Social development in infancy and the preschool years

Summary…

[From Social overview]

Social communication begins early

The first steps in social development are seen within the first few weeks of life, as babies begin to make eye-contact and to smile when they are picked up and talked to. They are beginning to learn about the significance of facial expression, tone of voice and body movement and how these indicate how someone feels. Babies with Down syndrome show very little delay in responding to their care givers. [TODO: references 30]

Some studies suggest that infants with Down syndrome continue to be very interested in face-to-face social games with a partner for longer than is typical. [TODO: references 2] This may be partly the result of delay in the development of motor skills and partly due to delay in the development of attention skills, as explained below.

Delayed ability to explore

By eight months of age most typically developing babies are developing their gross and fine motor skills. They are moving around the floor by rolling or crawling and they are increasingly able to play with toys and explore their physical environment. The motor skill development of the baby with Down syndrome is usually progressing more slowly. They are later to develop the fine motor skills which will enable them to manipulate toys and the gross motor skills which will enable them to get into cupboards, climb on to chairs and explore their physical world. Their main entertainment at 8-12 months will still be interaction and play with their care givers.

Developing shared attention

At about twelve months of age, typically developing babies are able to follow the line of gaze of another person or the direction of a pointing gesture, so that they can look at an object or activity while also attending to what their partner is saying about that object or activity. This ability is called joint reference - shared attention to an object or activity between two partners. This is important for language learning, as it provides the baby with the opportunity to learn the meaning of words, as the adult will name the object or talk about what is happening as they both look at the same object or event. Babies with Down syndrome take longer to reach this milestone. [TODO: references 2]

In order to increase episodes of joint attention, and in particular to encourage babies and toddlers with Down syndrome to initiate joint attention episodes, it is important to follow their lead. That is, to point to and to comment on an object or activity that the child is already looking at or engaged in. This will help the child to cope with the attentional demands of the situation and increase the likelihood that the child will be able to link the adult’s comments with their experience. Opportunities to engage children in joint attention episodes occur throughout the day, when engaged together in activities such as washing, eating, shopping or walking and when children are playing.

Increasing attention spans and shared activities

It is also important to encourage infants to enjoy shared activities such as looking at books and playing games together. This will help them to increase their attention span, to learn to listen, to engage with another person and to follow instructions. This will lead to competence in learning situations and in preparing children for sitting, listening and taking turns with others in a playgroup or class situation. Some children with Down syndrome have short attention spans, are distractible, and find sitting still for more than a few minutes difficult. [TODO: references 5] It is, therefore, important to develop attention skills and learning skills throughout the infant and preschool years.

Attention to a task is influenced by how interesting it is for the child, therefore sometimes attention and motivation become confused. A child may be described as distractible and having a poor attention span when a learning task is in front of them but the same child will concentrate happily when listening to a favourite story or when watching a video. The message here is that all learning needs to be fun and many learning situations can be more fun if teacher and child take turns at the task, so that success is modelled, or learning takes place in a group game with other children. To start to increase a child’s attention, choose a task the child enjoys and increase the time spent on it in small steps. With a task the child is not so keen to participate in, think of ways to make it fun and reward small increases in time spent on a task by allowing the child to choose another favoured activity.

The role of language

The social development of children with Down syndrome will be influenced by the delay that they usually experience in learning to talk. In the second year of life, typically developing babies begin to develop spoken language skills, with many children having at least a 50 word vocabulary by 18 months, and to be talking in two or three word utterances by two years of age. Clearly, the ability to use words to communicate greatly increases a child’s ability to manage social situations, to ask for what they want and to explain how they feel. Children’s rapidly growing understanding of language allows parents to explain actions and to reason with them. Although spoken language development is delayed for children with Down syndrome, they usually understand more than they can express. [39-41]

Longitudinal (follow-up) research suggests that the capacity to initiate and respond to social games in the early years is related to progress in expressive language and it is related to the social competence of children with Down syndrome at 10-13 years of age. [TODO: references 1] Parents and teachers should be aware, therefore, of both the potentially positive and negative effects of the social interactiveness of children with Down syndrome. Social interaction initiated by the children should be encouraged and responded to in most situations, but in a teaching situation children should be encouraged to attend to the task in hand and parents and teachers should not reward social diversions.

Learning by watching and imitating

Children with Down syndrome continue to show good understanding of the non-verbal cues in social situations and they also show good ability to learn how to behave in social situations that are repeated, where they can model what is expected by copying other children. For example, many children with Down syndrome are good at learning the routines for arriving at preschool, hanging coats on pegs, lining up, sitting at tables, and sitting on the mat for story-time because these actions are repeated every day and they can imitate the other children. Learning by imitation is a strength and one which children with Down syndrome use to learn effectively from other children in many situations.

A great deal of social behavior can be learned by watching the behavior of others over time, in real life and from television ‘soaps’. This can extend beyond classroom social behavior to include practically useful behaviors in a range of social situations such as clubs, shops, cafeterias, buses and church. It can also include learning about behaviors in different relationships, such as boyfriend/girlfriend behaviors and more adult social behaviors. This may explain why the social behavior of many teenagers and young adults with Down syndrome is often age-appropriate and competent, despite their language and cognitive delays. They learn by watching, imitating and then ‘doing’ - and their understanding increases by participation, practice and feedback rather than by explanation.

Playing with age mates

Children’s relationships with others of their own age play an important part in development. Many small children find the early stages of playing with other children difficult. They do not want to share their toys with others or to take turns in an activity, but they learn to do so and move towards co-operative play with others. There has been very little research into the way in which children with Down syndrome develop relationships and co-operation with their age-mates. Their delayed spoken language skills will affect their ability to play with other children and in preschool they will mainly play alongside rather than with others. However, they will be learning about play and social behavior from watching and from listening to the language of the other children, especially as children with Down syndrome usually understand more than they can express. As they begin to enjoy pretend play, they may join in play in the home corner - cooking or making tea with another child - joining in with the activity despite limited expressive language.

In pre-school, children with Down syndrome will benefit from being part of the group, learning to take turns and to share adult attention with other children. This is important preparation for school, especially as the child with Down syndrome may have had a great deal of one-to-one adult support for learning during their preschool years. Children with Down syndrome benefit from this support but they need to also be able to learn as part of a group and not be dependent on too much one-to-one support as they get older.

Self-confidence and self-esteem

Studies of typically developing children highlight the importance of early relationships in the family. It is the experience of being loved and valued within the family that is basic to a child’s sense of self-worth and self- confidence. If there are emotional difficulties and a child feels unloved or rejected this usually leads to social and behavioral difficulties at home and in school. In a small number of families, parents do not find it easy to accept a baby with Down syndrome and to make the usual close bonds with the baby. Research studies indicate that these relationship difficulties affect the progress of babies and infants with Down syndrome in the same way as they affect the progress of other children. [TODO: references 15] The experience of being a much loved and valued member of the family, and the resulting self-esteem and self-confidence, influences children’s academic and social progress throughout their school years and in adult life.

Understanding emotions

While the observations of parents, teachers and caregivers indicate that children with Down syndrome show good understanding of the emotions of others in real life situations, and usually respond appropriately, for example, with sympathy if someone is hurt or upset, some research studies question the children’s abilities to identify specific emotions from facial expressions. A recent review of studies of emotional responsiveness in the first two years of life concludes that ‘the process of emotional interaction develops in a similar way in infants with and without Down syndrome’ [31:p.109] The authors specifically contrast this with the situation for autistic children, for whom impairment in socioemotional abilities is a core deficit. Both groups of children may have similar ranges of cognitive and language delays but the contrast in their social understanding and responsiveness is usually very marked.

Recent studies indicating that children with Down syndrome have difficulty in recognizing emotions from photographs of facial expressions [TODO: references 44] Another possibility is that, in real life situations, children have many more clues available to help them to correctly identify emotions such as tone of voice and body movements as well as situational cues as to what is happening. They may respond to a range of emotions with an appropriate emotional and behavioral reaction themselves, as described by those around them, while still not having names for the emotions and still not being able to identify them from facial expressions alone.

There is a need for further studies of the emotional understanding of children with Down syndrome over two years of age to be studied in real life situations.

Encouraging age-appropriate behavior

In all situations, at home, at preschool and in the community, age-appropriate and socially acceptable behavior should be expected and encouraged. It is easy for children with Down syndrome to be ‘babied’ and allowed to behave in immature ways as a consequence of their small size and language delay. However, difficult behavior will affect children’s social opportunities and be a cause of family stress, therefore it is important to have good management strategies. This is discussed further in the [section on behavior].

A range of social experience

Children with Down syndrome will benefit from a wide range of social experience with both adults and children. They will learn how to get on with a range of different people and experience social expectations in different situations, for example, when visiting other families or relatives, going shopping, playing in the park, eating in a restaurant, going to church, going to the mother and toddler group, going to the swimming pool and joining the playgroup or preschool. In our view, the more social experiences a child has the better; social learning can only take place in social situations and all children learn from the reactions of others to their behavior.

The way in which children relate to others changes with age and these early competencies in engaging in communication with others lay the foundations for learning to communicate in more complex ways, to co-operate with others, to play together and to make friends.