Social behaviour

This section focuses on how parents can encourage competent and age-appro­priate social behaviour as they bring up their young child with Down syndrome. In other words, the focus is on developing effective social skills for getting on with others and the preventing of ‘behaviour difficulties’. Readers would be cor­rect to think at this point, “well that is the task for all parents of under-fives” and this is entirely correct. All toddlers can be difficult to manage at times as they wish to assert their independence and to do what they want to do as soon as they think of it, hence the use of the term ‘the terrible twos’ in the UK to refer to this stage in development. Therefore, the advice and information in this section covers, firstly, what is known about effective parenting strategies to help chil­dren learn to control their own behaviour in socially acceptable ways and, sec­ondly, what additional needs children with Down syndrome may have which may influence their ability to learn to manage their own behaviour. The importance of encouraging good behaviour from infancy cannot be over­estimated. We have already mentioned the study that shows that the behav­iour of children with Down syndrome at 3 years influenced their progress and their mental age scores at 10 years - that is, those with fewer behaviour dif­ficulties and better self-regulation skills made better cognitive progress. Chil­dren who have been helped to learn how to manage their behaviour will have better social lives and independence and be able to take full advantage of all the learning opportunities available to them. Readers are encouraged to read the section on Social Behaviour in the Social Overview in this series, as it contains details of the sort of behaviour difficulties that are common in children with Down syndrome and further advice on how to avoid them. Children with Down syndrome are at greater risk of developing difficult behaviours, therefore it is very important that parents and carers do understand how to support them to learn effective ways of behaving.

Readers who have older preschoolers who have difficult behaviours will find more detailed practical guidance on how to change them in the Behaviour Man­agement book in this series. Here we focus on highlighting the positive ways we can all influence children’s behaviour from the earliest months through to school age and outline the principles for effective behaviour management.

Emotions and self-regulation

Self-regulation refers to a child’s or adult’s ability to manage their own emo­tions and behaviour in order to be successful in relationships and in social situ­ations. The development of self-regulation begins in the first year of life and starts with babies beginning to regulate their bodily needs to fit into day and night patterns for feeding and sleeping. At first, the baby’s needs are regulated by parents as they respond to crying, hunger and tiredness and do much of the soothing of babies in the first 3 to 4 months. In fact, research indicates that par­ents who are responsive to their baby’s needs in these early weeks have babies who fuss less later. The ability to soothe oneself, to settle to sleep alone and to begin to be able to wait for feeds are the first steps on the pathway of self-regulation. (These are discussed in detail in the Independence and self-help section on pages 30-36.) Over the first 5 years, the responsibility and control for managing feelings, needs and the consequent behaviours shifts from parent managed (other-con­trol) to child managed (self-control). Emotions and behaviour are intertwined - especially when we are considering difficult or inappropriate behaviours. Children have to learn to understand and to control powerful emotions in order to behave in ways that are socially acceptable and socially successful. By 5 to 6 years, most typically developing children show a great deal of competence - they are able to wait for an ice-cream or other treats, to remain quiet through story-time in class and to ignore distractions while concentrating on a task. Most children with Down syndrome can learn to wait and not be disruptive at this age if expected to do so - some will still need some support to learn these behaviours. Psychologists consider that learning to control emotions and behaviour also links to learning to pay attention or concentrate in learning situations. This is confirmed by research that shows that children with Down syndrome with more difficult behaviours at 3 years make less cognitive and social progress by 10 years than those children with Down syndrome with less difficult behaviours. In addition, as children learn about their own emotions and the consequences of their behaviour, they also learn to understand how others may feel and may behave. This is important for successful social competence in friendship situ­ations and in all social interactions with others. By 5-6 years of age, typically developing children are able to begin to reason about what other people think or believe and how these thoughts may explain their behaviour. This level of understanding and reasoning will be achieved later in primary years by chil­dren with Down syndrome as it will be influenced by the language and cogni­tive progress.

Temperament

There is evidence that babies vary in basic temperament and that this is part of their genetic makeup - with some babies more fretful, and less easy to soothe while others are more calm and placid. Research studies suggest that tempera­ment cannot really be assessed or show any stability until infants are 4 months of age or older. Temperamental differences have been shown to be important. For example, studies show that some babies at 4 months of age love highly stimulating sounds, sights and smells - they smile, coo and waves arms around as if to ask for more. However, other babies at the same age become distressed in the same situation - they arch their backs, cry and struggle as if to say “take them away”. These reactions tend to predict which children will become outgo­ing and active and which become anxious and shy as toddlers and preschool­ers. Differences in temperament place different demands on children as they learn to fit in socially. For example, the fearful child has to practise being brave and outgoing, the highly active child has to practise sitting still. Children with Down syndrome are all individuals and vary as much in temperament as typi­cally developing children

Expressing and handling emotions

Over the first year, babies begin to express a wider range of emotions. These include excited laughter in play, angry defiance when resisting being placed in the high chair, to distress when hurt, and frustration when unable to do some­thing. Toddlers find it hard to manage the strong emotions that they feel as all parents know and at times they ‘lose control’ and have a full-blown tantrum. It is often hard for parents to resist their toddler’s demands in the face of the emotional and behavioural outbursts they can produce. However, parents need to be aware that by resisting, they are helping their child to learn to manage their feelings and that this is a vital step towards being a happy and successful child and adult. Children with Down syndrome may be a little later to begin to make demands and try to exert their own will but the need to help them control their feelings is the same as it is for all children. Strong emotional feelings are overwhelming and actually frightening for chil­dren. If parents do not set boundaries for their children to help them learn control, their children become unhappy and frightened by the power of the feelings that they are not learning to control even though this may not be obvi­ous to those around them. Small children, who are ‘out of control’ may demand to do everything from sleeping to dressing to eating and watching the TV when they want. When their behaviour changes as the result of a successful behav­iour management programme they are noticeably happier. They change from cross and whiney children to happy and engaged children - engaged with par­ents and others and engaged in play. This is equally true for children with Down syndrome. The experience of emotions increases over time from those associated with body states of hunger, cold, tiredness or pain to the experiences of pleasure, fear, anger and distress during the first year of life. By 12 months of age, babies also read emotional cues from others and look to their parents when in new situations to see if they should be happy and touch the new toy or be afraid, based on their parents’ emotional cues - this is called ‘social referencing’. Chil­dren with Down syndrome pick up on emotional cues and also look to parents, although some differences in their use of social referencing have been noted, perhaps because it may be a little more difficult for them to interpret situa­tions.

Children begin to show empathy at around 2 years, when they will comfort someone who is distressed or hurt. They also show emotional awareness in their play and can make their doll angry, happy or sad. (Much earlier, as babies, they will cry when another baby cries, or smile when the other smiles but this does not imply that they understand how the other is feeling). Babies learn to understand their emotions and how to handle them from the way that they see other children and adults behaving, as well as from the way their parents react to them. Children with Down syndrome also show empathy and prosocial behaviour appropriate for their developmental level.

Family climate and consistency

Parents play a large role in the social development of all children. The social climate in the home matters. Children thrive in families where the relationships between parents, other family members and the child are happy, stable, con­sistent and therefore predictable. Children do not do well in households where there is unhappiness, disharmony, conflict, abuse, depression or where others’ reactions to them are inconsistent. Of course, in all families, there are ‘ups and downs’, and at times of stress families are not harmonious and the behaviours of family members may be inconsistent or distressed. This is not going to harm a child who is used to a stable and happy family - coping with the ‘ups and downs’ is almost certainly a positive learning experience as the child also sees how parents cope with upsets and conflicts appropriately when they do occur. The research on the effects of family climates and parent behaviours on children’s development refers to the exposure to good or bad situations over the long term. In particular, young children are distressed by conflicting and confusing demands and by conflicting emotional responses - for example, a parent reacting in a loving manner one day and a cold and rejecting one the next. Children become confused when their parents react differently from each other, such as, when one parent disapproves and one approves of the same behaviour. In addition, if close family members provide conflicting role models, the child does not know how to expect others to behave as they move on to relate to other children and adults. Children with Down syndrome need consist­ency in the behaviour of the adults around them just as much as other children - possibly more so, as they will not always understand all the language around them and the subtle nuances of behaviours expressed by others in stressful family situations or in conflicts between family members.

The importance of talking about behaviour and feelings

All children are affected by the way in which their parents behave and they are also affected by the manner in which they talk to their children. Studies show that, when parents explain emotions and behaviour to their children, it helps them to progress faster in their own social behaviour. For example, parents can help their children by discussing why someone is upset - “because their dog is sick”, or why someone is angry - “because Jenny took their toy away”. They can help further by telling the child how they can help by sympathising or comfort­ing, or by finding another toy for the child. Parents who talk about how others are thinking and feeling, and why, help children to understand their own emo­tions and behaviours and also, importantly, to build up the understanding of what others are thinking, feeling and doing (known as ‘theory of mind’). Being able to correctly judge what someone else is thinking is a big part of being competent in relationships with others throughout life. This is one of the par­ticular deficits that children with autism have - they show very delayed and lim­ited development of ‘theory of mind’ skills. Much of the early research on this compared children with Down syndrome and children with autism on ‘theory of mind’ tasks. Even though the two groups of children were of similar ages and at similar cognitive levels, children with Down syndrome were much better at knowing what someone else was thinking than the children with autism. How­ever, they will be older than typically developing children when they reach this level of understanding. There is, however, some research that suggests that parents of children with Down syndrome may not talk to them about how they and others are feeling or thinking as much as parents of other preschoolers do - probably because of the children’s language delays. However, they usually understand more than they can express and it is important to be sure that everyone does explain emotions and teach them the words for emotions during their preschool and primary years.

Role of language and self-talk

These last two points highlight the fact that children’s abilities in thinking and in language will influence their understanding and their behavioural develop­ment. Children’s language comprehension abilities will affect how much par­ents can explain feelings, the reasons why we should behave in particular ways or the consequences of behaving in certain ways to children. This, in turn, will affect the child’s ability to understand and later to control their own behaviour with ‘self-talk’ - a significant part of self-control. Children internalise the rules of social behaviour and by 4 to 5 years can self-instruct themselves by thinking “if I hit Billy he will not want to play with me again” or “if I run in the road, a car might hit me”. Children with Down syndrome are developing language more slowly, so may not be able to control their behaviour with this kind of ‘self-instruction’ by 5-6 years. However, they will still learn to behave in age-appropriate ways by watch­ing and modelling the behaviour of other children without disabilities in pre­school settings and by being praised and rewarded for appropriate behaviour.

Link with growing understanding of self

At around three years of age, typically developing children show an increasing awareness of self. They use “mine”, “I do it”, quite frequently and they begin to show pride in their successes, guilt and shame when in trouble and embar­rassment when they make a mistake or have an accident. The development of a self-awareness - who am I, what am I like, what am I good at - is very much shaped by social experience and the feedback that children get from others, adults and, especially, from children their own age. This leads to developing a sense of self, and self-confidence or self-esteem develop as children succeed in different aspects of their lives and are praised. They begin to make social comparisons between themselves and their peers during primary school years. Children with Down syndrome are equally influenced in developing a sense of self - who they are, what they are good at, how they fit into to the family and class - by the reactions, support and praise they receive from everyone around them.

Social influences on behaviour

It is clear from all the issues discussed so far, that children’s behaviour is influ­enced by many aspects of their social and family lives and how people sup­port them in managing their emotions and ‘wants’. Everyone around a child is responsible for contributing to their social learning and behaviour. Children learn the social behaviours expected at home, in church, in the playground, the swimming pool or in the classroom by going to those places and seeing how others behave there. The more social experience a child with Down syndrome has, the more they are able to learn how to behave from modelling other children’s behaviour, provided the expectations are the same as for the other children.

Behaviours are learned

In addition to learning from copying others, children’s behaviour is power­fully influenced by rewards. Parents and teachers guide children’s behaviour by rewarding them for ‘good’ or socially appropriate behaviour, usually with praise and by not rewarding them for ‘bad’ or socially disruptive behaviour and making clear their disapproval of the behaviour by saying ‘no’ and explaining why the behaviour is a ‘no’. Behaviours that children repeat are behaviours that they find rewarding. Behav­iours that are not, in some way, rewarding are not repeated. When a child keeps engaging in a ‘difficult’ behaviour - one that is not socially appropriate - they will definitely be getting a reward each time. Rewards can be a little less obvious than first appears - praise can be a reward but so can escaping from something one did not want to do, even though an adult is cross with you. It follows that, if behaviours are learned and maintained by the rewards that the child gets, then to change the behaviour we need to stop rewarding it. We explain this in detail in the Behaviour management book but a couple of further examples will illustrate the principle. A common complaint from par­ents of children with Down syndrome is that they run away in the street and the shops - up to half of 7 year olds with Down syndrome are still doing this according to one study. If we think this through - the first time the child runs away, they are chased by a worried adult because of the danger involved. From the child’s point of view, it is fun to be chased - it is a reward, so he or he is more likely to run again next time you are out. We are rewarding behaviour we do not want and therefore increasing the likelihood that it will happen. We need to reward walking on reins or holding hands - we need to actually pre­vent running as, once the child runs, we have to run after them. If we are alerted to this before children start to walk, we can be sure we ‘train’ them to always walk beside us holding hands or the pushchair. Another common behaviour that worries parents of toddlers with Down syn­drome can be throwing - all babies mouth, bang and throw toys at a certain stage in their development but a slower learning child may stay at this stage for longer so throwing seems to be a problem. If a toddler is throwing as part of play but an adult promptly jumps up and says ‘no throwing’ to the child, picks up the toy and hands it back, the likelihood is that the child will now throw to get the adult to react as that was more interesting than play. The child is now throwing to get adult attention - and can control adult behaviour - and the adult taught the child to do this! The solution at the throwing stage is to make sure a child only has toys that cannot do any harm if thrown and then ignore throwing behaviour - or get on the floor and play with the child to distract them from throwing and engage them with play you can praise them for.

A child’s behaviour is our responsibility

While some children may have more difficult temperaments and be more anx­ious or demanding, basically children learn to behave in the ways that we teach them. Children with Down syndrome may bring less understanding and lan­guage to a situation - they may be less well-equipped to learn to manage their behaviours - but they still learn from the reactions of the adults around them and behave in the ways that we teach them. This may be a hard message to accept but if a child is being difficult - it is the adults around that child who have to learn to change their behaviour, to change the way they are reacting to the child’s behaviour if they want the child’s behaviour to change.