Common Behavior Issues & Recommendations for Children (and adults) with Down Syndrome

Dr. Jennifer Kimes

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Behavior is another way your child is trying to communicate. Discipline is not a bad word; it is a way to ‘Teach Your Child How to Get Their Needs Met Appropriately’. Inappropriate behavioral responses are often related to:

  • A learned pattern of reinforcement
  • Communication issues – difficulty verbally expressing when they are tired, sick, angry, frustrated, etc.
  • Auditory processing and delayed processing speed – difficulty with some verbal instructions and when not allowed ample time to respond or when given too many instructions at once.
  • Difficulties reading subtle social cues (e.g. personal space, assessing what is friendly versus threatening behavior, and being socially savvy).

Reinforcement (providing something positive or removing something negative), especially social rewards (praise, smiles, high-fives, etc), typically work best for children with DS. Remember to reinforce behaviors you want repeated and not to reinforce behaviors you are trying to extinguish. All reinforcement should be delivered immediately after the desired behavior.  

Praise should be genuine and specific – let the child know exactly what he/she did that you are proud of. Many children will get ‘hooked’ on the positive praise and removal of this (including eye contact) will often reduce inappropriate behavior.

Prevention:

  • Identify triggers & attempts to eliminate these. For example, children will have ‘meltdowns’ when they are tired or hungry, so try not to schedule important events during these times. If transitions are difficult, keep these to a minimum. If the child needs more personal space, use visual cues and educate peers to respect boundaries. 
  • Provide directions and explanations that are brief and use consistent and developmentally appropriate language – lectures will not be remembered or effective. Use the same terms and try to use language phrased in positive terms, but still conveys the message (e.g. Walking Feet vs. No Running or Cup Stays on the Table vs. No Throwing).
  • Phrasing/How  you say something can make a huge difference: say it positively, matter of fact, statement vs. a question. First and Then cues (First we clean up, then we go outside) help children understand that reinforcement is coming soon.    

Assess the Motivation for the Behavior:

Conduct behavioral observations and track the behavior to provide adequate information of precipitators, consequences and setting/time of the behavior. Enlist an observer and log your observations. Rule out potential health-related issues that may be impacting your child’s behavior, especially if the behavior is new or more intense; however more chronic issues can impact behavior (e.g. thyroid, constipation, ear infection). 

  • Sensory Seeking or Avoidant  = Redirect & meet sensory need in safe and socially appropriate way.
  • Attention Seeking = Ignore (unless dangerous), redirect and/or offer replacement behavior.
  • Avoidance or Delay = Assist young child in completing the task or ‘wait out’ the older child. When using physical assistance, be quick and matter-of-fact. 
  • Aggressive or Destructive = Developmentally appropriate discipline strategies (e.g. Time Out, Removal of privileges, token economy, etc.)

Sensory-Based behavior

Find socially appropriate ways for your child to meet their sensory needs (e.g. use heavy work, tactile or vestibular activities intermittently and prior to high-need times).

Redirect to sensory activity while avoiding reinforcing inappropriate behavior – try to anticipate and replace the inappropriate behavior before it occurs.

Anticipate sensory-overwhelming situations/activities and have a plan (e.g. noise cancelling headphones, visual distractors, alternate transition times/points)  

Annoying or Attention-Seeking

Ignore and/or redirect the child’s attention. Do not acknowledge or make eye contact and point out something else in the environment or routine – “Oh, look at the ____”.

Because negative attention is better than no attention, how you react is just as important as the discipline strategy you use.

Teach and practice how to appropriately obtain attention and when and where they cannot (e.g. during story time, while you are on the phone, etc.). 

Escape/Avoidant or Delay

For food, have a ‘Learning Plate’ to place unwanted food to explore later. Use Shaping and Backward Chaining strategies to systematically move from rejecting food to smelling, licking, tasting, eating. 

For throwing toys/materials, have an ‘All-Done’ container to place items, followed by saying/signing “All done”. Once the child has established this skill, then encourages the child to complete brief activities or complete “one more” of a lengthy activity. Also use “First-then” cues. Discontinuation should occur on the adult’s terms, not the child’s, but be within a short time limit initially. 

For refusal behavior, for example, the child refuses to pick up blocks at cleanup time, use hand-over-hand assistance to help the child complete the activity. Do not reinforce the goal of avoidance.  Assist the young or smaller child in completing the activity and ‘wait out’ the older or larger child, whom you cannot safely physically redirect. 

Aggressive or Destructive

If behaviors result from an emotional response, help the child label the emotions associated and provide an appropriate outlet or behavioral response to the emotion.

Decide on what is most appropriate discipline strategy for your child and family and try it for several months. You can use removal of privileges for children who can remember their privileges and the consequences for misbehavior and who can (to some degree) self-regulate their behavior.   

To introduce Time out, choose a high frequency (non-avoidant/delay) behavior and focus on that one. When the child engages in the behavior, calmly remind them that that behavior, e.g. “Hitting goes in Time out” and calmly place child in designated Time Out location without saying anything or establishing eye contact. Set timer and step away, move across the room if possible or busy yourself with something within arm’s reach.  At conclusion of Time Out, remind the child or why they were in Time Out & the appropriate behavior, but do not continue to nag or lecture – just start over.

To aide in increased attention span and appropriate transition between activities:

  • Utilize visual strategies (e.g. flash lights at cleanup time) and picture cues and schedules for daily activities.
  • Sing directions or silly songs during transitions (e.g. to line up or wash hands).
  • Utilize movement/sensory breaks or incorporate movement activities wherever possible (e.g. carrying heavy books or marching to next activity) and reward sensory –seekers with sensory input for appropriate behavior (e.g. high-5s, deep pressure or hugs). 
  • Utilizing ‘fidgets’ to keep wandering hands busy. Have distractible children be ‘helpers’ (e.g. holding the door, turning the pages of the book, handing out papers, etc.).
  • Use “First – Then” cues with picture card of token economy activity choice after given # of completed tasks. 
  • Use visual timers

To aide in appropriate peer relationships:

  • Use social stories and role- plays to teach and practice issues related to personal space, taking turns, obtaining someone’s attention, interpreting facial expressions and body language, etc.
  • Encourage peers, siblings and staff to ignore annoying or attention seeking (but not harmful) behaviors.
  • Encourage staff and peers to develop realistic expectations of the child’s behavior (e.g. he may always be more wiggly) and develop a plan ahead of time for how to respond to inappropriate behaviors. 
  • Develop an appropriate communication system for the child to obtain both adult and peer attention (e.g. tapping on shoulder or saying “excuse me”) and encourage peers to provide their attention if the child utilizes an appropriate and agreed-upon method. 

The inappropriate behavior typically increases in intensity or frequency as the child tests you, especially with planned ignoring; however it should subside once he/she understands there is ALWAYS the same response to the inappropriate behavior. Therefore, CONSISTENCY is EXTREMELY IMPORTANT when using any behavioral interventions.

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