Last spring, I read an intriguing book, When Slow is Fast Enough: Educating the Delayed Preschool Child. It is written by Joan Goodman, a child psychologist who specialized in the diagnosis and early intervention of preschool-aged children with developmental delays. Her book is the result of extensive and highly detailed observations of twenty early intervention programs around the United States.

As a homeschool mom of a preschooler with T21, I was keenly interested in her work. Frankly, I could not put it down. I found her astute observations of these early intervention programs concerning and her recommendations enlightening yet challenging.

Although this book is about early intervention pre-schools, there are some important and useful ideas that parents can glean from Goodman’s work for teaching their preschoolers with Down Syndrome at home:

On the Nature of Preschoolers with Down Syndrome:

According to Goodman, most children with T21 follow the normal stages of development as typically-developing children, just with a delay. However there are some differences in their information processing. Children with T21 tend to have slower mental processing and less sustained attention. In addition, their patterns of play tend to be more repetitive and rigid than children of the same mental age. This repetition, although boring for parents and teachers, is necessary for early mastery of skills. Hence, we should avoid diverting a child from purposeful activity, even if it seems limited and overly repetitive.

From the birth to two years old, typical children are in the sensorimotor stage of development. Children with Down Syndrome, however, tend to remain in that stage until about the age of five. Goodman writes that children in the sensorimotor stage enjoy pulling things apart, throwing toys, and repeating a simple schema with simple variations (such as stacking blocks and knocking them over). They like to play with objects by gathering, arranging, moving, and recovering them. They aso enjoy experimenting with disappearance and reappearance. They are interested in their bodies and like to move or climb up and down, in and out, under and over.

Because children with T21 tend to remain in the sensorimotor stage throughout their preschool years, they have difficulty understanding abstract concepts. Typically-developing children move onto the preoperational stage after the age of 2 and are usually cognitively ready for concepts such colors, antonyms, and prepositions by the time they begin preschool. Three to five year olds with Down Syndrome, however, are generally not ready to operate abstractly.

Thus, during her observations of early intervention programs, Goodman observed that IEP goals intended to prepare children with developmental delays for mainstream kindergarten result in a curriculum that is too simply hard for them. Reviewing at least 80 IEPs from the early intervention centers she visited, Goodman noted that often the same IEP goals are repeated for over two years. For example, a child might have the goal of learning colors on his/her IEP at the age of three, then four, then even five. However, according to Goodman, a child with T21, when ready, should not take more than twice the amount of time as an ordinary child to learn an objective. Thus, instead of trying so hard to “close the gap”, educators need to consider the child’s readiness and receptivity. Otherwise, as Goodman observed, “Hour after hour, day after day, and year after year children passively endure what they cannot readily absorb.” (p. 121)

And what is the result? Goodman cites several studies which show that children with Down Syndrome have following characteristics: “as having diminished intrinsic motivation, as being relatively unresponsive and low in initiative, rigid, poor at exploration, play, and spontaneous learning.”(p. 199) She proposes that these characteristics may not be innate but rather acquired. “Is it not possible that these children’s failures — to absorb instruction, to learn spontaneously, to initiate activities; their unresponsiveness, rigidity, and perseveration — signal distress from excessive demands, not, as teachers would have it, defects requiring extra repetition and control of attention?” (p. 201)

This last passage struck me, because our 3 yr old with T21 has not yet displayed any of the above characteristics. He is highly responsive, curious, and attentive. He often initiates activities. While his play is somewhat limited, he shows an exceptional ability to focus. During one of his assessments, our local school psychologist said she had never seen such focus in a child so young. He can be stubborn, but we have seen such obstinacy in some of his older siblings. The troubling list of characteristics associated with children with T21 makes me wonder if these traits can be avoided or at least minimized by constructing an environment that does not try to accelerate the child’s learning but allows for more explorative and autonomous learning. Goodman certainly thinks so.

What to avoid when teaching children with developmental delays:

When teaching children with developmental delays, there are some techniques we should be careful to avoid. According to Goodman, although these techniques may be well-intentioned, they are actually detrimental. Here are “teaching” techniques Goodman found to be widely used but which should be avoided:

• “Cheating” for the child by reducing the possibility of an error. For example, holding up a red block and a blue block and asking, “Which one is red?”. When the child hesitates, the teacher pushes the red block closer to the child and again asks, “Which one is red?”.
• Dominating the activity by “helping” too much on a task, giving a steady stream of instructions, excessively using hand-over-hand (the teacher places her hands over the child’s and “together” they cut or draw), or taking over a child’s play such that the child just ends up watching. All of these put a child into a more passive position. It would be better to reduce the demands or search for the child’s comfort level so he can do an activity more independently and then work up to a challenging task incrementally. (Note: hand-over-hand can be effective for demonstration or for helping children with motor planning. However, if a teacher has to use hand-over-hand too much on an activity and there is no gradual removal of the hand-over-hand technique, this may signify that the child is not ready for that activity.)
• Relying on the more advanced children to give the answers and moving the curriculum along at the pace of the advanced children.
• Distorting a child’s real emotions or intentions. For example, if a child eats another child’s crackers, the teacher says, “You didn’t really mean to eat Susie’s crackers.” Instead, a teacher should be direct and say, “Don’t eat Susie’s crackers.”
• Using praise to disguise a command (ie. “Good waiting”) instead of using praise for real achievement.
• Maintaining tight schedules which restrict children’s behaviors and results in too much rushing and no time for engrossed play.

While these techniques can be construed as helpful and confidence-building, Goodman points out that by using them, we actually “deny and distort who the children are, what they feel, and what they can do”. She further writes, “Denying a child the authenticity of his own drives seems a particularly bad form of brainwashing. It is respectful and honest to set limits, rules, and structure, and to enforce them with approval and disapproval; it is disrespectful and dishonest to tell children they want to follow the rules when they do not, or that they are good and doing well, when they are bad and doing poorly. The distortion is particularly hard to defend when directed at children who are weak, powerless, and rather easy to manipulate.” (p. 138) Furthermore, “When guesswork and pretense are encouraged, failures ignored, and feelings distorted, the child can only be confused about who she is and what she must do.” (p. 252)

Hopefully, since this book was written almost 30 years ago, many of these practices are no longer used. However, it is good to be aware of them so as to avoid them ourselves.

Best Practices for teaching preschoolers with T21

So what is the best way to teach preschoolers with Down Syndrome? According to Goodman, instead of creating long lists of learning objectives, our goals should be to:

• “Focus on providing an environment that invites prolonged productive participation”
• “Observe the child carefully so as to spot and enlarge upon nascent interests and skills with such small increments that labored drill is unnecessary”

The following practices (paraphrased from p. 225) should help us meet those goals:

• Methods of instruction should be informal, flexible, and affectively colored
• The teacher should solicit the involvement of the student and change the activity when the involvement wanes
• The content of instruction should be truer to life, concrete, and real rather than conceptual and abstract
• The content of instruction should be derived from what the child does spontaneously
• Teachers should abandon the typical preschool curriculum — numbers, shapes, colors, letters, antonyms, prepositions, and vocabulary lists
• Teachers should respect the child’s pace of learning (and not force them through a set of attainments from developmental checklists that have little to do with children’s interests, actions, motives, and manner of sorting out their world.)

Thus, Goodman is a strong advocate for child-led learning with the teacher acting more as a facilitator than a trainer during the early years of childhood. However, she does qualify that when it comes to social norms and behavior, the teacher does need to be more direct and lay down the rules. Moreover, she writes that “progressive methods (child-led and teacher facilitated) are apt to be more effective with children who have Down Syndrome than with children who are autistic.” (p. 249)

The Montessori Method for Children with Down Syndrome

Not surprisingly, Goodman’s recommendations align well with Maria Montessori’s style of pedagogy. (Montessori, it should be noted, began to develop her method while working with developmentally delayed children.) For example, both Goodman and Montessori place great emphasis on constructing an environment that promotes independence and allows a child to remain at an activity until his/her interest has waned. Observation is key to Goodman and Montessori’s pedagogies. (Montessori is often quoted for saying “Teach less, observe more.”). From Her Four Planes of Development, Montessori notes that children from age 0-6 are egocentric and process-oriented (as opposed to goal oriented), that they learn through movement and their senses, and that they love repetition and reality. Just as Goodman recommends that subject matter should be truer to life, Montessori teaches practical life skills, such as watering flowers, sweeping and mopping, and setting the table. In addition, her teaching materials are tactile and appeal to the senses.

Where they differ is that Montessori does not abandon typical preschool curricula, such as colors and shapes. However, Goodman is not saying to abandon these topics permanently, but rather to wait for a child’s readiness for these more abstract concepts, which in the case of a developmentally delayed child, might very well be after the preschool age years. Both agree that allowing a child to learn at his/her natural pace is ideal.

Teaching Preschoolers with Down Syndrome at home

For those who want to or have to teach their preschoolers with Down Syndrome at home, here are some practical applications:

• Keeping in mind that these preschoolers are still in the sensorimotor stage, find ways to help them learn using their senses and using movement. For example, you can practice counting together every time you and your child go up and down the stairs. Teach “up” and “down” at a playground by helping your child climb up a ladder and slide down a slide. My son also loved playing “over” and “under” by stepping over a rope and then crawling under it. 
• Remember, they enjoy gathering, arranging, moving, and recovering objects. My 3 year old loves to line up his peg crayons and his toy cars. As he does so, I name the colors for him and he often repeats the color names. He also loves to name a picture on a flash card and then put it through a slot in a box.
• Set up an environment for learning and independence: have a low Montessori shelf with carefully selected toys and activity trays that you rotate or change on a regular basis. However, put some of your child’s favorite activities just out of his reach so he has to ask for it (to practice using speech).
• Allow your child to choose the learning activities and the duration. Do not pull your child away from an activity he is engrossed in unless necessary.
• Trust that if your child refuses to do an activity, he is probably not ready for it. Put it away and wait a few months, then re-introduce. If in doubt, wait it out.
• Play with a purpose. Let your child initiate an activity/game and find ways to “sneak” in your speech and fine motor skills goals. For example, one of our goals is to help him say more 2-3 word phrases. So when he wants to play ball, we practice saying “roll the ball” every time he rolls it. When we’re playing with play-doh, we poke holes in it and practice saying “poke a hole”.
• Remember that children with T21 need more time to process auditory information. So speak slowly and give your child ample time to answer a question.

Finally, I don’t think that in a home environment where a child is taught one-on-one, parents need to give up on preschool curricula such colors, shapes, letters, etc. entirely. We can certainly expose our children to these concepts and find creative ways teach our kids. With close observation of our children, we can see when they are ready. Nonetheless, I do think the curriculum at this age should focus on speech and fine and gross motor skills.

Next post, I’ll share some of the activities we are doing at home to promote Junior’s speech and fine and gross motor skills.