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Young Children with Down Syndrome: Help for Parents and Teachers

Kathlyn Tipton, M.A., L.E.P., Licensed Educational Psychologist,

Introduction: Down syndrome is a genetic condition that is caused by the presence of an extra chromosome. Most often, it is an extra copy of chromosome 21, which causes problems with the development of the body and brain1. The most common, salient features include a round face, a protruding tongue, an extra fold of skin over the eyelids, short limbs, and retardation of cognitive and motor skills2. Women under the age of 18 and over the age of 38 are more likely to give birth to a child with Down syndrome2, and it is the most common single cause of birth defects1. It occurs approximately once in every 700 live births and is rare in African American children.2.

Health Factors3: Approximately 50 percent of children with Down syndrome are born with a heart defect. These children are also at greater risk for other congenital abnormalities and health problems. Health issues that occur at greater rates among this population include childhood leukemia, orthopedic disorders, thyroid disease, autoimmune diseases, seizure disorders, hearing and vision impairments, skin conditions, autism and other behavioral problems, and speech and language disorders. They also have increased odds for recurring illnesses such as colds, ear infections, respiratory problems, and gastrointestinal problems. These health issues tend to be more pronounced in the younger children. All children with Down syndrome should be evaluated by their pediatricians regularly.

Intellectual Functioning: A core feature of Down syndrome is intellectual disability. While the cognitive abilities of children with Down syndrome covers a fairly broad range, most fall in the moderately intellectually disabled range4. Research indicates that children with Down syndrome may experience more problems with symbolic functioning and auditory memory than their typical peers5, and are more oriented towards people than objects6. Visual memory7 and imitation6 tend to be relative strengths. Young children with Down syndrome may approach learning more through imitation than object exploration, and they tend to have a practical preference for whatever works instead of a drive to understand6.

Language Development: Limitations in symbolic functioning hinder the development of symbolic play, which is associated with language development5. This correlation is strongest in young children. Children with Down syndrome generally have exceptionally delayed expressive language skills, especially grammar and articulation5, and are often able to understand much more than they can produce7. This is associated with both weaknesses in auditory memory and symbolic functioning5. These children progress through similar stages and sequences of language development as their typical peers, just at a slower pace with longer developmental transitions5.

Social Skills, Temperament, and Behavior: Children with Down syndrome are often people oriented, showing a strength in social skills. They are often described as social, charming, engaging, and friendly4. Behavior problems can include inattention, stubbornness, non-compliance4, impulsiveness, and poor judgment1. People with Down syndrome show lower levels of psychological problems than people with other developmental disabilities, but higher rates of behavior problems8. Infants with Down syndrome are often reported to be calm and easy-tempered, but then temperament and behavior problems develop as they become toddlers8, requiring a shift in parenting approaches.

Play9: Children's play lays the foundation for cognitive, social/emotional, and motor development. Parent-child interaction during play is important in the facilitation of play development. The quality of parent-child interaction is especially important for children with special needs. Appropriate stimulation and social enrichment is critical. This is particularly challenging for parents of children with Down syndrome, however, since such interaction is two-way and parents respond to the behaviors of their children. Children with Down syndrome tend to be less responsive and communicative, initiate less, and engage less in turn-taking social games. The development of play skills follows a progression from sensory-motor exploration, to functional play, and then on to more complicated combinatorial and symbolic/pretend play. Exploratory play tends to be deficient in children with Down syndrome. Parent involvement in child play activities enhances the complexity, frequency, and duration of more advanced play.

Literacy: Reading is often a relative strength among children with Down syndrome. They frequently can learn to read at functional levels, and learning to read may help develop their language and cognitive abilities7. Phonological awareness (the awareness of sounds in words) and visual memory are associated with reading development in young children10. Other important skills include language development, auditory processing, and auditory short-term memory10, which are generally weaknesses among children with Down syndrome. Traditionally, due to their relative strength in visual memory, sight-word recognition has been the primary approach to teaching reading in children with Down syndrome; however, phonological decoding (phonics) must be taught if the child is to become an independent reader11. A rich home literacy environment is critical for the development of reading skills in young children. This includes parents reading to the child regularly, joint storybook reading, children's books being readily available in the home, reading material for adults being present, the child having plenty of space and time to engage with books, the child seeing adults reading, visiting the library regularly, and parents exhibiting a positive attitude about reading7. Parents should view reading as a source of entertainment, and use what/who questions, open-ended questions, expansions, and imitations when reading with their children.


  1. PubMed Health (2010, October 18). Down syndrome: Trisomy 21. Retrieved from
  2. Santrock, J.W. (2004). Life-Span Development (9th Ed.). New York, NY: McGraw-Hill.
  3. Schieve, L.A., Boulet, S.L., Boyle, C., Rasmussen, S.A., & Schendel, D. (2009). Health of children 3 to 17 years of age with Down syndrome in the 1997-2005 National Health Interview Survey. Pediatrics, 123(2), e253-e260.
  4. 4. Rosner, B.A., Hodapp, R.M., Jidler, D.J., Sagun, J.N., & Dykens, E.M. (2004). Social competence in persons with Prader-Willi, Williams and Down's syndromes. Journal of Applied Research in Intellectual Disabilities, 17, 209-217.
  5. O'Toole, C., & Chiat, S. (2006). Symbolic functioning and language development in children with Down syndrome. International Journal of Language and Communication Disorders, 41(2), 155-171.
  6. Wright, I., Lewis, V., & Collis, G.M. (2006). Imitation and representational development in young children with Down syndrome. British Journal of Developmental Psychology, 24, 429-450.
  7. Ricci, L. (2011). Home literacy environments, interest in reading and emergent literacy skills of children with Down syndrome versus typical children. Journal of Intellectual Disability Research, 53(6), 596-609.
  8. Fidler, D.J., Most, D.E., Booth-LaForce, C., & Kelly, J.F. (2006). Temperament and behaviour problems in young children with Down syndrome at 12, 30, and 45 months. Down Syndrome Research and Practice, 10(1), 23-29.
  9. Venuti, P., de Falco, S., Giusti, Z., & Bornstein, M.H. (2008). Play and emotional availability in young children with Down syndrome. Infant Mental Health Journal, 29(2), 133-152.
  10. Byrne, A., McDonald, J., & Buckley, S. (2002). Reading, language and memory skills: A comparative longitudinal study of children with Down syndrome and their mainstream peers. British Journal of Educational Psychology, 72, 513-529.
  11. Van Bysterveldt, A.K., Gillon, G.T., & Moran, C. (2006). Enhancing phonological awareness and letter knowledge in preschool children with Down syndrome. International Journal of Disability, Development and Education, 53(3), 301-329.

Kathlyn Tipton, M.A., L.E.P., Licensed Educational Psychologist,, is the director of EdTeam Education Solutions, Inc., in Fairfield, California. Edteam is an educational services agency providing comprehensive, specialized assessment and intervention services in a collaborative team environment for struggling students and students with diagnosed or suspected disabilities of all ages (2 through adult).

Disclaimer: Internet Special Education Resources (ISER) provides this information in an effort to help parents find local special education professionals and resources. ISER does not recommend or endorse any particular special education referral source, special educational methodological bias, type of special education professional, or specific special education professional.


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