In this article:

Having children with Down syndrome is not uncommon. Previously, they were credited with complete incapacity - the inability to serve themselves independently, to study. Today, the study of this genetic disease has made great strides forward.

Now the development of such a child gives very positive results - doctors, teachers and psychologists agree here. They are called "sunny" children, because these kids almost always have a good mood and a smile on their face.

Today there are modern methods for diagnosing this disease even during pregnancy. What to do is up to the parents, of course.... In order for such a baby to become a part of society, more attention, care, diligence will be required, as well as special conditions for learning. The development of these children takes longer, but they are capable of much.

Not like everyone else

A child with Down syndrome can be immediately noticed in a crowd of peers. If the parents paid enough attention to his development, education and socialization, he may well lead the life of an ordinary person.

Of course there are external differences that often scare off other children and their parents. Perhaps society is not yet fully ready to accept these people.... The thing is that for quite a long time people with Down syndrome were attributed to a variety of negative characteristics.

It is a misconception that such a toddler cannot learn or communicate. Of course, the usual school curriculum is difficult for him. He needs to pay a lot of attention - thanks to this he can achieve good results... Yes, they are "not like everyone else", but these children have the right to life.

Why is this happening?

In the twenty-first pair of chromosomes, a mutation occurs - an extra, third, chromosome is added to the usual two. Unfortunately, this disease cannot be cured. More often in total, women who give birth late, from 35 to 45 (47) years old, fall into the risk group. Today, doctors immediately suggest that they be diagnosed for a number of genetic diseases, including Down's syndrome. It is not a rare pathology - for every 700 births there is 1 child with this disease.

This disease has been known since 1866, when the scientist John Down first described its symptoms. It was only in 1959 that the first confirmation of the genetic nature of the disease appeared thanks to the work of Dr. Jerome Ligen. And John Down described this syndrome as a form of mental disorder.

Until 1970, there were very negative legends about Down syndrome.... Then such children were advised give to special institutions like psychiatric hospitals. It was believed that they are completely unable to learn, communicate, independently perform meaningful actions. Few wondered why this is happening, where the disease comes from and what people with this syndrome feel.

In such conditions, they rarely lived to be 20 years old, although today the life expectancy of people with this diagnosis is much higher. Many live an active life up to 35-40 years old.

Early diagnosis of Down syndrome

The detection of the disease occurs early in pregnancy. There are several methods:

• analysis of the mother's blood (identification of the elements of the child's DNA);
• analysis of amniotic fluid;
• ultrasound examinations.

Interventions are not recommended for women over 35 years of age (invasive diagnostic methods), as this can aggravate the course of pregnancy. The development of the fetus occurs at the same time as in healthy children... After 9 months, the baby is ready to be born. Today, due to the possibility of early diagnosis, the number of children with this diagnosis has decreased: parents often decide to refuse to continue their pregnancy.

External signs

All children with this syndrome are characterized by external features:

• flat face, small nose;
• oblique section of the eyes;
• a small mouth, but a large tongue (more often the tip is sticking out);
• deformed little fingers;
• weak muscles of the whole body;
• too flexible joints.

For Down syndrome internal changes are also characteristic, often requiring treatment or tight control:

• malformation of the heart;
• eye diseases (cataract, glaucoma);
• gradual hearing loss;
• problems with the gastrointestinal tract;
• shortness of breath due to abnormal structure of the nasopharynx.

Additional anomalies are periodically encountered, such as the absence of one rib, excessively short stature, and curvature of the chest.

How is the development of the child

Yes, the news that a woman is expecting a baby with Down syndrome is a huge shock for many. The doctor is obliged to inform the parents about what may await them after the birth of the baby. Today, many doctors are negative, although there are not many reasons for this.

It is best to consult with several specialists to find out the exact details of the diagnosis..

The development of such a child will take a different path, and it depends on the parents whether he will be happy and accepted by society. Physical exercises to maintain muscle tone must be performed every day - this gymnastics will become usual for a kid, and then for an adult. Do not forget about fine motor skills, because it suffers greatly.

It is also important to teach children to live in society, and not hide at home all their lives.... You need to show them the rules of self-care, the laws of communication, friendship. Please be patient.

Differences in physical development

Unfortunately, many problems of physical development cannot be solved. They are caused by a gene mutation. For instance, thin skin which is too susceptible the influence of the environment. In winter, the child's skin can dry out and crack, while in summer it will be rough to the touch. Frequent rashes in infancy are also the result of the fact that the skin is very delicate and thin.

Internal organ development is often slowed down by birth defects. The cardiovascular system suffers greatly. Cardiologists note frequent heart murmurs, circulatory problems.

The abdominal muscles are weakened, so that the belly sticks out a little. Exercise and supervision by a doctor will help here. Some children with Down syndrome suffer from a hernia, but it should not be removed unless it is in the way. Most often, by the age of 13-15, it goes away by itself.

The genitals are often smaller than those of other children and develop slowly. This is due to endocrine changes in the body due to a gene mutation. Not
it is worth worrying: this will not affect your normal life in any way.

The movements are often incoherent, there are problems with coordination. Although children are usually active, they like active games and run. Of course, it is necessary to monitor the condition of the joints - due to the special elasticity of the connective tissue... Otherwise, there are no more physical abnormalities that can harm a normal life than in other children.

Motor development

Fine motor skills are another problem.... In the first few months, these babies are almost motionless. Without the help of adults, they cannot roll over, take other positions in the crib. The muscles are very weak. Only at 4-5 months the world of objects opens up for children.

They reach out to
him, want to touch, play, consider... This is a normal child's interest, it just came much later.

The development of fine motor skills is difficult. This is due to a clear lag in cognitive development. By the time healthy children begin to crawl or even walk, "sunny" children are just learning to sit. Finger skills will need to be carefully practiced... There are many methods for this now, most of them are game ones.

Differences in mental development

For a very long time, it was believed that the diagnosis of Down syndrome is associated with mental retardation.... Now doctors and psychologists
agree that this is far from the case. These children show a slight or moderate lag behind the normal development schedule. It's not that scary. Only a small number of children are severely retarded. Children may well learn, most of them, with good care and education will be able to go to a regular school.

Of course, it is impossible to say that they fully correspond to the level of development of their age. At the age of 3 months, the baby usually already knows how to recognize voices, especially the mother's, smiles when she approaches. And a child with Down syndrome lacks this revitalization complex. He looks dispassionately at what is happening, does not recognize people.

Such children concentrate poorly, often absent-minded. Sometimes this is due to poor hearing - unfortunately, hearing problems are found in almost all of these babies. They may not respond to questions or, conversely, answer inappropriately. It usually depends on your mood. This complicates the learning process. The baby was active, involved in the work, and then there was an abrupt change in mood - he no longer wants to participate in the lesson. He closes in.

They enjoy watching the process more than taking part. For example, in the gym, children receive the same items: balls, hoops, jump ropes. A toddler with Down syndrome is happy to watch others doing, but he himself does not even want to try. Although such activity would not be a problem for him.

Another feature is focus on one task. Other children easily switch, they are often even bored with doing one thing. A toddler with Down Syndrome wants to complete a task, action... He cannot shift his attention until he is completely satisfied with the result.

First year of life

In the first year of life, the baby becomes more active.... Already at 6-7 months he is happy to play ordinary children's games, loves new toys. They are characterized by emotionality in the manifestation of feelings. It is impossible to hide emotions - children often laugh, smile, are rarely sad. For this they were nicknamed "sunny children", because babies with Down syndrome are very open, they are not afraid of new people. ... They are ready
meet and be friends... Often it is public opinion that interferes with their social life.

There is a misconception that a child with Down syndrome is aggressive and unpredictable. This is completely wrong, because aggression is not peculiar to him. Sometimes, through negligence, due to problems with coordination of movements, he can accidentally do a little harm to himself. Such children have no meaningful aggression.

At the end of the first year of life, such a baby loves to watch any actions of adults or other children, animals. The presence of a pet has a beneficial effect on his psyche. The development of eye contact does not occur immediately - you need to learn how to concentrate your gaze.

Second year of life

In the second year of life, a very important process takes place - the development of speech and understanding. If you do not miss this time, the child can be easily socialized. Already now, at the age of 2, psychologists and psychiatrists can note the benevolence of this little man, the ability to empathize.

Speech

By the age of 2, the vocabulary is small, only 20-25 words. Now the learning process will go more actively - the child will memorize words every month, expanding his vocabulary. The main thing is to stimulate his need for communication, the expression of his own thoughts.

The speech can be described as correct. Children
use all parts of speech, do without gross errors. Memorization of speech occurs in the usual way: the baby listens, and then repeats already familiar words and speech structures. Learning here is no different from teaching ordinary children.

Children with the least developmental delay learn up to 40 new words per month. Babies with severe disabilities - only 8-9 words. As you can see, a child with Down syndrome is quite trainable, provided there is a mild to moderate form of lag. A little later, by the age of 5, his vocabulary will be about 5000 words and word forms, which is no longer so bad. If such results have been achieved, then development is proceeding within acceptable limits.

Understanding

Comprehension of words occurs in the same way as in a healthy baby. Of course, this process is being delayed. Children repeat familiar words - most often words and sentences from the family everyday life. Parents also need to pay attention to their speech, because the child remembers everything well.

The development of the skill of understanding is slower - the baby needs to be shown and repeated several times. Usually, if this is done calmly, without irritation, then progress is not long in coming. At 2-3 years old, a child with Down syndrome has a normal interest in learning, he asks many questions.

Education

Even 30-40 years ago, there could be no talk of a baby with Down syndrome going to kindergarten or school.
Especially in a regular school. Then, special educational institutions had just begun to appear. Some knowledge about the world was given there, but the bulk of the work was organized in the same way as in kindergarten: the children were just being watched. The mental and mental development of such children remained at the level of 3-4 years for the rest of their lives.

Today everything has changed. There are not only special kindergartens and schools, but also additional education. For toddlers with mild delays, it is possible to enroll in the most basic school, although this is still a rare practice. Teachers do not always know the rules for working with such a child. Schools with a special program remain where there are several children in the class and everyone can be given attention.

In the west, this
the system is much better developed. Today in Spain there is a young man with Down syndrome, who was the first in the world not only to graduate from high school, but also a university. Now he deals with social problems, works, writes scientific articles and participates in professional conferences.

The development of a child depends on the parents. Of course, you will have to make more efforts, but as a result, these children can get a profession, work, become more independent.

Special Education: Preschool

Children with mild to moderate developmental delays can be sent to a regular kindergarten. This is a positive practice, because there they will have to learn to follow the established rules of behavior.

If it is very difficult for a child in kindergarten, it is better to transfer him to a specialized preschool institution..

This is also an ordinary kindergarten, just all the children in it are "special". There, too, there is an opportunity to communicate, make friends, study with a teacher.

It is very important to be in the company of other children. This gives the child examples to follow. He
copies the behavior of others during games, speaks faster and better. Leaving him at home - big mistake... This will only slow down its development, greatly reduce the chances of socialization.

Children with Down syndrome are good observers. They adopt the manner of communication, conversation. This means they learn quickly. By giving your baby to kindergarten, you help him. Many parents have the impression that the world is very hostile towards their child, and sending him to a special kindergarten means leaving him alone, without support. This is not true. It is among other people that he will be able to find himself and better understand life.

School years

Going to first grade is just as exciting for a child with Down syndrome as it is for other children. If he goes to kindergarten and already knows how to do things that are normal for children, then many problems can be avoided. Children are usually happy
go to school, because this is the prospect of new knowledge, discoveries and interesting acquaintances. The main thing is that other children, teachers, parents are fully aware that this is an ordinary baby, not a monster. Usually, having got to know the baby better, everyone will love him and accept him into the company.

It can be difficult to study due to the peculiarities of the psyche, but children endure all difficulties with an ordinary smile on their face. A low level of fine motor skills can greatly complicate the situation.... It will be difficult to write, draw, play, and do ordinary things. Also, difficulty concentrating often makes learning difficult. Small short-term memory can be a problem... You have to study several times harder in order to keep up with the rest.

Time passes - they learn, learn. With the support of the teacher, parents and class, the kid comprehends even difficult subjects. Oddly enough, these children are attracted
mathematics. The "sunny" child has good motivation, concentration on the subject. To solve the problem is his goal. Children like exact sciences, because everything is natural in them, nothing needs to be invented.

Hearing loss can be a problem. Unfortunately, hearing falls from year to year in most children with this syndrome. The hearing aid will correct the situation. The main thing is to understand in time that he is needed. Children often do not realize that their hearing is dropping and continue to behave as usual until the problem suddenly becomes apparent to their parents. Be attentive to them.

Social life of children with Down syndrome

A small man, a teenager, an adult with Down syndrome may well lead a normal social life. He attends classes, does physical education, he has his own hobby. If the parents make enough effort, then such a child has interests, the need for new knowledge and impressions. Development is proceeding, albeit according to its own schedule.

Such a child
can graduate from a vocational school, get a specialty. Usually, there are no problems in communication, on the contrary - these guys strive make friends with everyone in a row. In the west, the adaptation of people with Down syndrome is very progressive. They go in for sports, work, participate in social activities, act in films, write books.

The life of a person with Down syndrome can be very tragic and difficult if in childhood and after it is left without proper attention, education, and love. Or, conversely, she may be full of joy.... The choice here is made by the society, but first of all - by the parents.

Currently, a new category of children comes to schools I and II - children with Down syndrome. This material is devoted to the causes of this violation, the personality traits of these children and the tasks of the school in their education and development.

Download:

Preview:

Report

Children with Down syndrome

Personality features, development prospects

Prepared

A.A. Tkacheva

What is Down Syndrome

The word "syndrome" refers to a combination of many signs or characteristics.Down syndrome is the most common form of chromosomal pathology known today. First described in 1866John Langdon Down called "Mongolism". In 1959, the French professor Lejeune proved that Down syndrome is associated with genetic changes. Each cell contains a certain number of chromosomes. There are usually 46 chromosomes in each cell, half of which we get from the mother and half from the father. A person with Down syndrome has a third additional chromosome in the 21st pair of chromosomes, for a total of 47.

The most common form of Down syndrome is standard trisomy (full tripling of chromosome 21 in all cells of the body). This form accounts for 94% of all cases of the disease.

Less often (about 4% of cases) there is a translocation (displacement) of 21 pairs of chromosomes to other chromosomes.

The mosaic form (approximately 2% of cases) is the most rare form of Down syndrome, in which only some cells of the patient's body contain tripled 21 chromosomes, and the patients themselves have a normal appearance and intelligence, but are at great risk of having a child with Down syndrome ...

Down syndrome occurs in one in 600-1000 newborns. The reason why this happens is still not clear. Children with Down syndrome are born to parents of all social strata and ethnic groups with a wide range of educational backgrounds. Down syndrome cannot be prevented and cannot be cured. But thanks to the latest genetic research, much more is now known about the functioning of chromosomes, especially about the 21st.

Research has identified four factors that affect the likelihood of Down syndrome in a child:

• middle age of parents: mother is over 35 years old, father is over 45 years old
• too young mother's age (under 18)

For women under the age of 25, the likelihood of having a sick persona child is 1/1400, up to 30 - 1/1000, at 35 years old the risk increases to 1/350, at 42 years old - up to 1/60, and at 49 years old - up to 1/12. However, because young women generally give birth to many more children, the majority (80%) of all Down syndrome patients are actually born to young women under the age of 30.

• closely related marriages
• and also, oddly enough, the age of the maternal grandmother.

Moreover, the last of the four factors turned out to be the most significant. The older the grandmother was when she gave birth to her daughter, the higher the likelihood that she will give birth to her grandson or granddaughter with Down syndrome. This probability increases by 30% every year "missed" by the future grandmother.

The mechanism of this connection is not entirely clear, but it is hardly necessary to see something supernatural in it. After all, oocytes (future eggs) undergo the first division of meiosis while the female embryo is in the womb. It is during this division that the divergence of homologous chromosomes occurs - either correct or not. Girls are born with a ready-made full set of oocytes that have undergone the first meiotic division. Among these oocytes, some part already carries an extra 21st chromosome: if these cells are destined to be fertilized, they will become children with Down syndrome. And the number of such defective cells in the ovaries of a newborn girl, apparently, depends on the age of her mother.

Clinical picture

The most characteristic external signs of Down syndrome, according to which a presumptive diagnosis can be made immediately after the birth of a child, is:

• "Flat" face - 90%
• thickened cervical skin fold
• brachycephaly (short-headedness) - 81%
• slanted eyes
• a lunate skin fold at the inner corner of the eye (epicanthus).

Further examination of the child reveals:

• muscle hypotension (decreased muscle tone)
• increased joint mobility
• short and wide brushes, small arched palate, flat nape
• deformed auricles, large wrinkled nose.
• transverse palmar fold, as a universal sign of Down syndrome, can occur in only 45% of children born with this disease
• chest deformity, keeled or funnel-shaped
• pigment spots along the edge of the iris of the eyes (Brushfield spots).

Also, children with Down's syndrome may experience certain changes in the internal organs.

• combined, multiple, congenital heart defects such as ventricular septal defect, atrial septal defect, large vessel anomalies, open atrioventricular canal
• on the part of the respiratory system - cessation of breathing during sleep due to the large tongue and the structural features of the oropharynx;
• vision problems(congenital cataract, glaucoma, strabismus strabismus)
• hearing impairment
• thyroid disease (congenitalhypothyroidism)
• pathology of the gastrointestinal tract (intestinal stenosis, megacolon, atresia of the rectum and anus)
• abnormalities of the musculoskeletal system (dysplasia of the hip joints, unilateral or bilateral absence of one rib, clinodactyly (curvature of the fingers), short stature, deformity of the chest)
• hypoplasia (underdevelopment) of the kidneys, hydroureter, hydronephrosis

The final diagnosis of Down's syndrome can be made only after examining the karyotype (chromosome set) of the child.

The structure of mental underdevelopment in children with Down syndrome peculiar:

• speech appears late and remains underdeveloped throughout life, speech understanding is insufficient, vocabulary is poor, sound pronunciation in the form of dysarthria or dyslany is often found
• Difficulties in mastering speech in children with Down syndrome are associated with frequent infectious diseases of the middle ear, decreased hearing acuity, decreased muscle tone, a small oral cavity, and a delay in intellectual development.
• children with Down syndrome have small and narrow ear canals, this negatively affects auditory perception and listening skills, that is, hearing sequential coordinated sounds of the environment, focusing attention on them and recognizing them
• during the development of speech, tactile sensations are essential, both inside the oral cavity, children often experience difficulties in recognizing their sensations: they have a poor idea of ​​where the language is and where it should be placed in order to pronounce this or that sound
• children with Down syndrome often speak quickly or in separate sequences of words, without pauses between them, so that the words run over each other, in addition, at the age of 11-13 years, these children develop stuttering
• children with Down syndrome experience significant difficulties in the formation of the ability to reason and build evidence. Children find it more difficult to transfer skills and knowledge from one situation to another. Abstract concepts in academic disciplines are not available for understanding. It can also be difficult to deal with practical problems that arise. Limited ideas, insufficient reasoning underlying mental activity make it impossible for many children with Down syndrome to study hotel school subjects.
• deep speech underdevelopment of these children often masks the true state of their thinking, creates the impression of lower cognitive abilities. However, when performing non-verbal tasks (classifying objects, counting operations, etc.), some children with Down syndrome may show the same results as other pupils.
• features of visual perception: children with Down syndrome fix their attention on single features of the visual image, prefer simple stimuli and avoid complex pictorial configurations. This preference persists throughout life, children do not see the details, do not know how to search and find them. They cannot carefully consider a part of the world, they are distracted by brighter images. However, as a result of numerous experiments, it was found that it is better to operate with materials perceived visually than by ear.
• children with Down syndrome do not know how and cannot integrate their feelings - simultaneously concentrate attention, listen, watch and react and, therefore, are not able to process signals from more than one stimulus at a given time
• but, despite the severity of the intellectual defect, the emotional sphere remains practically preserved. Downists can be affectionate, obedient, and benevolent. They can love, be embarrassed, offended, although sometimes they are irritable, spiteful and stubborn.
• most of them are curious and have a good imitative ability, which helps to instill self-care skills and work processes.

The level of skill and skill that children with Down syndrome can achieve varies greatly. This is due to genetic and environmental factors.

Thus, profound disabilities are naturally accompanied by a significant decrease in the quality of life. A child's serious illness also affects communication with peers, education, work, and the ability to self-service. The child, unfortunately, is excluded from public life. All of the above determines the importance of the problem of social adaptation and correction of the corresponding contingents of children.

In the medical literature, Down's syndrome is considered as a differentiated form of oligophrenia and, therefore, is also subdivided into the degree of mental retardation.

1. A profound degree of mental retardation.

2. Severe mental retardation.

3. Average or moderate degree of mental retardation.

4. Weak or mild mental retardation.

The main directions of work on the adaptation of children with Down syndrome

The goal of correctional work with children with Down syndrome is their social adaptation, adaptation to life and possible integration into society. It is necessary, using all the cognitive abilities of children, and, taking into account the specifics of the development of mental processes, to develop their vital skills so that, as adults, they can independently serve themselves, perform simple work in everyday life, improve the quality of their life and the life of their parents.

Achievement of the set goals is ensured by the solution of the following main tasks:

1. Development of children's mental functions in the process of work and the earliest possible correction of their deficiencies.

2. Education of children with Down syndrome, the formation of their correct behavior. The focus of this section of the work is on habit formation. Children need to develop the skills of cultural behavior in communicating with people, to teach them to communicate. They must be able to make a request, be able to defend themselves or avoid danger. Much attention must be paid to external forms of behavior.

3. Labor training, development of self-service skills and preparation for feasible types of household work. Self-service skills must be developed.

Corrective education of deeply retarded children can lead to significant positive changes in the development of the child, which should affect his future fate.

Sensory education is one of the areas of work on the social adaptation of children with Down syndrome.

Sensory education is the initial stage of the learning process and is aimed at fostering full-fledged perception in a child with developmental anomalies; this is the basis for cognition of the surrounding world. Sensory perception is based on the development of sensory perception. Perception affects the analyzers of the child's feelings. The accumulation of sensory feelings about the world around them contributes to the activity of the child's sense organs. The child begins to feel, positively perceive the surrounding reality through his practical activities,

Sensory perception develops the child's orienting activity in the world around him, since the child becomes acquainted with the signs, and it is this activity that is impaired in children with Down syndrome.

In order for the child to be able to assimilate the transmitted information, it is necessary to develop thought processes, including comparison, analysis, synthesis, generalization, classification.

The attitude of the state to the problem of "special" children

In domestic medical, pedagogical and psychological science, for many years, the position of the hopelessness of this diagnosis for the further development of the personality has been affirmed. It was believed that a person with Down syndrome is not trainable, and attempts to treat this "genetic disease" were doomed to failure in advance. State policy, recognizing the value of a person according to his ability to work for the good of society, contributed to the fact that people of this category were attributed to the "inferior minority", outcasts, outcasts. Therefore, the main concern of the state was to isolate them from society, placing them in a system of closed-type institutions, where only elementary care and treatment was carried out as needed. Programs of psychological, pedagogical and social and household rehabilitation of people with Down syndrome have not been developed. It was generally accepted that neonatologists had to convince parents in the maternity hospital to abandon the child, citing the futility of any kind of assistance to such children. As a result, most children with Down syndrome, as soon as they were born, became orphans with living parents. The number of social orphans with developmental disabilities, increasing from year to year, increased so much that a significant number of special closed-type institutions for isolating these children from society were overcrowded.

Such a state approach to solving the problems of "special" children with non-observance of the rights of the child, the absence in the country of laws on the civil rights of persons with disabilities and on special education, led to a crisis situation both at the level of preschool and school education of children, vocational training and social and labor rehabilitation of adults with Down syndrome, so at the level of training to work with this category of the population of Russia.

Attempts to change the current situation on the part of state and government structures in recent years of socio-political transformations in the Russian Federation were expressed in the adoption of a number of laws and regulations. These regulatory documents consider persons with problems in the intellectual, physical, psychological spheres as an object of special public care and assistance. And the attitude of society towards such people becomes a criterion for assessing the level of its civilization and development.

Plastic surgery for children with diabetes

In the past ten years, both in the press and in the medical literature, the problem of plastic surgery for people with Down syndrome has been discussed. In particular, in Germany, Israel, Australia and occasionally in Canada and the United States, attempts were made to correct the facial features of these people with the help of such operations. Despite the fact that the surgical procedure itself may vary depending on the individual needs of the child and the approach that the surgeon prefers, nevertheless, as a rule, the operation includes the removal of folds between the nose and the eyes, straightening slightly oblique eye slits, and cartilage implantation. in the area of ​​the nose, cheeks and chin and removal of part of the tip of the tongue.

Supporters of plastic surgery believe that some shortening of the tongue will improve the child's speech abilities. In addition, in their opinion, after such an operation, children with Down syndrome will be better accepted in society, since, as a result, they will have less saliva oozing, it will be easier for them to chew food and drink; they will be less likely to be exposed to infectious diseases. Although some subjective parental observations indicate that people with Down syndrome benefit from such surgeries, more recent studies have not shown much difference in pronunciation before and after tongue shortening surgery (the number of abnormal sounds did not decrease). Analysis of the pronunciation estimates made by the parents of children who had and did not have surgery did not reveal any difference between these groups of children. Many issues related to plastic surgery on the face remain unclear and continue to be discussed in scientific circles. It is not completely clear for whom, in fact, such an operation is being performed: for a child, for parents or for society. Should the child be involved in deciding whether the operation is necessary? What should be the indications for plastic surgery? What is the impact on the child of the trauma, without which no surgery is complete? Can you avoid prejudice against a child with Down syndrome by correcting facial features? What will the results of the operation mean for the child's self-identification and his self-image? Should the degree of mental retardation be a criterion when deciding whether to undergo plastic surgery?

Other complications relate to incorrect expectations that the child will become "normal" after surgery. This in some cases can lead to denial of violations that he has. Currently, there is a controversial attitude towards plastic surgery in the case of Down's syndrome.

Early assistance system

The establishment of an early assistance system in our country today is one of the development priorities of the special education system.

Studies by foreign scientists have shown that systematic early pedagogical assistance to children with Down syndrome in a family with the involvement of parents in the process of correctional work allows to bring to a new qualitative level not only the process of child development, but also largely determines the process of integration into society. At all stages of life, children with Down syndrome should, according to scientists, be under the patronage of specialists who organize the process of accompanying these people in the educational and social space.

Educational programs for children with diabetes

1. Early Educational Assistance Program for Children with Developmental Disabilities"Small steps", developed at Macquarie University (Sydney, Australia, 1975), tested at the training center of this university for the category of children with Down syndrome and other developmental disorders. This Program encourages children to interact more fully with the world around them.Developed at the Australian McQuery University, it is successfully applied in many countries, it is recommended for use by the Ministry of Education of the Russian Federation.
   The methodology is presented in 8 books, which deal with the basic principles and techniques of teaching. The curricula of the program cover specific areas of development: general motor skills, speech, physical activity, fine motor skills, self-care, social skills of the child. The method of teaching the child in each of the sections of the program allows you to gradually form a skill, ability, knowledge. The last book contains a list of the skills that determine the development of a child, and a series of checklists that allow you to test toddlers. Many children who were taught using these methods were able to continue to attend integrated and inclusive classes in mainstream schools.The conceptual provisions of the Little Steps program represent an innovative approach to the education of children with developmental disabilities:

• “All children can learn. A child with developmental disabilities learns more slowly, but they can learn!
• Children with mental and physical disabilities need to master all the skills they need in play, communication with others, in achieving the maximum possible independence for integration into society.
• Parents, like educators, play the most important role.
• The effectiveness of the training largely depends on the age of the child. Classes should be started from the moment the diagnosis is established.
• An individual child's program must satisfy both the needs of the child himself and the capabilities of his family.

1. Methodology for the formation of basic motor skills (MAH)

   Developed by Peter Lauteslager, a Dutch physiotherapist specializing in motor development and specialized care for children with Down syndrome. It is used for children from 3 months to 3-4 years old. It includes testing the levels of development of the basic motor skills of the child and drawing up a program of classes with him. The methodology implements a functional approach to stimulating the development of children, allows you to assess the dynamics of development and optimally plan classes. It is aimed at habilitating the child, warns and corrects deviations in the baby's motor development. It does not provide for the impact on the child, but for interaction with him with the active participation of the parents. The level of motor development is directly related to the primary research activity of the child and his inclusion in ordinary life - socialization. Testing gives a clear idea of ​​the successive stages of the formation of each motor skill, which allows specialists to competently draw up a program for the child's motor development and develop recommendations for parents. Mastering motor skills provides a child with a certain level of independent existence, which allows him to consistently learn everything that ordinary children can do. The successful development of the child in the motor field propels him forward in the field of communication.

   3. "Step by step"

   First of all, a child with Down syndrome should be taught the skills of self-care and behavior in everyday life, which not only ensure his independence and independence, but also serve the development of the personality, contribute to confidence and self-esteem. For many years in Europe and America, the step-by-step methodology has been used to teach children with special needs. It is very effective for children with Down syndrome. Difficulties in social adaptation of such children are largely determined by the insufficient formation of their elementary everyday skills. The basic skills that ensure independence for a child in any situation include self-care skills and home-care skills. And it is important to learn them in a timely manner. Any activity is based on basic motor and mental functions: concentration, general and fine motor skills. These are preparatory skills. One or another self-service skill can be taught only when the child has freely mastered the preparatory skills included in it. The process of learning to master skills should be purposeful, taking into account the characteristics of psychophysical development and life experience, carried out against a positive emotional background with widespread use of rewards. Your child needs dedicated time to practice skills, learn and review. It is necessary to teach the independence and everyday skills of the child using the simplest material and in the simplest conditions.
   

   4. Socio-psychological model Portage
   The technique was developed in the USA in the 70s of the last century, and is successfully used in many countries of the world. The goal of the Portage is to work with families with a disabled child, help to reduce barriers to disability, and socialize children. The family is visited by a home visiting specialist. A team of project leaders, specialists who know the methodology and specially trained volunteers from among students, future doctors, psychologists and teachers participates in the process of rehabilitating a child. During the visits, parents are taught structured teaching techniques for use in their daily interactions with the child. Parents are taught to observe the child, plan attainable goals, and reward desirable behaviors. Sections of the Portage include stimulation of an infant, socialization, cognitive activity, development of physical activity, speech, and self-service skills. The Portage methodology consistently describes all the skills, abilities and knowledge that a child must master as a result of purposeful learning. It clearly defines what to teach, when to teach and how to teach.
   5. Methodology for the development of speech and teaching to read by Romena Avgustova
   This is a one-of-a-kind method for developing the speech of children with Down syndrome. The author, who has been engaged in speech pedagogy all his life, explains in simple and accessible language in his book “Speak! You can do it ”, how to teach a child with complex developmental disabilities to speak, how to communicate with such children, help them reveal their abilities and creative inclinations. Children studying according to the Augustova method not only master oral speech well, but also learn to read with enthusiasm.
   6. Hippotherapy
   Corrective horse riding - hippotherapy, is very effective and multifunctional for solving the problems of rehabilitation of children with Down syndrome. It develops the motor, sensory, emotional and psychological abilities of children. Communication with horses, caring for and caring for them increases the feeling of trust, patience, and reduces anxiety. Hippotherapy develops the intellectual abilities of children, contributes to their social adaptation and better adaptation to life. Specially trained teachers own the methodology for conducting hippotherapy classes.
   7. System "Numikon"
   It is very difficult for a child with Down syndrome to learn mathematics, even the basic skills needed in everyday life. "Numikon" is a set of educational material and a specially developed methodology for working with it when teaching the basics of mathematics. Numbers in the set of visual material are represented by forms-templates, painted in different colors, which makes them accessible for visual and tactile perception. The set includes colored pins, a panel, and task cards. The child's manipulations with details lead to the fact that actions with numbers become visual and tangible. This allows you to successfully teach children with Down syndrome the basics of mathematical knowledge.
   8. Lekoteka
   The word "lekoteka" literally translates as "toy storage". In Russia, this new methodology, developed by Swedish scientists, is being successfully applied for psychological support and special pedagogical assistance to parents raising children with severe disabilities and developmental problems. The library service forms the prerequisites for educational activities in children, supports the development of the personality of each child, conducting training in the form of a game. Forms of the lekothek's work: consultations for parents, diagnostic play sessions, therapeutic play sessions, group parenting trainings. The arsenal of lekothek contains many toys and games for the development of children, special equipment, video libraries, music libraries. Children with Down syndrome can attend classes in lekotheques from 2 months to 7 years.
   

Schooling

The school should

• teach basic disciplines: reading, writing, mathematics
• teach the ability to do the job to the end
• to teach the ability to get along with people and know where to turn to find the answer to a question
• build independence and self-confidence
• to form the ability to occupy oneself

Although social relationships are an important part of life, children should be able to spend part of the day alone. They should learn to occupy themselves. Time spent alone is also beneficial for development. It is at such hours that the child can assimilate the ideas that he encountered, try to do something new on his own. He must have the right toys and materials so that he does not get bored alone.

• to ensure the musical development of children with diabetes

Movement helps in the development of general motor skills, teaches to maintain balance. They are a means of self-expression. Rhythmic dancing improves the coordination of movements and makes the movements themselves more graceful. Such activities give the child pleasure and self-confidence for years to come.

• sports development

Sports activities will contribute to the diversified development of the child, and using his physical capabilities, he will be able to increase the general level of his fitness for life, endurance, develop muscles, improve coordination of movements, the quality of general motor skills

As full-fledged members of society, people with Down syndrome can, like their healthy peers, lead an active lifestyle: study, work.

The main didactic principle in teaching such children is

• the use of different channels of perception, that is, different senses. First of all, it is necessary to ensure the clarity of training, and to improve the result, connect the touch, hearing and kinesthetic sensations.
• the process of assimilating new knowledge should go in small steps, it is more expedient to break one task into several parts.
• classes should be made as interesting and enjoyable as possible for the child, noting his slightest achievements and successes

Modern research has shown a deep connection between the psychological environment in the family, the level of interaction between parents and the child, the effectiveness of early assistance programs, preschool and school assistance.

A favorable combination of the organism's compensatory capabilities with correctly selected programs at each stage of training, effective forms of its organization can largely, and sometimes completely neutralize the effect of the primary defect on the course of the child's psychophysical development.

The future of children with Down syndrome is more promising now than ever, and many parents have already dealt with the challenges they face.

Try to adhere to the following rules, it will make your life easier:

1. Overcome fear and despair.
2. Don't waste time looking for the culprit. It just doesn't exist.
3. Determine what kind of help your child needs and
your family, and start contacting specialists:
medical assistance (consultation with a pediatric neuropsychiatrist and other specialists);
psychological and pedagogical assistance (training in a specialized institution based on the recommendations of the PMPK).

Down Syndrome

How do children with Down syndrome develop?
From the first months of life, children lag behind in psychomotor development. Most of them later develop speech and have defects in sound pronunciation. Children do not understand well the speech addressed to them, their vocabulary is poor.
“The relative preservation of the emotional sphere, good imitation of children with Down syndrome contribute to the fact that the intellectual disability of these patients for parents becomes apparent at a slightly older age, usually after 2-3 years. Mental retardation in Down syndrome manifests itself in varying degrees. Patients are distinguished by concrete, slow thinking, their attention and semantic memory are impaired. Mechanical memory remains more intact.
Children are friendly, sociable, trusting. They usually show tender affection for loved ones and those caring for them. However, some of them can be highly excitable, disinhibited, stubborn.

How can parents help their children?
If a child has Down syndrome, the baby should be carefully examined by specialists. First of all, it is necessary to find out if the child has a congenital heart defect, and if it is found, it is necessary to resolve the issue with specialists about the possibility and expediency of surgical treatment. Congenital heart defects in Down syndrome are observed in 30-40% of cases, and, as a rule, these children are characterized by slight somatic weakness, they may often have difficulty breathing, shortness of breath. And then it is necessary to ventilate the room where the baby is especially well. In some cases, it is helpful to use a humidifier.
All children with Down Syndrome should have their hearing tested, as they have frequent hearing impairments. And undiagnosed hearing impairments significantly complicate the development of speech and the general mental development of the child. The kid should also be consulted by an eye doctor and an endocrinologist.
Many children with Down syndrome have various visual defects, insufficient function of the thyroid gland and other endocrine glands.
Watch your child carefully, do not miss various paroxysmal conditions with a fleeting blackout, twitching in various parts of the body. It is known that about 10% of children with Down syndrome have epileptic seizures.

What developmental level can a child with Down syndrome achieve?
The answer to this question largely depends on how early and how hard the basic skills and abilities are taught to the baby. Despite the fact that children with Down syndrome are lagging behind in mental development and require a lot of attention, they are members of the family, society and respond gratefully to love and care.
Since these children are inactive, the independence they have shown in various activities, in the game, and in self-service skills should be encouraged.
When teaching a child with Down syndrome self-care skills, it is necessary to use his imitation. Create as many situations as possible in which the child could observe your actions when dressing, undressing, washing, cleaning the premises, etc. If there are more children in the family, give him the opportunity to observe their actions and play as much as possible. Gradually teach these actions to the sick child. Do this systematically and you will definitely see the result of your work.
To stimulate the child's own activity, music lessons are very useful - music therapy or music treatment, since children with Down syndrome are very susceptible to music, they move with pleasure to it, clap their hands, sing. Therefore, special games with musical accompaniment are useful for them, for example, rolling a ball, rhythmic movements, imitation of the actions of characters from fairy tales, etc. With them, you can learn simple poems, counting rhymes. Special games aimed at developing general motor skills and coordination of movements are important. Children should be taught to run, jump, throw and catch a ball, and slide down a slide. In carrying out all these activities, one should use the characteristic feature of these children - their imitation and musicality. Caress, hug your child more often, and he will express his attitude towards loved ones in the same way.
Show your baby big bright pictures, teach him to look at them, briefly explain their content.
Particular attention should be paid to the development of the baby's speech. In this case, again, it is necessary to rely on the great imitation of the sick child. Therefore, in addition to conducting special classes on the development of speech, make it a rule for yourself to comment on your actions, which the baby is watching, with simple sentences such as: "I wash my hands", "put on a coat", "cut bread", "my cup", etc. Name the objects and activities on which the child's attention is currently focused. By doing this constantly, you will make significant progress in the development of his speech.
Read more books to your child, select texts according to his level of understanding. In doing so, use publications with bright, large pictures to illustrate the content of the text. It is useful to draw individual characters at the same time while reading.
For a child with Down syndrome, it is very important to adhere to the regimen, accustom to accuracy, early participation in various types of household work together with adults, and then independently under their guidance. And no matter how difficult it is for you, no matter how despair grips you, remember: the main thing is patience and love.

Which specialists should consult a child with Down syndrome?
An objective examination of vision and hearing is important, since up to 60% of children with Down syndrome have various pathologies of the visual system and 40% of hearing.
Also, a child with Down syndrome should be observed by a neuropsychiatrist, pediatrician and endocrinologist; it should be remembered that these children have heart defects, insufficient functions of the thyroid and gonads.

Is breast milk good for babies with Down syndrome?
Children with Down syndrome easily catch colds, especially their ears often hurt - breast milk increases their immunity.
They are also susceptible to intestinal infections - breast milk promotes the multiplication of beneficial bacteria in the intestines, and this facilitates the course of the disease.
Children with Down syndrome are often constipated - breast milk has a laxative effect.
They also have frequent heart defects - breast milk contains less salt and is more physiological.
Babies with Down syndrome often suckle sluggishly - breastfeeding has a rhythm that makes it easier to suck.
Children with this syndrome are mentally retarded and breast milk is good food for brain development.
As a rule, children with Down syndrome are hypotensive, suck poorly, they need help and training. You need patience and patience again, until mom and child understand each other.

Why is early diagnosis and assistance important?
In the first year of life, early diagnosis and assistance is very important for the development of motor functions. With the help of early diagnosis and therapeutic exercises, the child acquires motor abilities much earlier than without this help. Playing together is important for the development of all children, and especially for the mentally retarded. Finger games, knee bounces, rhymes and songs are fun for both the child and the parents. They help develop speech and empower the child.
Children with Down syndrome, like other children, need a lot of toys. Toys should encourage active action and facilitate the learning process. It is important to include other children with normal development in the game, this will bring a lot of pleasure to both the child and his play partners.

How to raise a child with Down syndrome?
The upbringing of children with Down syndrome in a family is somewhat facilitated by the fact that most of them are friendly, they try to win the approval of adults to the best of their ability and ability. If a child has siblings, they will, of course, be important playmates.
In the second year of life, it is especially necessary to develop speech. This is helped by children's songs and picture books and simple play material. Any book helps to learn, consider and name already known pictures, and this is better than meaningless examination.

Family life
A Down syndrome child will develop better if parents, siblings, relatives and neighbors treat him with patience and love. Of course, parental help will be more effective if there is agreement and understanding in the family. If parents try to resolve the relationship once and for all, take care of each other and give other children enough attention, then everything will go for the good of the child with Down syndrome.
In Russia, self-help groups for parents and communication groups for children are now being created. Such family assistance services are successfully operating under public organizations, they will help look after the child so that the parents have free time.
Over time, most families develop the experience of dealing with a mentally retarded child and the ability to perceive him as he is.

Features of sight and hearing in children with Down syndrome
It has now been established that in children with intellectual disabilities, much more often than in the general population, there are visual and hearing impairments, which can complicate the underlying defect or are the leading defect. Knowing about the peculiarities of damage to the organs of vision and hearing in such children is necessary not only for specialists working in the field of correctional and special pedagogy, but also for parents, who can also contribute to the timely medical correction and special adaptation of the child. The auricles in children with Down syndrome are smaller than usual, rounded in shape, with a flattened curl, protruding antihelix, a mild tragus, antigus and lobe, in some cases with cutaneous tubercles in front of the auricle. Deformation of various degrees of the auricle is almost always combined with a narrowing of the external auditory canal. His skin is dry, with sloughing epidermis and sulfur, which, lingering in the external auditory canal, form sulfur plugs. Dryness of the external auditory canal is the result of dryness of the outer integument, as well as dryness of the mucous membrane of the lips, due to which transverse cracks form on them.
The instillation of drops of peach, apricot, sunflower (sterilized) oil has a beneficial effect on the condition of the skin and the features of the external auditory canal. It is enough to bury two drops of oil warmed up to body temperature three to four days a month. In this procedure, the auricle is pulled upward and slightly backward to straighten the ear canal. Subsequently, with each hair wash, the auricle with the external auditory canal is washed with soapy foam and then thoroughly wiped off. Rinsing the auricle with water should never be done to a child with chronic otitis media. In order to prevent water from entering the external auditory canal, before each hair wash, it is necessary to put an oiled cotton swab into it, which does not allow liquid to pass to the eardrum. Face and hand skin care is well helped by an aqueous infusion of chamomile, string, and mint.
The herb is brewed with boiling water at the rate of one tablespoon for half a liter of water, settles, after which you can wash with the infusion. The appearance of inflammatory processes in the middle ear is largely facilitated by the shape of the skull (increased transverse size compared to the anteroposterior), which causes a more horizontal position of the auditory tubes, which facilitates the penetration of infection from the nasal cavity, nasopharynx into the tympanic cavity.
The nasal cavities and nasopharynx in children with Down syndrome are narrowed, the first is due to the high Gothic hard palate, which is the bottom of the nasal cavity, and the second is due to the enlargement of the nasopharyngeal tonsil (adenoids) and lymphoid ridges around the mouth of the auditory tubes, which are often inflamed due to inflammatory changes in the nasal cavity. Narrowing of the nasopharyngeal space and nasal cavity makes it difficult to aerate the nasopharynx and auditory tubes, which creates conditions for the occurrence of inflammatory processes in the auditory (Eustachian) tube and middle ear.
Violation of nasal breathing is accompanied by the presence of mucous membranes in the nasal passages, which negatively affects the state of oxygen metabolism. Lack of oxygen in the body leads to disturbances in the functioning of the heart, changes in intracranial, spinal and intraocular pressure. In this regard, an increase in the second-third degree adenoids is an indication for their surgical removal. It is important to teach the child to empty the nasal cavity, blow his nose, alternately closing one or the other nostril. This prevents mucus from entering the pipe.
The presence of frequent catarrh of the middle ear, acute and chronic purulent otitis media leads to hearing impairment, which complicates the already limited communication capabilities of the child, adversely affects the development of speech in early childhood.
Hearing impairment can also be caused by anomalies of the auditory ossicles in the tympanic cavity, a change in their configuration, the fusion of two bones, for example, the malleus and the incus. Sometimes the bones grow together with the bony wall of the tympanic space or ossification of the ligaments occurs from the malleus. An anomaly such as ossification of the ligament around the oval window may be due to a violation of metabolic processes characteristic of Down's syndrome. Changes similar to those described, mainly in the zone of low and medium frequencies from 16 to 1000 Hz in the range from 30 to 60 dB. by air conduction, do not affect bone perception of sound. Thus, hearing loss can be of varying degrees (whispered speech is perceived from a distance of one to five meters). Hearing loss can aggravate both speech underdevelopment and impaired understanding of addressed speech and affect communication and cognitive activity.
Sensorineural hearing loss, which is also characteristic of children with Down's syndrome, manifests itself on the audiogram as an increase in the auditory thresholds for both bone and air conduction (the curves go side by side) mainly at high frequencies - from 2000 to 20,000 Hz. The likelihood of sensorineural hearing loss increases with age, which is associated not so much with a long-term chronic purulent process in the middle ear, but with an unusually accelerated aging process of the cochlea, which is combined with general premature aging. It is impossible to exclude neurosensory hearing loss of central origin in connection with dysplasia of the gyri of the brain, including the upper temporal, where the center of hearing is located, since the symptom of impaired speech intelligibility is also characteristic of children with Down syndrome.
Thus, hearing loss in both sound-reproducing and sound-perceiving types is typical for children with Down syndrome. It follows from this that an audiometric examination of such children is necessary, especially since parents do not always pay attention to the fact that the child's hearing is impaired.
The thickened and elongated tongue (covered with cracks - "geographical"), which slows down chewing, is corrected with the help of an operation - resection of its part. It also contributes to a decrease in appetite, and, consequently, excess weight, which is apparently associated with a decrease in the number of taste buds on the tongue.
Surgical removal of a part of the tongue, as well as the removal of a part of the enlarged nasopharyngeal tonsil (adenoids), allows children to keep their mouths closed, has a beneficial effect on the development of the jaws, correcting the occlusion; in addition, salivation decreases.
A child who has undergone these operations is less at risk of respiratory diseases. Children with mild mental retardation recognize that their physical appearance has improved as a result, which leads to increased self-esteem and improved mental well-being.
Children with Down syndrome are characterized by an oblique cut of the eyes (the outer angle is higher than the inner one), the epicant is a vertical fold that hides the inner corner of the eye, a wide flat nose bridge, light spots on the iris (Brushfield spots) due to a decrease in the pigment content in it.
Changes in the cornea are manifested by its protrusion in the form of a cone, which is called keratoconus. Keratoconus is more often manifested during puberty, has a progressive nature, it may be associated with endocrine pathology, which affects the hypofunction of the thyroid gland. The process begins with softening of the cornea as a result of its invasion by blood vessels. Under the influence of blinking movements, the cornea acquires, as already mentioned, the shape of a cone, the top of which gradually becomes thinner, becomes cloudy due to the rupture of the most dense and elastic part of the cornea, which protects against infection and moisturizes it. Corneal opacity and keratoconus significantly change refraction (refractive power of the eye), various types of astigmatism occur and vision decreases. Keratoconus is often associated with cataracts and glaucoma.
At least half of children with Down syndrome suffer from cataracts in childhood, and by the age of 10 years, its signs are detected in most children. In congenital forms of cataract (1 -5% of all cases) already in the maternity hospital or in the first year of life, on examination, a "grayness" is found in the pupil area. The pathology of the lens is associated with an anomaly of the vessels of the lens capsule (occurs in the second month of uterine life), which is manifested by its opacity. Since the lens is the second most refractive medium of the eye after the cornea, its opacity reduces vision and requires the earliest possible surgical removal with replacement with an artificial lens.
Complaints of a child about pain in the eyes after prolonged eye strain (TV, computer games), occasional blurred vision, iridescent circles before the eyes, headaches, a desire to rub the eyes - all this indicates the possibility of increased intraocular pressure - glaucoma. Glaucoma occurs as a result of a violation of the outflow of intraocular fluid. Congenital glaucoma is the result of underdevelopment or improper development of the drainage system in the corner of the anterior chamber of the eye. With an increase in intraocular pressure, blood circulation through the vessels of the eye worsens and the intraocular part of the optic nerve is especially affected, which can lead to atrophy of nerve fibers.
Children with glaucoma should be separated into a separate group in the classroom, since inclinations are contraindicated for them; such a child should not lift weights or dive into the water. Congenital glaucoma (hydrophthalmos, buphthalmos) is treated surgically - a drainage system is recreated in the corner of the anterior chamber of the eye for the outflow of intraocular fluid.
One third of children with Down syndrome develop severe myopia (myopia), combined with astigmatism (different types of refraction - refraction - in one eye or different degrees of one type of refraction). In myopia, light rays are collected in front of the retina, their main focus does not reach the retina. In this case, they speak of strong refraction, which is aggravated by an increase in the length of the eyeball. Near-sighted objects see distant objects vaguely, as in a fog; to see them more clearly, they have to squint.
They can see nearby objects perfectly. There is evidence of the congenital nature of myopia. The development of myopia is promoted by prolonged visual work at a close distance, in poor lighting of the workplace, for example, reading text with small print at a distance of less than 30 cm. This is also facilitated by excessive removal of the axis of the eye, caused by endocrine disorders inherent in children with Down syndrome.
It is necessary to observe measures aimed at improving the health of the child's body and, consequently, the visual system: to withstand the exercise regime, the daily routine in general, to create good living and nutritional conditions. In order to compensate for myopia in Down syndrome, glasses are prescribed, with a weak degree of myopia (up to 3.0 diopters), glasses are prescribed only for distance and are used in the theater, at the exhibition.
With severe myopia (3 diopters and more) glasses are used constantly. In order to prevent the development of myopia, it is recommended to do exercises that train the weakened accommodative muscle. Surgical treatments can also be recommended. The most common of them at present are notches on the cornea in order to reduce its refractive power or to strengthen the scleral membrane of the posterior pole of the eyeball. Unfortunately, lenses are ineffective in this case, as children with Down syndrome cannot care for them.
A sharp decrease in vision in one or both eyes as a result of refractive errors, in particular myopia, as well as changes on the part of the central nervous system, which are always observed in children with Down syndrome, and frequent inflammatory diseases cause changes in the oculomotor system: there is an incorrect position of the eyes, their restriction movements and involuntary rhythmic movements of the eyeballs - nystagmus. With strabismus, binocular (with both eyes) vision is impaired, the central vision of the squinting eye decreases. Strabismus can be convergent, if the eye deviates towards the nose, and divergent, if the eye deviates to the temple, as well as strabismus, in which the eye is directed upward or downward. In this case, strabismus can be unilateral, when the same eye is constantly deflected, and bilateral, in which one or the other eye alternately deviates, depending on which of them is currently fixing. Since strabismus makes it difficult for the eyes to work together, an involuntary suppression of the functions of one of them occurs - as a rule, it is worse than the seer. The worse seeing eye begins to deviate more often, and after a while the strabismus becomes permanent, and vision in this eye deteriorates. Such a decrease in vision, arising from the "disuse" of the visual function of the eye, is called amblyopia. Amblyopia is observed in 60-80% of cases of concomitant strabismus and is its consequence. The success of strabismus and amblyopia correction largely depends on the timeliness, correctness and activity of individual treatment, as well as the persistence of both the patients themselves and their parents.
If a child is diagnosed with Down syndrome, there is reason to believe that there is a possibility of further impairment of the auditory and visual functions. This should be taken into account when developing correctional-psychological-pedagogical measures. With this approach, in the future, it is possible to overcome the reactive states that arise in a child or adolescent. For long-term detection of a complex defect in children with Down syndrome, compulsory periodic comprehensive medical care is required, including otorhinolaryngological, audiometric, ophthalmological examination with fundus examination, and regular repeated experimental psychological studies. Carrying out such studies allows you to detect all the defects of functions in a child, which is necessary for the provision of timely and adequate medical, psychological and pedagogical assistance.

Reader for parents of children with disabilities
(Compiled by O.Yu. Piskun, T.V. Voloshina, Novosibirsk State Pedagogical University, Novosibirsk 2009)

Consultation on the topic: "TEACHING CHILDREN WITH DOWN SYNDROME"

Features of children with Down syndrome

Children with Down's disease have a peculiar type of face: narrow eyes with raised outer corners, small, "button", nose, blush on the cheeks. The mouth is half-open, the tongue is thick, with folds and deep grooves, the teeth are sparsely spaced, the skull is smaller than usual, the forehead is sloping, and the fingers are very short. They are very different: some of them are lethargic and apathetic, others, on the contrary, are excitable and restless.

Children with Down syndrome have a passive vocabulary much richer than an active one, that is, they understand someone else's speech better than they speak themselves. If the child is given tasks that are not related to his own speech, for example, put pictures of furniture and utensils into groups or show a circle, a square, he will easily follow all the instructions.

Down kids are emotional. They experience anger, fear, joy, sadness. Some children develop epileptoid character traits: egocentrism, excessive accuracy, ill will. But most of them are affectionate, friendly, balanced, love to listen to music, they have a sense of rhythm. Due to the fact that these children are emotional, communicative, they can be helped if they are persistently and kindly dealt with. The parents of such a child are interested in whether they should be taught to read and write. Making the right decision is not easy. Not all deeply mentally retarded can learn to read, write, and count. In many cases, the child learns the elements of literacy, but these activities are purely formal in nature. Having mastered the reading technique, a down child often does not understand the content of what he read. Writing is often reduced to mechanical copying of written signs. Many of the children are not able to master the count, they memorize the multiplication table, not understanding the meaning of these actions. In addition, it takes a lot of time and effort to acquire this formal knowledge, which could be more usefully spent on something else, necessary and useful. Both parents and educators do not always correctly understand the tasks of teaching children with Down syndrome.

Parents often believe that they should not spend a lot of time on physical education, drawing, modeling, dramatization, talking with children, since it is difficult to evaluate the result of these activities, and it is very easy to check the knowledge of letters, numbers, reading, writing, and counting. This is a deeply flawed approach to learning. Teaching a down-child to read and write should be approached carefully, very individually, taking into account the child's level of development, his ability. These activities should not be turned into meaningless, mechanical memorization of letters and numbers. There are many cases when children are taught letters every day for years, but they never learn to read. The same applies to writing and invoicing. The old, traditional, ingrained practice should be revised and changed in order to more realistically and expediently address the issue of education and upbringing of children with Down syndrome.

A fairly large practice of raising children in special institutions and in family conditions has shown that many of them are capable of life-practical and elementary labor training. Some master the elements of literacy and concrete counting. These children, with proper training and education, can adapt to life in the family and society. Observations of these children, the study of their activities and behavior allow us to say that with low intellectual abilities of these children, it is still possible to identify in them "elements of learning", that is, more intact components of cognitive activity and the emotional-volitional sphere, on which they can rely educators in the process of correctional work.

The behavior of children with Down's disease is mainly characterized by obedience, easy obedience, good nature, and gentleness. Emotions are dominated by a positive tone. This is a good basis for educational work. The child, as a rule, does not resist the instructions of adults and follows them to the best of his ability. Some basic manual activities are available to children with Down's disease. They retained the perception of spatial relationships and color distinction. Many of them relate objects in shape and size. All this can serve as a basis for teaching children with Down's disease the simplest types of play and learning activities. The practice of family upbringing of such children also proves their learning ability and upbringing.

Learning to write

Writing skills are considered in two ways - from the point of view of speech activity and from the point of view of motor skills (fine motor skills), i.e., in relation to knowing what to write (to draw), and in relation to the ability to write on paper (motor skills).

DRAWING AND WRITING PROGRAM

Redraw the circle;

Redraw the cross (+);

Redraw the oval;

Draw a face;

Draw a square;

Draw a person;

Redraw the triangle;

Draw without going over the two boundary lines;

Circle the lines;

Circle a circle;

Redraw letters;

Circle the name;

Redraw the name;

Circle words;

Redraw words;

Drawing by imitation and with the teacher's comments ("I draw the line down, then along, then up, and again along. You do the same.");

The child draws a square after being told what needs to be done for this (the teacher prompts the child with the words: "Lead down, along, up, along");

The child draws a square after the teacher, taking his hand in his own, drew a square with him (the teacher, taking the child's hand in his, draws a square with him, delaying the drawing of the line with each change in the direction of the hand, that is, in the corners of the square);

The child connects 4 points to form a square (draw 4 points on paper, say: "I connect these points. Look, I've got a square." Draw the same points and tell the child how to connect them.).

Due to the lack of fine motor skills, it is advisable for children with Down syndrome to be given exercises for redrawing according to the pattern of outlines of letters and numbers, and only after that he can try to draw them on his own. An important point is learning without mistakes: enough practice in tracing, and then in sketching.

In teaching writing (drawing), it is possible to redraw with a blindfold according to a template presented to him in advance. In this case, visual feedback from the hand is neutralized, the child focuses on only one feedback system - proprioceptive. This neutralization allows you to consolidate the "motor programs" - provided that the child draws outlines exactly according to the template.

Account training

Mastering numeracy skills for children with Down syndrome is more difficult than mastering reading, which is associated with the need to understand the abstract nature of number.

I. TRAINING PROGRAM FOR NUMBERS FROM 1 TO 5

Mechanical count from 1 to 5;

Counting moving objects from 1 to 5;

Counting of fixed items from 1 to 5;

Counting randomly moving objects from 1 to 5;

Counting of fixed but disordered items from 1 to 5;

Mechanical counting by naming numbers from 1 to 5;

Counting and sizing a set of 1-5 items;

Recalculation of subsets of a set of 1-5 items;

Matching with numbers from 1 to 5;

Selecting a number from 1 to 5;

Naming in order of numbers from 1 to 5;

Calling numbers from 1 to 5 in any order;

Score from 1 to 5, indicating the corresponding card with a number;

Arranging cards with numbers from 1 to 5;

Mechanical account up to the number shown (from 1 to 5);

Selection of cards with numbers from 1 to 5;

Selection of components from cards with numbers from 1 to 5;

Selection of a set of items corresponding to a card with a number from 1 to 5;

Comparison of sets (sets) of objects with cards with numbers from 1 to 5.

II. ACCOUNT FROM 1 TO 10

Counting moving objects from 1 to 10;

Fixed items count from 1 to 10;

Counting randomly moving objects from 1 to 10;

A count of fixed but disordered items from 1 to 10;

Mechanical counting by naming numbers from 1 to 10;

Counting and determining items of a set of 1-10 items;

Recalculation of subsets of a set of 1-10 items;

Matching with numbers from 1 to 10;

Selecting a number from 1 to 10;

Naming in order of numbers from 1 to 10;

Calling numbers from 1 to 10 in any order;

Score from 1 to 10, indicating the corresponding card with a number;

Arrange cards with numbers from 1 to 10;

Mechanical account up to the number shown (from 1 to 10);

Selection of cards with numbers from 1 to 10;

Selection of subsets from cards with numbers from 1 to 10;

Selection of a set of items corresponding to a card with a number from 1 to 10;

Comparison of sets (sets) of objects with cards from 1 to 10.

Self-service training and household work

A child with Down syndrome needs to be taught self-care skills - that is, teach him how to eat, wash, dress, undress, if possible, use a comb, soap, toothbrush, toilet paper. You need to teach your child to eat independently.

Children with intellectual disabilities can do basic household chores. For example, they may dust, clear the table and wash the dishes, water flowers from a children's watering can, etc. these responsibilities should be changed periodically to maintain interest in them and develop the ability to switch from one activity to another. It is necessary in every possible way to encourage the desire of a child with Down syndrome to do the job correctly, even small, sometimes subtle successes should be noted.

The degree of manifestation of intellectual disabilities in children with Down syndrome varies greatly, which depends both on innate factors and individual characteristics, and on the time of the beginning of training according to special methods. Such children are learnable, but the success of training is directly dependent on the appropriateness of using a particular methodology, the professionalism of teachers, the interest and participation of parents in the development of their child.

Development and Learning Opportunities for Children with Down Syndrome

There are a fairly large number of methods that allow you to effectively teach and develop children with Down syndrome. But this process is more difficult and takes longer than the assimilation of similar skills and knowledge by an ordinary child. The earlier you start classes with your child, the more chances you have to achieve success. The main didactic principle in teaching such children is to use different channels of perception, that is, different senses. First of all, it is necessary to ensure the clarity of training, and to improve the result, connect the touch, hearing and kinesthetic sensations. The process of assimilating new knowledge should go in small steps, it is more expedient to break one task into several parts. Classes should be made as interesting and enjoyable as possible for the child, noting his slightest achievements and successes.

Early help

Early assistance is provided from the moment a child's violations are established until he enters an educational institution. It is designed to ensure the maximum realization of the child's capabilities, to prevent the development of secondary disorders, to include children with Down syndrome in the general educational stream (integrated, inclusive education in preschool and school institutions). The activities of early intervention services involve the active participation of parents in the correctional process, their training, accompaniment and psychological support.

Methodology for the formation of basic motor skills (MAH)

Developed by Peter Lauteslager, a Dutch physiotherapist specializing in motor development and specialized care for children with Down syndrome. It is used for children from 3 months to 3-4 years old. It includes testing the levels of development of the basic motor skills of the child and drawing up a program of classes with him. The methodology implements a functional approach to stimulating the development of children, allows you to assess the dynamics of development and optimally plan classes. It is aimed at habilitating the child, warns and corrects deviations in the baby's motor development. It does not provide for the impact on the child, but for interaction with him with the active participation of the parents. The level of motor development is directly related to the primary research activity of the child and his inclusion in ordinary life - socialization. Testing gives a clear idea of ​​the successive stages of the formation of each motor skill, which allows specialists to competently draw up a program for the child's motor development and develop recommendations for parents. Mastering motor skills provides a child with a certain level of independent existence, which allows him to consistently learn everything that ordinary children can do. The successful development of the child in the motor field propels him forward in the field of communication.

Step by step

First of all, a child with Down syndrome should be taught the skills of self-care and behavior in everyday life, which not only ensure his independence and independence, but also serve the development of the personality, contribute to confidence and self-esteem. For many years in Europe and America, the step-by-step methodology has been used to teach children with special needs. It is very effective for children with Down syndrome. Difficulties in social adaptation of such children are largely determined by the insufficient formation of their elementary everyday skills. The basic skills that ensure independence for a child in any situation include self-care skills and home-care skills. And it is important to learn them in a timely manner. Any activity is based on basic motor and mental functions: concentration, general and fine motor skills. These are preparatory skills. One or another self-service skill can be taught only when the child has freely mastered the preparatory skills included in it. The process of learning to master skills should be purposeful, taking into account the characteristics of psychophysical development and life experience, carried out against a positive emotional background with widespread use of rewards. Your child needs dedicated time to practice skills, learn and review. It is necessary to teach the independence and everyday skills of the child using the simplest material and in the simplest conditions.

"Small steps"

This is a programmatic and methodological support for early pedagogical assistance to children with Down syndrome, encouraging them to interact more fully with the outside world. Developed at the Australian McQuery University, it is successfully applied in many countries, it is recommended for use by the Ministry of Education of the Russian Federation.
The methodology is presented in 8 books, which deal with the basic principles and techniques of teaching. The curricula of the program cover specific areas of development: general motor skills, speech, physical activity, fine motor skills, self-care, social skills of the child. The method of teaching the child in each of the sections of the program allows you to gradually form a skill, ability, knowledge. The last book contains a list of the skills that determine the development of a child, and a series of checklists that allow you to test toddlers. The Little Steps are similar to the Carolina Special Needs Infants and Young Children program, which parents of children with Down's Syndrome can use under the guidance of early intervention specialists. Many children who were taught using these methods were able to continue to attend integrated and inclusive classes in mainstream schools.

Socio-psychological model Portage

The technique was developed in the USA in the 70s of the last century, and is successfully used in many countries of the world. The goal of the Portage is to work with families with a disabled child, help to reduce barriers to disability, and socialize children. The family is visited by a home visiting specialist. A team of project leaders, specialists who know the methodology and specially trained volunteers from among students, future doctors, psychologists and teachers participates in the process of rehabilitating a child. During the visits, parents are taught structured teaching techniques for use in their daily interactions with the child. Parents are taught to observe the child, plan attainable goals, and reward desirable behaviors. Sections of the Portage include stimulation of an infant, socialization, cognitive activity, development of physical activity, speech, and self-service skills. The Portage methodology consistently describes all the skills, abilities and knowledge that a child must master as a result of purposeful learning. It clearly defines what to teach, when to teach and how to teach.

Methodology for the development of speech and teaching to read by Romena Avgustova

This is a one-of-a-kind method for developing the speech of children with Down syndrome. The author, who has been engaged in speech pedagogy all his life, explains in simple and accessible language in his book “Speak! You can do it ”, how to teach a child with complex developmental disabilities to speak, how to communicate with such children, help them reveal their abilities and creative inclinations. Children studying according to the Augustova method not only master oral speech well, but also learn to read with enthusiasm.

Hippotherapy

Corrective horse riding - hippotherapy, is very effective and multifunctional for solving the problems of rehabilitation of children with Down syndrome. It develops the motor, sensory, emotional and psychological abilities of children. Communication with horses, caring for and caring for them increases the feeling of trust, patience, and reduces anxiety. Hippotherapy develops the intellectual abilities of children, contributes to their social adaptation and better adaptation to life. Specially trained teachers own the methodology for conducting hippotherapy classes.

System "Numikon"

It is very difficult for a child with Down syndrome to learn mathematics, even the basic skills needed in everyday life. "Numikon" is a set of educational material and a specially developed methodology for working with it when teaching the basics of mathematics. Numbers in the set of visual material are represented by forms-templates, painted in different colors, which makes them accessible for visual and tactile perception. The set includes colored pins, a panel, and task cards. The child's manipulations with details lead to the fact that actions with numbers become visual and tangible. This allows you to successfully teach children with Down syndrome the basics of mathematical knowledge.

Lekoteka

The word "lekoteka" literally translates as "toy storage". In Russia, this new methodology, developed by Swedish scientists, is being successfully applied for psychological support and special pedagogical assistance to parents raising children with severe disabilities and developmental problems. The library service forms the prerequisites for educational activities in children, supports the development of the personality of each child, conducting training in the form of a game. Forms of the lekothek's work: consultations for parents, diagnostic play sessions, therapeutic play sessions, group parenting trainings. The arsenal of lekothek contains many toys and games for the development of children, special equipment, video libraries, music libraries. Children with Down syndrome can attend classes in lekotheques from 2 months to 7 years.

Preschool education

A child with Down syndrome may attend a compensatory preschool for children with intellectual disabilities. The training program in such institutions contains 6 sections: "Social development", "Health", "Physical education and physical development", "Formation of activities", "Cognitive development" and "Aesthetic development". All classes according to the sections of the program are conducted by teachers according to the methods of teaching and developing children with intellectual disabilities.
Recently, integrated or inclusive education in preschool and school educational institutions has become more and more popular. It provides for teaching children with disabilities and healthy children in a joint educational environment, providing special conditions and social adaptation. If a child with Down syndrome visits integrated or inclusive groups in mass kindergartens, individual curricula are developed for them in accordance with the possibilities.

Schooling

Education of children with Down syndrome of school age can be carried out in special correctional schools of the VII or VIII types, engaged in a program for children with intellectual disabilities. The teaching methods of all subjects included in the school curriculum are developed taking into account the laws, principles, methods and techniques of teaching persons with intellectual disabilities.
Schoolchildren with Down syndrome, who, thanks to the early use of teaching and developmental methods in preschool age, managed to achieve a high level of development, can successfully study in integrated or inclusive classes at mainstream schools. The teachers of these classes, with the assistance of special education specialists, develop individual curricula for each such student, taking into account the child's capabilities and levels of development.