Cognitive Variations

Cognitive Variations can include:

• Various levels of Intellectual Disability and Cognitive Delays

• Compromised Speech and Language Development

• Processing Delays

• Increased risk of Epilepsy

• Increased risk of Mental Health Conditions

• High risk of Dementia & Regression Syndrome

• Higher risk of Dual Diagnosis ASD ADHD PDA

• Learning Differences

• Problem solving and Adaptability Challenges

• Proprioceptive & Interoceptive Challenges

  
  

  Lets consider Communication - Speech & Language

Communication is Key......

Building a clear line of Communication with clients with Down Syndrome and Autism is one of the most important factors when it comes to successfully building a good relationship with the client.

• HEARING....

• HYPO.... Seeks out and makes lots of sounds, likes sounds, responds well to counting, music, tapping, banging, humming and always searching for sensory input in order for their nervous system to get what what it needs. ( Its Neurological not Logical)

• HYPER..... Don't like loud noises or sudden noises, unsettling noises can upset them for long periods of time (not just in that moment) Often they will make their own sounds to drown out sounds that are irritating to them.

• HEARING IMPAIRMENT ..... Hearing Loss is very common with Folk with Down Syndrome, often learning environments are too difficult and trigger anxiety and sensory processing challenges.

• VISUAL IMPAIRMENT ...... Vision too plays a major role in how we communicate, visual impairment is common in Down Syndrome.

  
  

What can we do ?

There are many ways to increase, manage and create good communication with clients with Down Syndrome.

• Auslan Sign (key word) maybe preferable along side verbal language to assist in understanding and engagement.

• Picture Communication Boards to provide general communication example: shoes off, sit on mat, this type of general communication board becomes a regular tool which most clients become very familiar with.

  
  

• Sequencing Charts, these can be made up using images from Boardmaker or Tummee.com (Tummee have a sequencing site with 100's of images from Pilates, Yoga , Aerial Yoga) or alternatively you can use photographs of the client . I like to also provide an image list of props that will also be used as to not overwhelm if a new ball or block is being introduced.

• See - Sign & Do - can work well with younger clients, example: Image of a Dog - Sign Dog - Downward Facing Dog. This can work well with younger clients and those who enjoy story telling through movement.

• Social Stories can be useful for client to feel comfortable with any processes or routines that may normally cause anxiety. Social stories are written in a very direct and simplistic format.

• Making sure we take into consideration any Hypo/Hyper hearing diagnosis ( be very mindful of back ground music or using singing bowls etc)

• Showing consideration and creating an environment that is visually accessible - clear images - free from visual distraction and sound sensitive.

Proprioception and Interoception

Body Awareness:

Proprioceptive awareness allows us to know where our body is in space. Not being aware of what your body is doing has a large impact on movement, coordination and physical experience whether it be in an Aerial Hammock or on the mat.

Interoceptive Awareness can also be challenging, not being able to feel sensations in the body or connecting sensation to movement, physical or emotional. A good example to explain this is knowing when your bladder is full and making the connection with the physical sensations that maybe present , often making connection only when it's too late.

Often clients with Down Syndrome can struggle with both Proprioceptive and Interoceptive Awareness.

What can we do ?

• Introduce Weighted props, as weighted pressure can provide proprioceptive awareness to the sensory system.

• Pressure also grounds the nervous system, providing the opportunity to feel connection to where the body is in space.

• Providing clues that are focused on the Brain Body connection, increasing proprioceptive awareness.

Examples-

• Body Tapping and naming body parts. This exercise can be useful to assist with identification of body prior to cueing an exercise

• Using rhythmic vocalisation and naming body parts out loud and possibly adding sensations and feelings also.

  
  

Pathological Demand Avoidance PDA

What is it ?........ and Why is it happening ?

• PDA is a set of characteristics than can co-exist with Autism and Down Syndrome. PDA is a recognised behaviour profile connected to Autism and Dual Diagnosis.

• A persistent need to avoid demands of everyday life.

• Oppositional behaviours due to high anxiety ( its NOT a choice)

• PDA prevents individuals from engaging in their preferred activities and everyday life.

• It can appear to have an irrational quality about it.

• PDA can sometimes become physical and often verbally expressed if misunderstood.

There is no shortage of what a demand is. There are obvious ones like direct demands and less obvious ones like praise. Often totally irrational and persistent and anxiety driven.

Preventative Strategies for PDA in the Therapy Space

My favourite strategy is the PANDA method.

P ..... Pick battles - enable some choice and control, minimise rules and explain reasons, reduce demands (when they are in the calm Yellow Zone)

A..... Adaption - be flexible, try to balance the amount of ' Give & Take', allow plenty of

time, (example: when stopping a preferred activity) finding different ways to reach the same outcome.

N.... Negotiation & Collaboration - make a neutral statement and wait for client to suggest

activity/task or proactively ask for opinion. "What do You Think"?. Giving meaningful options.

D.... Disguise and manage demands - reframe demands and make them seem less like demands

by avoiding negative words like, No, Can't, Must and Have to. ( Do you want to, is it

possible to) or "What would make this easier?" "How could we do this?"

A .... Anxiety Management - Reduce uncertainty, recognise underlying anxiety, social and sensory.

treat distressed behaviours as panic attacks, support and move on. Focus on safety and regulation. Allow processing time.

Routine and familiarity is key also, once client is comfortable with set program keep it same same each week,

any changes to program will need careful consideration and consultation with client. Include them in the structure.

I try and add the smallest changes each week to seek a little insight.

Use visual prompts, external cues, timers so the demand is not soley coming from you the teacher. Meddy Teddy can also be used here as the class instructor . #meddyteddy.com

Example- a sorting game, normally a selection of green and blue balls. Green balls to the left of client and blue to the right. Client on belly in a low hammock. Balls to place in corresponding boxes on opposite sides (cross body) as they swing forward. By hiding a red ball in the green balls as the client grabs the red and there is no corresponding red box she questions, my answer is .... what do you think if we add a red box in the centre next week? This can be a great way to expand an exercise without changing the pattern too much, minimising the challenges of change.