Capstone Final

Communication Difficulties In Individuals With Down Syndrome

Senior Capstone

Steven Larson

10/2/14

Description/Demonstration

What a ride. This college journey has finally come to a close and there is no better way I would have wanted to end it. I chose an interactive project as my senior capstone, titled, ‘Communication Difficulties In Individuals With Down Syndrome’. Through this project I created a 5 week course for three of my Down Syndrome clients to go through with me. In this course, we worked on a variety of things establishing ways to help improve their social interactions. This project was also paired with my internship which were both done at my full time job at RISE. RISE is a program for special needs adults that provides all types of services ranging from Residential, Day Program, and Employment. This project, at the end of the day, helped me just as much, if not more than the clients who participated in it.

The capstone was done over a period of 5 weeks at 2 hours a day, totaling my Internish and capstone combined at 140 hours. Some days would be a full 2 hours with all three of my clients, others we would pair off for 40 minutes at a time or as long as it took to complete that lesson. The clients participating in this project were the ages of 37(Preston), 34(Randy), and 27(Danny). All of the clients had a moderate diagnoses of Down Syndrome. Randy and Preston are very mellow individuals whereas Danny is very outgoing. Danny would usually get through his assignments much faster than the others. All were a complete joy to work with.

The project began with a pre-test, this same test would be given after the course as a post-test to see the individual improvements. The results, although not overwhelming, were wonderful. I was very pleased with the areas of improvement, mainly, their ability to talk in full sentences. I have video recorded part of their post-test and posted it to my blog, with permission. All work was done with the approval of each of their guardians, and they were periodically updated on the work being done. A signature sheet was obtained at the start of the project from the guardians with all information being inclosed.

My objective in this project was obtainable, but something that we had to work for at the same time. I had the objective to improve communication abilities using various lesson plans with three down syndrome adults. I wanted to help them in five different areas, including; Sentence structure, pronunciation of individual words, ability to participate in a prolonged conversation, vocabulary, and expression of feelings (their ability to do so). Through the results which I have attached to this document, the objectives were reached. It would take a much longer period to perfect these things as well as possible, but what we did in such a small period of time was wonderful. The clients all improved in their structure of speech and the ability to talk in full sentences, they finally began to ask questions in a conversation by the end of the course, and they did very well in expanding their vocabulary.

As I look deeper into the work that my clients did, I’m more thrilled with their response to the class more than how they did in it. They were so excited to learn, every day they would be so ready to come to my office as soon as I said their names. They would sit around my desk the same way every day and began this ritual to learn. It was interesting to see how quickly they adapted to a new environment. I was very happy with the initial response of each of their guardians before the work even started. They were excited that I would provide this type of service to their dependent and that helped create another bond between myself and them.

All of my work was either created by myself, or used through websites such as http://www.webenglishteacher.com/ and http://www.k12reader.com/. These websites were fantastic, mainly K12 Reader because of the ease of access and description for what age group the assignments were appropriate for. This was the toughest part and something I definitely could improve on if I was to ever do something like this again; distinguishing what assignments would be appropriate for which clients in the first place because their ages differed so much mentally. But, as I stated earlier, this is something that I have come away and learned something from just as they have.

Each assignment was documented and attached to my final printouts. After each class period, I would take 5 extra minutes alone to write a couple of sentences to document how I felt each individual client did during that lesson. It was extremely apparent that these individuals are just that; individuals and no lesson was done the same way. They all responded to something things better than others and didn’t do well in things that others did. The function levels of the clients had direct impact on how they responded as well, everyone was able to do everything, but some took much longer to complete the lessons some plays than the other.

My reason for choosing this type of project were prior assumptions and research done proving that down syndrome individuals had communication difficulties. I read and read about what these other people did to find out that they had these limitations, which I will talk about later in the paper, but I never came across articles describing what they did to help their situations. I wanted to do that, I wanted to help in any way I could. My study, was done to show that these difficulties, with enough work, can be overcome.

Attendance also played a role in this study, Preson, one of the participants, was not in attendance for the first two weeks. He was very easy to catch up though, and always willing to learn. I tried to keep each lesson to equal importance as the next or last, so that If a client was absent one day, all would be ok. Danny was my most active client in attendance and was definitely the easiest to teach, he would get sidetracked at times, but was willing to do whatever was put in front of him. Sometimes, clients would respond better to projects dealing with pictures and fun things, but usually they enjoyed having that individual time with me to work together. Whenever a client would be absent, I would be informed prior by their guardians and would attach a blank document of the work they missed to their individual packets for them to just look at next time.

Literature Review

The work that I have done was pre-determined by studies of research showing that Down Syndrome Individuals have these difficulties to begin with. Attached to each of the individuals packets is the literature review from each source that I used to base my work off, I will also attach it here:

LIBBY KUMIN (1994) INTELLIGIBILITY OF SPEECH IN CHILDREN WITH DOWN SYNDROME IN NATURAL SETTINGS: PARENTS' PERSPECTIVE. Perceptual and Motor Skills: Volume 78, Issue , pp. 307-313.

One of the factors that affects speech intelligibility for children with Down syndrome is

difficulty with voluntarily programming, combining, organising, and sequencing the movements necessary for speech. One of the main difficulties with speech is verbal apraxia (brain has problems moving the right body parts to speak correctly. Survey that parents responded on their children's ability to speak. 1620 surveys were analyzed, girls were easier to to understand than boys with down syndrome (My study will be all boys). A lot of parents responded that it was hard for their children to imitate words they said.

Roberts, J. E., Price, J. and Malkin, C. (2007), Language and communication development in down syndrome. Ment. Retard. Dev. Disabil. Res. Rev., 13: 26–35. doi: 10.1002/mrdd.20136

Most individuals with Down syndrome have mental retardation and speech and language deficits. Individuals with Down syndrome have

- delay in cognitive development with specific deficits in speech, language production and auditory short-term memory

- fewer adaptive behaviour problems than individuals with other cognitive disabilities

- increased risk for depression and Alzheimer´s disease

Females showed milder degrees of intellectual disability, People with mild to moderate intellectual disability and better speech are often able to express their feelings verbally, which may be helpful to adaptation. Learning and adaptive behaviour are variably affected in all people with Down syndrome.

Chapman RS, Hesketh LJ. Language, cognition, and short-term memory in individuals with Down syndrome. Down Syndrome Research and Practice. 2001;7(1);1-7.

PROBLEMS:

• Deficits in:

working memory: executive functions in verbal and visual, traceable to problems in inhibiting currently active schemas; auditory and visual short-term stores

• Expressive language delay compared to mental age and comprehension levels
• Syntax comprehension delay emerges, compared to mental age and vocabulary comprehension
• Sentence structure more delayed than vocabulary in both comprehension and production

STRENGTHS:

• Comprehension vocabulary can exceed nonverbal cognition, with experience
• Language learning continues throughout late adolescence and young adulthood in both comprehension and production
• Almost half of individuals studied acquire literacy
• Intelligibility improves with chronological age and continued therapy work

Journal of Speech, Language, and Hearing Research, February 1995, Vol. 38, 157-167. doi:10.1044/jshr.3801.157

History: Revised September 30, 1993; Accepted July 14, 1994

Many children with Down syndrome display asynchrony in development with the acquisition

of language preceding at a slower pace than the acquisition of other cognitive skills. Recent research suggests that the expressive language delays that are displayed by these children may be associated with an earlier disturbance in the development of nonverbal requesting skills. The results of the study indicated that this sample of children with Down syndrome exhibited a disturbance in nonverbal requesting. Furthermore, individual differences in nonverbal requesting were associated with the subsequent development of expressive language in these children.

http://books.google.com/books?hl=en&lr=&id=rszjuelU-kAC&oi=fnd&pg=PA1&dq=communication+difficulties+down+syndrome+research&ots=8Geiwk842I&sig=GnbpVbTYFzjHsr2q6cHJDDjxj9k#v=onepage&q=communication%20difficulties%20down%20syndrome%20research&f=false

With Down Syndrome, the link between speech production and speech perception are very

slow to develop. The link of nonverbal requesting is also slow, these all trail around to making it hard to understand information relayed to the children with down syndrome. Individuals with down syndrome typically show a huge language deficit.

Chapman, R. S. (1997), Language development in children and adolescents with Down syndrome. Ment. Retard. Dev. Disabil. Res. Rev., 3: 307–312. doi: 10.1002/(SICI)1098-2779(1997)3:4<307::AID-MRDD5>3.0.CO;2-K

Just like babies develop language in steps, so do children with Down Syndrome. It does not

make them any different. This article demonstrates some useful techniques to interact effectively with children with Down Syndrome. Although the study was focused on sibling interaction, the same can be applied to all persons who want to communicate with children with D.S.

PLO’s and Artifacts

I want to quickly go over the artifacts that I have connected with my capstone. I made the mistake of not recording the pre-test but was able to record the post test. This did make it a bit harder to really analyze the results, but I was able to based off of the basic hand-written tests that we did together. The tests, were done in a format of me asking the clients the question so that I could better explain it if necessary. After I asked the question, I would let them answer it providing little help if necessary.

Artifact A deals with my friend Danny. Danny is very outgoing and loving and will do anything for his friends and family. He has a moderate case of Down Syndrome and is the most talkative out of the group. Danny did very well with most worksheets and his only issue was keeping focus. Danny got through each assignment usually the quickest and was happy to be done and rushed out of the room. He was also very happy to start though and would rush into the room at the beginning. Danny was a fantastic participant in this project.

Artifact B is of Preston. Preston is the nicest person I have ever met. He is always willing to do things for others and his favorite hobby is cleaning. Preston loves to take his time and was definitely the slowest through each of the worksheets. At times, with Preston, I would make the mistake of repeating myself before he had a chance to answer because I felt that he lost focus, when, he was only getting ready to answer. Preston is very pleasent to work with and is extremely intelligent. I’m fully confident that if he didn't miss the first two weeks of class he would have excelled even more than he already did.

Artifact C is of the wonderful Randy. Randy is the funniest person that you could possibly know. He is always joking, and mimicking me at serious times and puts a smile on my face when I am taking things too serious. Randy did things in moderate speed, he took his time on parts, but certain subjects he would finish very quickly. Randy didn’t have issues with many of the worksheets but had trouble with ones that didn’t deal with him being able to talk about things that he was interested in. Randy was an extremely fun person to work with in this project.

My project used a number of PLO’s along the way. The ones that I feel were most implemented were; Research, Content Creation, and Global Perspective.

Research was a very important part to what I was doing. As stated in my literature review, I had tons of research prior to the work I did. The research was deep and thorough and was very important to what I wanted to do; It helped give me groundwork to go off of. Through my prior research, I had the ability to see what others have done, and if what they did succeeded or failed. This helped me come up with my own plan and try something my way that I felt would be successful, and, indeed it was.

As the course went on, I felt it necessary to not only document their work but to also take notes on it and document how I felt each individual did immediately after they were done, as it was fresh on my mind. This helped me a ton in my analysis and gave me a lot of information to go off of. Through this, I was also able to communicate with each individual one last time before the course was over, and personally ask them how they felt they did and how they felt I did. The happy people they are, I got back all positive responses, usually ranging from “O.K.” to “good”.

Content creation is pretty self-explanatory. All of the work created in the course was by me, I used my prior research and knowledge to how I felt the clients would respond to the work and I wanted to be sure I made something they would be able to handle. So all of the groundwork for the course was created with those envisions in mind; that the participants would be able to handle it. It was tough to balance the effectiveness of the worksheet with making them entertaining enough for the clients to stay focused, because of this, I stuck with 2nd-4th grade work from my websites that I used to create everything.

And finally, global perspective was applied during the study. As hard as someone can try, you don’t just simply talk to Down Syndrome individuals the same way that you would talk to me. It took an understanding that isn’t just learned overnight. This is why I feel it was a great project for me to do in the first place, I had a ton of prior experience with these types of people that helped me along the way of this course. I had to use my skills that I naturally obtained through my 3 years at RISE to distinguish how I talk while I am dealing with the clients.

Analysis

When all of the work is done and finished, its tough to not see the improvements. Randy especially improved in his vocabulary whereas Preston did brilliant with his improvements of his sentences (talking in full sentences). Danny who is always willing to learn, did well in most categories.

I saw a lot of confusion in the first few weeks of the project, which is to be expected. It was a learning experience for me and the clients both. As stated earlier, I truly believe that I learned just as much, If not more than them throughout this project. I saw a ton of active engagement throughout the course from Preston which I think is why he improved so much. Danny had a lot of trouble staying focused throughout it. Preston, before this experiment, was in speech therapy every day. At speech, Preston went through different exercises and learning activities with trained professionals to help him learn to communicate better, so, naturally, he knew what needed to be done because he’s been in that type of setting before.

Randy and Danny went through a thing called “post-high”. Through post-high  they were able to stay in a learning environment longer than other students their age, which, is supposedly supposed to help them. Between all three of their backgrounds, it wasn’t that hard to get them on board with the learning activities. When I began providing the worksheets, I noticed slight disinvolvement from all of the clients, this only happened through the first few days of the capstone before I caught onto it, and lowered the grade-level worksheets that I was providing so that they would retain more interest.

Activities such as telling what faces were doing, or simply conversing about what they like to do, were things that kept them all involved. When we got away from that and worked on adding commas, or taking breaks in our speech to add meaning, a lot of interest was lost. Danny especially had a tough time with boring things, while it was easy to tell Preston and Randy felt disinvolved. By the end of the course, I feel that I was providing fun work to do, which made the environment and learning easier for all 4 of us.

In conclusion, it has been a ride to say the least. I started out my college career not knowing 
what direction I was going, what I wanted to be when I ‘Grew Up’, and with no plan. Four years 
later, here I am. I have found a career, a way to provide to my family, and its something I love. 
The ability to involve my seminar and internship with it at the same time has been a joy and a 
pleasant experience. I will continue to love my work and help these special needs individuals in 
any way that I can.