University of Edinburgh

Supporting Deaf Pupils with Additional Learning Needs

Presented on Tuesday, 18 January 2011

Down's Syndrome

Wendy McCracken

What do we know?

  • Audiologically complex
  • Problems of longer latencies
  • Challenge of conductive loss
  • Importance of on-going audiological surveillance
  • Changes in skin of ear canal - moulds
  • BAHAs
  • FM amplification

Short-term memory

  • They have a specific impairment in short-term memory for verbal information.
  • This will make processing verbal information and, therefore, learning from listening, especially difficult for children with Down's syndrome.

For children with Down's syndrome:-

  • hearing impairments and poor auditory discrimination skills
  • impairments in phonological loop function leading to 'poor' phonological representations being constructed and maintained in the loop
  • slow development of clear speech leading to 'poor' phonological representations being constructed and maintained in the loop
  • less familiarity with words, due to slow vocabulary learning and delayed production of words
  • being slower to retrieve phonological information from long-term memory
  • being slower when organising and saying spoken words
  • lack of rehearsal strategies

The ability of the phonological loop to construct and to maintain a memory trace will effect verbal short-term memory skills.

  • Does the phonological loop construct a good representation of the sound pattern of the word?
  • Does it maintain this representation for an adequate length of time?
  • Children with Down's syndrome are using phonological coding but probably not rehearsal strategies as they get older, unless they receive specific training
  • Both verbal and visual short-term spans can be improved by teaching children rehearsal strategies

Visual short-term memory spans tend to improve with training more than verbal spans

Visual information may be used to support verbal recall tasks and visual recoding of verbal information may be used to aid memory

To build the phonological loop

  • Must have access to sound
  • Hearing aids must be fitted appropriately
  • FM systems should be in place
  • Expectation will be a key factor promoting 'success'







What's gone?

what's gone

what's gone

Rehearsal training

  • Objects
  • Pictures
  • Numbers
  • Spellings


  • Children with DS use more gesture and use it longer than hearing children
  • Make use of iconic gesture
  • Are on target with gesture (topic and meaning) even when speech was unintelligible
  • Implications

Case studies

Working in a small group

Developmental v Global delay

Developmental delay

  • 3% of children will have developmental delay
  • Of these only 15 % will gone on to have abnormal development
  • The remainder go on to develop 'normally'

Global developmental delay

A child with global delay will:

  • Have delays in all areas of development
  • Usually caused by a static disorder at or near the time of birth
  • A range of complex conditions
  • Global developmental delay does not necessarily include a cognitive disability
  • This is very challenging to 'untangle'

Typical development

  • Is linear -may miss steps and develop at different rates BUT 95% meet milestones
  • Should be benchmark against which child's development is mapped
  • Known groups at high risk for HI problem of overshadowing 'not important'

When to red flag?

  • Must be clusters of behaviours
  • Must include a holistic view (has child been ill, mother hospitalised etc)
  • Should be observed over time BUT should NOT be 'wait and see what happens'
  • So how good are we at recognising issues?

Atypical gross motor development

Favouring one hand when

  • Crossing midline to pick up a toy
  • Fisting of the hands beyond when?
  • Persistent primitive reflexes beyond when ?

Motor skills and communication

For a child developing spoken language

  • Difficulty with lip closure
  • Drooling
  • Poor tongue movement
  • Problems with chewing and swallowing

For a child developing sign language

  • Difficulty grasping objects
  • Unable to make fist
  • Difficulty palming objects
  • Inability to hold gaze
  • Inability to cross midline

Emotional attunement

  • Mother recognises and responds to baby's cues
  • BY months baby smiles responsively
  • BY months baby shows interest in people and surroundings
  • BY months babies should be tuned to emotional tone, initiate interaction with a smile, show range of emotional states
  • Avoidance of eye contact, delayed smiling, disinterest in toys or lack or emotional attunement should be red flagged.

Red flags for LD

  • Communication delays, such as slower to establish eye gaze, poor turn taking, feeding difficulties
  • Poor coordination and uneven motor development, such as delays in learning to sit, walk, manipulate toys
  • Problems with memory and routine; for example, not remembering specifics of daily activities, no evidence of anticipation
  • Delays in socialization including playing and relating interactively with primary carer and other children.