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Gross Motor Development in Children With Down Syndrome & Autistic Spectrum Disorders: Clinic Observations
by Patricia C. Winders, PT
As a part of my work at Kennedy Krieger Institute's Down Syndrome Clinic, I have seen 17 children with Down syndrome and autistic spectrum disorder (DS-ASD). Of these 17, I only saw eight enough to observe their gross motor development. The others ranged in age from 4.5 to 16 years. I have noticed some similarities among the children I have seen, but because there are so few, I am not certain these observations are true for all children with DS-ASD.
Based on the additional diagnosis of autistic spectrum disorder, you might expect children who have DS-ASD to be slower in developing gross motor skills. This does not seem to be the case. In my small sample, children with DS-ASD did seem to follow the usual patterns of development seen in children with Down syndrome. There also did not appear to be any regression in gross motor development with the onset of autistic spectrum, though it is seen in other areas of development. However, children with DS-ASD do seem to be slower to master the more advanced motor skills such as walking down stairs, alternating feet or jumping.
Children with Down syndrome characteristically have one of two temperaments. Temperament is the characteristic way a child thinks, behaves and reacts when learning motor skills. The first temperament is motor driven: children who love to move and take risks physically. The second group are observers: children who prefer to be stationary, observe their surroundings and like to be careful and in control. All of the children I have seen with DS-ASD are clearly observers. They prefer being stationary to moving and they tend to be cautious rather than being a risk-taker. Participating in new motor activities, or attempting to do them, was scary for them.
For example, when I asked Scottie to walk up and down a ramp, he found it frightening. He wanted hand support and moved very slowly. To make things worse, the ramp at the clinic has black non-skid strips, which he found visually confusing, and he did not like the feel of them on his feet. In addition, to walk down a one inch curb Scotty slid his foot off the edge to feel for the floor before stepping down. Scottie is an example of an observer.
All of the children with DS-ASD wanted to walk at a slower pace than I asked and resisted moving too quickly. To limit how far we went, they sat down to stop. They needed motivation to continue walking. When I gave them my hand, they were open to walking more quickly and frequently smiled at me. This told me they had the energy to walk faster and farther, but needed hand support as encouragement to try.
It is important to understand and respect your child's temperament, as well as other factors such as sensory issues your child may have because of DS-ASD. For instance, children with DS-ASD are often overwhelmed by things going on around them such as loud noises, children crying or a lot of activity. They often do better in familiar surroundings or in situations that have some routine. This means in a clinic or school setting, children with DS-ASD may become upset because the environment is unfamiliar and they are bombarded with new experiences and stimuli. Madison is an example of a child who prefers a familiar environment in which she feels she has some control. When she came to clinic there were many new skills for her to try. The clinic was full of sounds and commotion that are usual for a clinic, but were overwhelming and new to her. Her mother and I thought a less busy area would be best, which is where we have the balance beam. Madison was afraid to try, so her mother did it with her. During the session she resisted participating, but she watched out of the corner of her eye. At the end of the session when we were discussing a home program for her, Madison initiated practicing walking on the balance beam on her own and learned to do it independently. She demonstrated that she would try new skills if she could try them on her own terms at her own pace. It was important that we did not impose ourselves in the process because that would upset and scare her. The way activities are set up for Madison needs to be just right to get the best performance.
Children with DS-ASD often have sensory needs (see page x). I am surprised by how many children with DS-ASD have a great love for swimming and water activities. One parent said when her child is swimming, he is in constant motion, has great endurance and is highly motivated to participate. Another said her child loves to swim to the bottom of the pool and pick up pennies or pool toys, can hold his breath for 30 seconds and swims using a dog paddle stroke. Another mother reports that her child learned the back stroke and another child loved just floating on the water.
Even though these observations are based on a few children, they do suggest that similarities exist in children with DS-ASD. Gathering more observational data may provide additional clues that will be useful to parents and professionals. We need to understand how children with DS-ASD perceive and react to life experiences so we can interact with them in a way that respects their preferences. They will be, like anyone, more open to new experiences if they are presented in a way that is acceptable and not frightening.
Patricia T. Winders, PT, is a physical therapist who has a special interest in children with Down syndrome. She is currently the senior physical therapist for the Down Syndrome Clinic at Kennedy Krieger Institute and author of the book, Gross Motor Skills in Children with Down Syndrome: A Guide for Parents and Professionals. She also serves on the Professional Advisory Board of the National Down Syndrome Congress and the Clinical Advisory Board of the National Down Syndrome Society.
The article above is reproduced from the September/October 1999 issue of Disability Solutions, Volume 3, Issues 5-6 . Permission was granted for its use on this web site. In accordance with federal copyright restrictions, the contents of this article may not be reproduced by photocopying or any other means without written permission from the copyright holder. © 1999 Disability Solutions