estimation may provide confirmatory evidence of clinical dementia in this group of mentally handicapped individuals.

The present authors report the case of a 42-year-old female with Down's syndrome who developed a misidentification syndrome, erotomanic delusions towards her Bible instructor, and increasing grandiosity following the death of her father. The authors believe that her symptoms may be formulated in developmental and dynamic terms.

Functional behaviours in relation to age were investigated using data from approximately 3000 people on the Wessex Mental Handicap Register. The main functional data on the register, the National Development Team's 24-item questionnaire, were cluster and factor analysed to derive a series of client-defining variables. Age-trends were analysed in relation to self and community care skills (activities of daily living and instrumental activities of daily living), problem behaviours, chronic medical conditions, mobility and sensory abilities. Generally, it was found that differential mortality leads to an older population in good health and with a high level of functional skills. As with the general population, however, people over 70 years old show increasing prevalence of age-related infirmities.

Videorecordings were made in the homes of six children with Down's syndrome whose developmental ages ranged between about 1 and 2 years. Analysis of sequences initiated by parental offers to their children suggests that these children's response behaviour is sensitive to both non-verbal aspects of the offerer's behaviour and the context in which the offer is made.

The ADIECAS classroom behaviour rating scale (Evans & Hogg, 1984) was used with a sample of 123 children with Down's syndrome as part of a wider study of child and family adaptation. According to Evans & Hogg, the ADIECAS scale measures two types of behaviour: attentiveness-distractability, and inhibition-excitability. Such measures of behaviour style may be related to behaviour problems and child and family relationships for children with mental handicap. The factor structure of the 16 ADIECAS items was investigated by using confirmatory factor analysis within the LISREL program. Overall, the original factor structure was found to be a poor fit to the new data, in that, while the distractability factor replicated well, the excitability factor split into three. After examining the components of the four factors, two were discarded as containing unreliable items, and goodness of fit statistics on the two revised factors, using 10 of the original 16 items, gave the best results. Thus, the factors structure showed only limited replicability with a different subject group from the original Evans & Hogg study.

The occurrence of moyamoya disease in a child with Down's syndrome is reported. Ten previously published instances of this association are briefly reviewed, with comments on its possible significance.

Sudden-onset, unprovoked aggression has typically been difficult to reduce or eliminate in persons with mental handicaps or dementia. Several medications have been reported in the literature with varying success, though some risk serious side effects. This study tested the effectiveness of a low dose antidepressant (trazodone) with a serotonin-enhancing diet to reduce aggression while not risking serious side effects. Aggression decreased by 96% in a mentally handicapped adult with Down's syndrome showing signs of Alzheimer-type dementia. The benefit was robustly demonstrated using an on-off-on-again design with detailed recording for nearly 4 months.

An index of self-sufficiency in children with Down's syndrome was developed for use in a study of the process of adaptation in families living in the Greater Manchester area. The children were 6-14 years old, and living at home. Index scores were based on the mothers' responses to a questionnaire covering their children's personal and domestic functioning and community self-sufficiency, and were obtained from 111 of the 117 mothers who took part in the study. A wide range of child- and family-related variables were found to be significantly associated with self-sufficiency scores on a univariate level. Multiple regression analysis was used to identify those variables which best predicted the level of self-sufficiency achieved. After the child's mental age, the most significant variables were excitability, behaviour problems, the extent the mother used practical means of coping, and the level of social activity experienced by the child. Together, these five variables explained 63% of the variance in self-sufficiency scores. The dynamics by which such factors may relate to self-sufficiency in children with Down's syndrome are discussed, and intervention aimed at promoting the use of practical ways of coping by parents is suggested.

A questionnaire in the form of a bipolar rating scale was constructed using 26 personality attributes drawn from the literature on personality of children with Down's syndrome (DS). This was administered to nine groups of adults with differing levels of experience and contact with children with DS. Adults who had frequent contact proved to be significantly less likely to rate the personality of children with DS as stereotypical than those with little contact. The implications of acceptance of the stereotype are discussed in relation to integration and to development of the mother-child relationship.

Eight adult male stutterers with Down's syndrome (DS) were compared with a matched group of fluent speakers with DS on verbal and manual motor production tasks at two levels of complexity. The simpler tasks involved diadochokinetic rate (syllable repetition) and finger tapping; the more complex tasks involved the imitation of sentences and placing pegs in the grooved pegboard. On both verbal and manual tasks, stutterers were faster on the simpler but slower on the more complex tasks than were the fluent speakers. The findings suggest that stutterers with DS have a different motor organization than fluent speakers with DS.

Frequency of participation in organized activities and informal play contacts with other children were investigated for a group of 118 children with Down's syndrome. Measures were based on mothers' reports. As part of a study of child and family functioning, a wide range of child, parent and family variables was measured and the relationships of these to the extent of the children's social contacts were investigated in multivariable analyses. Family variables of social class, parental education, marital relationship, and achievement and recreational orientation were found to be significantly related to the measures of the child's social life. In addition, children at the lower end of the IQ range in this sample were likely to have fewer informal play contacts. These results point to the influence of the family in stimulating and maintaining the children's social activities.

The ability to comprehend syntactically ordered sequence by Down's syndrome adults and adults with mental retardation of no specific aetiology was studied. Both samples exhibited patterns of comprehension that resembled those of children who are not mentally retarded. However, the Down's syndrome individuals had significantly more difficulty when sequence was indicated by syntax with no supporting extralinguistic context. The Down's syndrome adults appeared to be arrested at an earlier stage of development than the other mentally retarded adults.

A 26-year-old profoundly mentally handicapped woman with Down's syndrome and severe self-injurious behaviour was treated by dietary means. Treatment consisted of regular institutional entrees, supplemented with serotonin-containing foods, and modified to ensure dietary sources of potassium each intake and low protein relative to carbohydrate. Dramatic benefit was evident the first day and, after 6 months self-hitting was still close to 90% lower than baseline rates. Relevant literature was discussed regarding why a serotonergic approach was chosen for reducing self-injury.

A profoundly mentally handicapped patient is described with the karyotype 47,X, fra (X) (q27), + 21. Her phenotype demonstrates features of both Down's Syndrome and fragile-X syndrome. The authors believe only one other similar case has been described.

This investigation attempts to examine a sense of rhythm in relation to levels of response to rhythmic stimuli in normal children and mentally handicapped children, particularly children with Down's syndrome. Ten Down's syndrome (average CA: 158 months, average MA: 43 months), ten other mentally handicapped children (average CA: 147 months, average MA: 44 months), and ten normal children (average CA: 50 months, average MA: 46 months) were required to listen to a rhythm and to shadow certain rhythms by tapping them out simultaneously with the stimuli. Three different rhythms of increasing complexity were used. After a practice session, responses were collected from subjects using a tapping device; these were recorded on a computer. Results obtained in all aspects of the tests were very similar in both normal and Down's syndrome groups. The other mentally handicapped children were considerably weaker than the other two groups. It is suggested that at this level there is no difference between Down's syndrome and normal children of the same mental age in rhythmic discrimination. Differences lie between Down's syndrome and other mentally handicapped children and this comparison could account for the attribution to Down's syndrome children of a higher than normal level of musical skills.

Play with parents is recognized as an important learning medium for all children, yet there have been remarkably few studies of mothers' spontaneous actions with toys while playing with their children and none at all with Down's syndrome infants. This was a home-based study which commenced when the infants were 12 months old, and observations were made at approximately 6-weekly intervals until the infants were 24 months old. Significant differences were noted in mothers' play patterns with different toys and over the year there were marked changes in their actions. These seemed to result from developments in the children's play with toys. The findings reinforce the competency of most mothers as interactors with, and teachers of, their children. Possible implications for intervention strategies are discussed, especially the provision of more specific information about the sequences of development in children's play.

The structural features of sensorimotor intelligence were examined among two groups of Down's syndrome infants administered the seven Uzgiris and Hunt scales of infant psychological development. Two measures of associative relationships (stage congruence and intercorrelations) among the subjects' performances on these scales were subjected to both hierarchical cluster analysis and factor analysis to discern the underlying structure of the data. The analyses yielded between two and four clustering networks of behaviours for each sample of infants. Moreover, the clustering and factor solutions for both samples were quite alike. Comparisons of the findings with those in other investigations showed that both Down's syndrome groups manifested patterns of organization very similar to structural networks for more heterogeneously formed groups of mentally retarded subjects. The need for better designed comparative studies is noted.

This study was designed to investigate both parents' and physicians' attitudes and perceptions concerning facial plastic surgery in persons with Down's syndrome. The results of this inquiry revealed that more physicians (63%) than parents (28%) feel that the children's facial features negatively affect their social development; most parents (85%) see their children well accepted by society whereas only 4% of physicians do so; approximately half of the physicians (51%) and parents (41%) thought that after hypothetical facial plastic surgery a child with Down's syndrome may accomplish more socially; the majority of the parents (92%) and physicians (76%) were concerned with the risk of the operation; and only 13% of parents but 44% of physicians indicated that facial plastic surgery should be done on children with Down's syndrome.

Using automated equipment, contingent responding and auditory preferences were examined in 15 severely, profoundly and multiply handicapped children (CMAs 3-20 months) and 2 non-handicapped children at ages 5.0 and 9.5 months. 15 children showed contingent responding; prolonged responding was shown by the profoundly handicapped group. Where auditory preferences were apparent, they were the same as those seen in Down's syndrome and non-handicapped groups at the same developmental level. Children at the 5 months developmental level and less, had difficulty in making choice responses. Implications for intervention are discussed.

Groups comprising twelve Down syndrome, twelve other mentally handicapped children and twelve normal children, matched for M.A., were tested on a visual discrimination task. There was some evidence to support the suggestion that certain types of mentally handicapped children attended to single cues, rather than to total configuration. There was also evidence of perceptual distortion resulting in reversal and attraction to "good form". Differences were detected between Down syndrome and non-Down syndrome handicapped children which were consistent with the suggestion that Down syndrome children characteristically show flexibility in approach to perceptual discrimination tasks. The results were not inconsistent with interpreting perceptual processes in handicapped and normal children as essentially similar.

Seventy-five children were examined in tasks involving matching figures in order to establish whether there exists a specific attraction to symmetrical or Gestalt type "good form" displays in mentally handicapped children and particularly in Down's Syndrome or if the tendency was towards image reversal. Twenty-five children with Down's Syndrome were matched on M.A. with twenty-five non-Down's Syndrome subnormals and twenty-five normal children. Symmetrical and asymmetrical displays were presented to the groups for reproduction and reproduction from memory. The results supported the hypothesis that mentally handicapped children have a significant attraction to symmetrical arrangements and that Down's Syndrome children are more significantly attracted than other handicapped children. Evidence is presented to show that what often is mistaken for a tendency to image reversal is in fact an attraction to "monotonicity" and is more related to "good form" than to reversal.

A battery of tasks to indicate stage membership within the Lurian theory of development of verbal control of motor behaviour was given to children whose moderate level of mental retardation derived from organic pathology, familiar conditions or Down syndrome, and to a group of normal preschool children matched for mental age. The results supported Luria's contention that the development of mentally retarded children, regardless of aetiology, is arrested at the second (asemantic) stage and that their performance deficiencies are even greater than might be predicted simply on the basis of their developmental level.

Smiling by five Down's syndrome and seven nonhandicapped infants was recorded longitudinally during face-to-face interactions with their mothers over the first 6 months of the infants' lives. Two conditions, 'mobile' (mothers were asked to talk to the baby as naturally as possible) and 'immobile' (silent and maintain an impassive face), were contrasted. Between-group comparisons confirmed previous findings of significantly delayed emergence and less frequent smiling by the infants with Down's syndrome. Their smiles were also found to be shorter, and less discriminative between the two face-to-face conditions. The non-handicapped infants showed significantly more cry/distress vocalizations in the immobile than in the mobile condition, while the reverse was found for the Down's syndrome infants. A close temporal association between smiling and eye contact with mothers was found for both groups of infants. In a free interaction condition, mothers of the Down's syndrome babies showed a stronger tendency to use kinaesthetic and tactile stimulation than mothers of the non-handicapped infants.

The purpose of this study is two-fold: (1) to describe developmental and family characteristics of infants with Down's syndrome who were enrolled in an intervention programme; and (2) to examine developmental and caretaking patterns related to maternal age and congenital heart defects. Infants and their home environment were assessed at about 3 1/2 months and at 24 months of age. A sample of normal infants of equivalent developmental age were also tested for comparison. We found that while the infants with Down's syndrome showed a significant decline in their developmental quotient compared to the normals, their home environments resembled those of the normal group, particularly at the pretest. Yet, there were more improvements in the homes of the group of normal infants than in the homes of the infants with Down's syndrome, mainly in maternal responsivity. Older mothers restricted their infants with Down's syndrome more than younger mothers, but otherwise they did not seem to differ from each other. Infants with Down's syndrome without heart defects were provided with a better home environment than were infants with Down's syndrome with a heart defect. These results are discussed in the light of the biological limitations placed on the Down's syndrome infants and difficulties in parental adaptation to the diagnosis of Down's syndrome.

Public policy now provides that mentally handicapped children should as far as possible be integrated into normal schools and playgroups. Down syndrome children are among the most hopeful candidates for such integration and the the paper reports observations of several such children on their first day in a normal playgroup or after regular attendance at a playgroup over a period. The observations were by opposed video cameras fitted with telescopic lenses and placed at opposite ends of the room, far enough away to be ignored by te children. It appears that the normal children make heroic but unsuccessful attempts to establish contact with the DS child but eventually give up, with the result that the DS child becomes an isolate in the group--interacting with no one except the adult helpers. (The DS children had been well prepared and were capable of all the activities engaged in by the normal children.) It is suggested that their failure may be interpreted by the other children as gaze aversion--evidence of a desire to avoid interaction.

Four infants with Down's syndrome (aged 19-33 months) were presented with a restructured version of an object-permanence task. Restructuring consisted of the embedding of single trials of the task within a sequence of simpler, related steps. Following failure on a standard presentation of the task, three Down's syndrome (DS) infants demonstrated success on trials embedded in the training sequence. Comparison was made with the performance of normal infants (aged 14-19 months) matched in terms of failure on the pre-test. Only two out of nine normal infants registered success on the embedded trials. Results are discussed in terms of the differences between the DS infant and the normal infant, and the former's reliance on the deliberate structuring of his learning environment by a parent or educator.

Thirty-four children were selected who had reached a criterion on a matching task. Seventeen Down's syndrome were matched on M.A. with seventeen normal children (M.A. 6.0 X 0.5); there were nine females and six males in each group. All subjects were tested on two matching tasks, one involving increasing density of pattern and the other of both increasing size and density of pattern. The tests were repeated with the introduction of a short-term memory variable. Results showed that both groups had a preferred dimension for size over pattern. When size and pattern were combined, the Down syndrome group were confused by the two dimensions, showing preference for one or the other. The performance of the Down syndrome group was significantly weaker than the normal group, who were able to accommodate the imposition of patterns on size. In contrast to the Down syndrome group, attention to two dimensions helped to improve performance in the weaker dimension.

The reinforcing properties of four sensory stimuli (continuous and flashing light, vibration and sound) which were under the subject's control, were examined and the effect on stereotyped behaviour observed. The subjects were 24 severely retarded children in three diagnostic groups; Down's, Rubella and a group which included neither of these diagnoses. Duration of stimulation with continuous light was significantly lower than the other three stimuli, but there were no differential effects on stereotypy, nor diagnostic group differences.

Previous cross-sectional studies of Down's syndrome have suggested that deficits in cognitive and neurological functioning after the age of 35 years are symptomatic of Alzheimer's disease. It has been claimed that this pattern corresponds to post-mortem neuropathological findings of Alzheimer's disease in all Down's syndrome patients who die aged over 35 years. In the present study of Down's syndrome patients aged between 19 and 49 years, results showed that, for those over 35 years, intellectual deterioration had occurred in less than a third. No relationship was found between chronological age and the level of self care skills or the presence of disturbed behaviour. Results are discussed in terms of the interpretation of the existing neuropathological literature, the methodology of future studies and clinical decisions regarding hospitalized patients with Down's syndrome.

136 mongol, 129 non-mongol subnormal and 152 normal children were tested in a series of experiments to determine visual discrimination and perceptual skills in size, form and order. An attempt was made to demonstrate possible differences in strategies and behaviour in the groups, particularly in the mongol group. It was shown that, in spite of contrary impressions arising from results of normal standardised tests, in these three groups matched on M.A., there was no significant difference in performance when extraneous developmental factors were eliminated. The literature relating to this is discussed. There was further support for the existing experimental evidence that poor short-term memory for visual stimuli in terms of size, form and order is a characteristic weakness of subnormal groups. No relationship was found between M.A. and visual perceptual tasks in any group; supporting the theory that perceptual skills develop independently. A peculiar phenomenon was discovered in the mongol group significant enough to warrant further investigation, viz. a distinctive form of perseveration and a related and clearly marked tendency to order reversal. Suggestions are made and possible reasons presented for this, but, at this stage, without experimental backing.

The authors investigated parental perceptions of social interactions, interest in the opposite sex, sexual functions and issues concerning sex education in young persons with Down's syndrome. The evaluation of the data revealed that more than half of the study population showed interest in the opposite sex and are attending social gatherings. Many of the youngsters had expressed a desire to get married, however, only a few had an interest in sexual relationships. Masturbation was observed in 40% of the young men and in 22% of the young women. About half of the parents feel that their children should be sterilized or should have other forms of birth control if they would be able to reproduce. Only a limited number of adolescents had sex education. More parents who have girls with Down's syndrome than those who have boys are worried that their child may be taken advantage of sexually.

Extinction responding of children with severe retardation was compared when one component of a multiple schedule (VR-20/VR-20) was interpolated with one session of additional reinforcement. Either variable ratio 10 (VR-10), variable ratio 5 (VR-5) or continuous reinforcement (CRF) were interpolated in one component prior to extinction in both. Interpolated reinforcement resulted in an extinction process at least as efficient as traditional methods. Total responding in the VR-10 and VR-5 components was less than in the comparable unchanged components. Results support and extend research with animals and humans. Results also suggest the feasibility of using such a procedure to gain control of behaviours that are controlled by intermittent schedules of reinforcement, are under multiple or inconsistent stimulus control or occur infrequently.

Lifelong nocturnal enuresis in a 9-year-old boy with Down's syndrome was tackled using progressive lifting, in which he was lifted and potted at a time in the early evening when he was found to be reliably dry. The programme was designed for the boy to be lifted progressively later in the evening until all-night dryness was achieved. However, all-night dryness began to occur 4 months after the start of the programme and lifting was at only half an hour beyond the original time when it was discontinued. Four months after this the boy was completely dry. Possible reasons are discussed.

Psychological tests were administered to a complete population of severely retarded children aged 0-14, from one area of south-east London. The fifty-six children selected for the present study included all those who had obtained scores on measures of social maturity, visuo-spatial skills not involving symbolic concepts, and level of language comprehension. The results show very low correlations between the age-related quotients obtained for each measure. This suggests that, in severely retarded children, marked discrepancies can occur between different areas of cognitive and social development. Some children could be classified as moderately or mildly retarded on one type of test but as profoundly retarded on another. The profiles on the tests can be related to diagnosis and behaviour pattern. The findings highlight the problems of assessment and educational placement of retarded children.