a longitudinal study of children with down syndrome who experienced early intervention programming

8/8/2019 A Longitudinal Study of Children With Down Syndrome Who Experienced Early Intervention Programming

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A longitudinal study of children with Down

syndrome who experienced early

intervention programming.

Studies on the mental and motor abilities of children with Down syndrome Downsyndrome, congenital disorder characterized by mild to severe mental retardation, slow physicaldevelopment, and characteristic physical features. Down syndrome affects about 1 in every 730 livebirths and occurs in all populations equally. have been reported for many years. Initially, thesestudies were cross-sectional in nature, and few, if any, longitudinal studies were done. These initialreports document the development of children with Down syndrome as similar to that of typicallydeveloping children, but occurring at a much slower rate. Several studies[1-6] have demonstrated ageneral decline in intelligence quotients intelligence quotientn. Abbr. IQAn index of measured intelligence expressed as the ratio of tested mental age to chronological age,multiplied by 100. (IQs) in children with Down syndrome from infancy to late childhood.

Motor skills in children with Down syndrome have also been studied in detail. The general rateof motor skill development has been reported to be below that of children without Down syndrome,although there is variability among children attributable to factors such as home rearing and healthstatus.[3,7,8] Attainment of early motor milestones are thought to be delayed because of problemswith ligamentous laxityLigamentous laxity is a term given to describe "loose ligaments."

In a 'normal' body, ligaments (which are the tissues that connect bones to each other) are naturallytight in such a way that the joints are restricted to 'normal' ranges of motion. in some joints,decreased strength, and hypotoniahypotonia /hypotonia/ (-tone-ah) diminished tone of theskeletal muscles.

hypotonian.

1. Reduced tension or pressure, as of the intraocular fluid in the eyeball.

2. .[9-11] Additionally, postural control problems have been identified in children with Downsyndrome. Shumway-Cook and Woollacott[12] found that postural responses to loss of balance wereslow in young children (1-6 years of age) with Down syndrome, and they concluded that theseresponses were inefficient for maintaining stability. They also stated that the presence of themonosynapticmonosynaptic /monosynaptic/ (-si-naptik) pertaining to or passing through a singlesynapse.

monosynapticadj.

Having a single neural synapse. reflex during platform perturbations suggested that balanceproblems in children with Down syndrome do not result from hypotonia, but rather from defectswithin higher-level postural control mechanisms.

Motorproficiency proficiency
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n.pl.proficienciesThe state or quality of being proficient; competence.

Noun1.proficiency - the quality of having great facility and competence studies in older childrenwith Down syndrome have revealed deficits in eye-hand coordination,lateralitylateralityorhemispheric asymmetry

Characteristic of the human brain in which certain functions (such as language comprehension) arelocalized on one side in preference to the other. , and visual motor control.[13-15] Connolly andMichael[16] compared the scores on the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP)of children withretardation retardation: see mental retardation. , both with and without Downsyndrome, who were between the ages of 7.6 and 11 years. They found that the group with Downsyndrome had significantly lower scores in running speed, balance, strength, and visual motorcontrol than did the group without Down syndrome. Henderson et al[17] reported that children withDown syndrome who were between 7 and 14 years of age scored consistently low on agility andbalance tasks when compared with matched control matched study, matched control

a comparison between groups in which each subject animal is matched by a comparable animal interms of age and all other measurable parameters. Called also matched or paired control. children.Le BlancLe Blanc is a commune and asous-prfecture in the Indre dpartementof France.Geography

Le Blanc is the main city of the Parc naturel rgional de la Brenne, on the banks of the Creuse River.et Al[18] also found that children with Down syndrome whose mean age was 12 years haddifficulty with static balance when they were compared with children matched forchronological agechronological agen. Abbr. CAThe number of years a person has lived, used especially in psychometrics as a standard againstwhich certain variables, such as behavior and intelligence, are measured. and IQ. More recently,Shea[19] assessed a group of 11- to 14-year-old children with Down syndrome using the PeabodyDevelopmental Motor Scales and found that static balance was the area in the test of greatestdifficulty in gross motor skillsThe term gross motor skills refers to the abilities usually acquiredduring infancy and early childhood as part of a child's motor development. By the time they reachtwo years of age, almost all children are able to stand up, walk and run, walk up stairs, etc. .

The effects ofearly intervention early interventionn. Abbr. EIA process of assessment and therapy provided to children, especially those younger than age 6, tofacilitate normal cognitive and emotional development and to prevent developmental disability ordelay. programs (EIPs) on the developmental skills of children with Down syndrome have been ofinterest to researchers for a number of years. Early intervention programs usually are focused onstimulation of developmental skills in the child as well as on facilitating parent-child interactions.The beneficial effects of early intervention have been demonstrated by Brinkworth,[20] Connolly etal,[21] and Sharav and Shlomo.[22] These studies, however, did not have randomly assigned controlgroups. An attempt at a controlled study was made by Piper and Pless,[23] who reported that earlyintervention had no effect. Their study, however, was conducted for a relatively short time (ie, 6months), and the investigators were unable to assess the degree to which the program wasimplemented in the home by the parents. Additionally, the infants were seen for only 1 hour everyother week by the researchers. It is possible that infants in that study may have received as little as12 hours of training during the study.[24] The choice of the Griffiths Scale for assessment of
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outcome in these infants may also have limited the sensitivity of the evaluation and may not haverevealed important changes in the infants.[24] Few long-term follow-up studies have been under-taken to validate the effort and expenditures of early intervention services. Only two suchlongitudinal studies of the effectiveness of EIPs have been reported in the literature.[21,22]Investigators in both studies concluded that EIPs, along with home rearing, have improved thefunctioning of children with Down syndrome. Car[6] reported a longitudinal studylongitudinal

study

a chronological study in epidemiology which attempts to establish a relationship between anantecedent cause and a subsequent effect. See also cohort study. of individuals with Downsyndrome between the ages of 6 weeks and 21 years; however, these subjects were not involved inan organizedEIP(1) (Enterprise Information Portal) See corporate portal.

(2) (Extended Instruction Pointer) The program counter on x86 CPUs. .

Although the two longitudinal studies on the effectiveness of EIPs have demonstrated beneficialeffects,[21,22] questions persist about positive outcomes of early intervention. Simeonsson et al,[25]in a review of 27 studies on the benefits of early intervention, concluded that (1) children withhandicaps in EIPs seemed to make better progress than those children not in such programs, butstatistical significance was not attained because of the small sample sizes in the studies; (2) childrenin the programs often made progress in areas not measured by the research instrument; and (3)improvements were noted in areas not specific to the child (eg, family orsibling sibling /sibling/(sibling) any of two or more offspring of the same parents; a brother or sister.

siblingn. adjustment). White,[26] in a recent review, concluded that insufficient information was availableto be confident about the long-term impact of early intervention but felt that immediate positiveeffects of intervention with disadvantaged children tend to provide support for long-term benefits.

In our last follow-up of children with Down syndrome who were involved in an EIP, we found thatthey had significantly higher scores on measures of intellectual and adaptive functioning adaptivefunctioning,n the relative ability of a person to effectively interact with society on all levels and care for one'sself; affected by one's willingness to practice skills and pursue opportunities for improvement on alllevels. than did children of comparable ages with Down syndrome who did not participate in anEIP.[21] Additionally, this group of children did not show the decline typically seen over time inintellectual and adaptive functioning noted previously in children with Down syndrome.[4] Asexpected, the children were found to be functioning below their chronological ages in gross andfinemotor skills The examples and perspective in this article or section may not represent a worldwideview of the subject.Please [ improve this article] or discuss the issue on the talk page.

Dexterity redirects here. For other uses, see Dexterity (disambiguation). , but, unexpectedly, theirfine motor skill levels exceeded their gross motor skill levels. In particular, the children were foundto perform poorly on measures of running speed, balance, strength, visual motor control, and overallgross motor and fine motor skills in comparison with children without Down syndrome but ofcomparable chronological chronological also chronologicadj.

1. Arranged in order of time of occurrence.
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2. Relating to or in accordance with chronology. and mental ages.[16]

The purpose of this study was to examine the functioning of adolescents with Down syndrome whoexperienced early intervention as infants and who continued their education in classroomsappropriate to their needs. We compared the motor development of the children involved in an EIP

with the normative normativeadj.Of, relating to, or prescribing a norm or standard: normative grammar.

nor data from astandardizedstandardized

pertaining to data that have been submitted to standardization procedures.

standardized morbidity rate

see morbidity rate.

standardized mortality rate

see mortality rate. motor assessment tool and with previous motor assessments using the same toolon the same children. In addition to assessment of motor functioning, we used the same measures ofintellectual and adaptive functioning with these children as in our previous studies[21,27,28] inorder to evaluate developmental changes in these areas. We were also interested in comparing theintellectual and adaptive functioning of these children with that of children with Down syndromewho had not experienced early intervention. A control group was not used when this longitudinalstudy was begun in 1973 because of the ethical concerns surrounding the withholding Withholding

Any tax that is taken directly out of an individual's wages or other income before he or she receivesthe funds.

Notes:In other words, these funds are "withheld" from your wages. of services from infants assigned tocontrol groups.[24] Shortly after the initiation of the study, state mandates that provided educationalservices for all children with handicaps andpermissive permissive adj. 1) referring to any act whichis allowed by court order, legal procedure, or agreement. 2) tolerant or allowing of others' behavior,suggesting contrary to others' standards.

PERMISSIVE. programming for the preschool child precluded the use of children who might haveserved as noninterventionnoninterventionn.

Failure or refusal to intervene, especially in the affairs of another nation.

non control subjects,

The specific questions addressed in this study were 1. Did differences in gross motor and

fine motor skill levels occur over
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time in our sample of adolescents

with Down syndrome who were

involved in an EIP? 2. Have the same areas of strengths

and weaknesses in gross motor

and fine motor skill levels as assessed

by the Bruininks-Oseretsky

Test of Motor Proficiency continued

over time in our sample of

adolescents with Down syndrome

who were involved in an EIP? 3. How do the current gross motor

and fine motor skill levels compare

with the intellectual levels of our

sample of adolescents who were

involved in an EIP? Have the motor

skill levels progressed at the same

rate as the intellectual levels since

the last systematic study of these

children? 4. Do differences in intellectual functioning

exist between our sample

of adolescents with Down syndrome

who participated in an EIP

and a comparison group that did

not participate in an EIP? 5. Do differences in social and adaptive

functioning exist between our


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sample of adolescents with Down

syndrome who participated in an

EIP and a comparison group that

did not participate in an EIP? 6. Did our sample of adolescents with

Down syndrome who participated

in an EIP and subsequent appropriate

educational programming show

the typical deceleration deceleration /deceleration/ (de-sel?er-ashun) decrease in rate or speed.

early deceleration in intellectual

and adaptive functioning reported

in the literature with children

with Down syndrome?

Method

Subjects

Ten of the children with Down syndrome who participated in previous studies reported by Connollyand colleagues[21,27,28] Constituted the early intervention (EI) group in this study. Forty childrenwith Down syndrome who were participating in an ongoing EIP were the subjects in the originalstudy.[27] By the time of the first follow-up study,[28] however, only 20 of the children could belocated. Sixteen of the children had moved from the area, 3 children failed to continue in theireducational programs, and 1 child did not consent to participate. Fourteen of the 20 children in thesecond study also participated in the next follow-up study.[21] Only 10 of those children, however,were available for follow-up evaluation in the current study. Three of the 14 children had movedfrom the area, and 1 child's parents did not respond to requests for participation. All of thesechildren had completed the EIP at theUniversity of TennesseeThe University of Tennessee (UT),sometimes called the University of Tennessee at Knoxville (UT Knoxville or UTK), is the flagshipinstitution of the statewide land-grant University of Tennessee public university system in theAmerican state of Tennessee. Child Development Center by 3 years of age, had remained in theirhomes, and had been placed in educational settings appropriate to their level of functioning. For thecurrent study, the age range of the EI group subjects for thepsychological testingpsychologicaltesting

Use of tests to measure skill, knowledge, intelligence, capacities, or aptitudes and to makepredictions about performance. Best known is the IQ test; other tests include achievement testsdesigned to evaluate a student's grade or performance was 13.9 to 17.8 years (X [bar]=15.7,SD=1.3). Their age range for gross and fine motor testing was 13.9 to 17.9 years (X [bar]=16.3,
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SD=1.1). The EI group consisted of 7 female and 3 male subjects. Four of the children had attendedprivate special education schools, and 6 of the children had attended public special educationschools. A signed informed consent statement was obtained from each parent before testing.

An attempt was made to compare the intellectual and adaptive skills of the EI group with those ofchildren with Down syndrome who had been evaluated at the same center but who had not

experienced early intervention. Our 1984 study[21] used, as a comparison group, children withDown syndrome of comparable ages from a normative study.[3] The normative data, however, didnot include mean IQs or social quotients (SQs) for children over 10 years of age. For the currentstudy, the comparison data were drawn from the records of children who had been evaluated at thecenter during the previous 12-year period and who fell within the same age range at the time oftesting as the EI group subjects. From a pool of 20 children, 10 children were selected on the basisof three criteria: (1) availability of scores on the Stanford-Binet Intelligence Scale Stanford-BinetIntelligence Scale

test used to measure IQ; designed to be used primarily with children. [Am. Education:EB, IX: 521]

See : Intelligence , Form L-M,[29] and the Vineland Social Maturity Scale[30]; (2) closeness in ageto the EI group subjects at the time of testing; and (3) gender. Age at time of testing was used as theprimary matching variable because previous studies have consistently shown a deceleration in therate of development in intellectual and adaptive skills with increased chronological age in childrenwith Down syndrome.[3,4]

The age range (at time of testing) of the children in the comparison group was 12.1 to 18.6 years (X[bar]=14.8, SD=1.8). A t test indicated no significant differences in age at testing between the EIgroup and the comparison group. The gender distribution of the comparison group was 6 femalesand 4 males. A chi-square test chi-square test: see statistics. revealed no significant differences ingender distribution between the EI and comparison groups.

Although the comparison group was from the same geographic region as the EI group and bothgroups appeared to be representative of a broadsocioeconomic socioeconomicadj.

Of or involving both social and economic factors.

socioeconomicAdjective

of or involving economic and social factors

Adj.1. range, lack of precise records on such variables as parental income and educational levelprecluded control of socioeconomic level, which could be a confounding variable A confoundingvariable (also confounding factor, lurking variable, a confound, orconfounder) is an extraneousvariable in a statistical or research model that should have been experimentally controlled, but wasnot. . Another problem concerned the possible cohort effect The term cohort effect is used in socialscience to describe variations in the characteristics of an area of study (such as the incidence of acharacteristic or the age at onset) over time among individuals who are defined by some sharedtemporal experience or common life because the children in the comparison group were, on theaverage, 8 years older than the children in the EI group although their chronological age at the timeof testing was comparable) and may not have had, for example, the same educational opportunities.
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The implications of these limitations in comparative data are discussed later.

Tests

The BOTMP (long form) was individually administered to each of the children who had beeninvolved in the EIP by a physical therapist experienced in the administration of the test.31 Validity

of the BOTMP scores has been established through consideration of (1) the relationship of testcontent to significant aspects of motor development as cited in research studies, (2) the relevantstatistical properties of the test, and (3) the functioning of the test with contrasting groups ofhandicapped and nonhandicapped children.[31] Reliability for test scores has been establishedthrough studies on interrater reliability (r=.90-.98) and test-retest reliability test-retestreliability Psychology A measure of the ability of a psychologic testing instrument to yield the sameresult for a single Pt at 2 different test periods, which are closely spaced so that any variationdetected reflects reliability of the instrument (r=.86-.89).[31] The BOTMP consists of subtests inrunning speed, balance, bilateral coordination of the arms and legs, strength, upper-limbcoordination, response time, visual motor control, and speed and dexterity of theupper extremitiesupper extremityn.

The shoulder, arm, forearm, wrist, or hand. Also calledsuperior limb, thoracic limb. . The BOTMP,a standardized test A standardized test is a test administered and scored in a standard manner. Thetests are designed in such a way that the "questions, conditions for administering, scoringprocedures, and interpretations are consistent" [1] , yields two ages for each of the individualsubtests: a gross motor skills composite age and a fine motor skills composite age. if a child scoresbelow thebasal basal /basal/ (bas'l) pertaining to or situated near a base; in physiology, pertainingto the lowest possible level.

basaladj.

1. age of the test (ie, 4 years 2 months), he or she is assigned a score of below 4 years 2 months.The test is standardized for children between the ages of 4 years 2 months and 16 years. Althoughmost of the children in this study were chronologically chronological also chronologicadj.

1. Arranged in order of time of occurrence.

2. Relating to or in accordance with chronology. beyond 16 years of age, the test was felt to beappropriate because their mental and motor ages were below 16 years. Motor ages on the eightsubtests of the BOTMP as well as a gross motor and a fine motor composite age were determinedfor each child. Data on the BOTMP were not available on the comparison group because of the lackof availability of the BOTMP prior to 1978. The test scores of the children involved in the EIP werecompared against the normative data presented on the BOTMP and against their own previousscores.

Both the Stanford-Binet Intelligence Scale, Form L-M, and the Vineland Social Maturity Scale wereindividually administered to the children by a trained psychological examiner. The Stanford-BinetScale served as a measure of general intellectual functioning, and the Vineland Scale served as ameasure of general adaptive functioning includingsocialization socialization /socialization/ (so?shal-i-zashun) the process by which society integrates the individual and the individual learns tobehave in socially acceptable ways.
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socializationn. , communication, and self-help skills. Both scales have been demonstrated to be psychometricallysound instruments with acceptable reliability and validity.[29,30] For the Vineland Scale, eachchild's mother or father provided the information from which the SQ was derived. Although morerecent editions of each of these scales are now available, the editions used in our past follow-up

studies were used to allow for more valid comparisons from study to study.

Procedures

Data collection took place at the Boling Center forDevelopmental Disabilities developmentaldisabilities (DD),n.plthe pathologic conditions that have their origin in the embryology and growth and developmentof an individual. DDs usually appear clinically before 18 years of age. at The University ofTennessee, Memphis, or at the Department of Psychology at Memphis State University. One childwas seen atVanderbilt University Vanderbilt University, at Nashville, Tenn.; coeducational;chartered 1872 as Central Univ. of Methodist Episcopal Church, founded and renamed 1873, opened1875 through a gift from Cornelius Vanderbilt. Until 1914 it operated under the auspices of theMethodist Church. , but by the same examiners who evaluated the other children in the study. Theorder of testing of the children was random and not according to according toprep.

1. As stated or indicated by; on the authority of: according to historians.

2. In keeping with: according to instructions.

3. their individual developmental or chronological ages. To obtain the data, a total of 4 hours ontwo separate occasions was spent with each child and parent. The administration of the cognitive,adaptive, and academic tests at times different (with one exception) from that of the administrationof the motor tests should not have influenced the results of the study.

Data Analysis

Descriptive andinferential statisticsinferential statistics

see inferential statistics. were used to describe and analyze fine motor and gross motor skills of theEI group subjects as well as their intellectual and adaptive functioning. Means, ranges, and paired t-test values were used for analysis of the first two research questions. The Pearson Product-MomentCorrelation CoefficientNoun1.Pearson product-moment correlation coefficient - the mostcommonly used method of computing a correlation coefficient between variables that are linearlyrelatedproduct-moment correlation coefficient was used to determine the relationships between changes inmental ages and motor ages for research question 3. Means, ranges, and independent t-test valueswere also used to analyze the datapertaining pertainintr.v.pertained, pertaining, pertains1. To have reference; relate: evidence that pertains to the accident.

2. to research questions 4 and 5. Descriptive statistics descriptive statistics

see statistics. of means, ranges, and percentages were used to analyze information related to
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research question 6. When inferential inferentialadj.

1. Of, relating to, or involving inference.

2. Derived or capable of being derived by inference.

in statistical analysis was performed, a .05 level of significance was used. Caution should be usedin interpreting statistical significance from multiple t tests, because at least 1 of every 20 testsundertaken will achieve statistical significance by chance alone. Use of a smaller alpha-risk or levelof significance, however, allows one to be more certain about accepting or rejecting a hypothesis.

Results

Motor Skills

On the average, the children in the EI group had a mean gross motor composite age of 6.05 years(SD=1.38) compared with a fine motor composite age of 5.64 years (SD=1.01), as determined bythe motor assessment tools. The range of individual scores was from 3.5 to 7.7 years in gross motorskills and from 3.0 to 7.5 years in fine motor skills. Table 1 compares the scores obtained for the EIgroup in the previous follow-up study[21] and in this study.Table 1. Composite Scores for Fine Motor Skills and Gross Motor Skills of Early

Intervention Group (N=10)

Second Follow-up Present

Category Study[21] Study

Gross motor composite age (y)

X [bar] 4.85 6.05(a)

SD 0.72 1.38

Range 3.5-5.9 3.5-7.7

Fine motor composite age (y)

X [bar] 4.50 5.64(b)

SD 0.82 1.01

Range 3.0-5.7 3.0-7.5

(a) significant at t=2.69, df=18, and P=.0249.

(b) significant at t=4.02, df=18, and P=.0003.

Changes for the EI group on specific subtests of the BOTMP are shown in Table 2. Significantdifferences were noted in running speed, balance, strength, visual motor coordinationGross motorcoordination addresses the gross motor skills: walking, running, climbing, jumping, crawling,lifting one's head, sitting up, etc.

Fine motor coordination , and upper-limb speed and dexterity. A further comparison of the subtestscores of the children revealed that strength, upper-limb coordination, bilateral coordination, andupper-limb speed and dexterity continued to be areas of strength and that balance, visual motorcoordination, running speed, and response time continued to be areas of weakness (Tab. 3). Five ofthe children had fine motor skill scores that exceeded their gross motor skill scores; the other fivechildren had gross motor skill scores that exceeded their fine motor skill scores. Interestingly, thosechildren who had attended a private school that emphasized participation of the children inSpecialOlympicsSpecial Olympics
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International sports program for people with intellectual disability. It provides year-round trainingand athletic competition in a variety of Olympic-type summer and winter sports for participants.programs had gross motor skill scores that surpassed their fine motor skill scores.Table 2. Bruininks-Oseretsky Test of Motor Proficiency Mean Component Scores

for Fine Motor Skills and Gross Motor Skills of Early Intervention Group (N=10)

Second Follow-up Present

Component Study[21] Study

Running speed >4.17 5.42(b)Balance 4.00 4.92(b)

Bilateral coordination 5.17 5.92

Strength 5.92 7.42(a)

Upper-limb coordination 5.92 6.67

Response speed >4.17 4.92

Visual motor coordination 4.42 5.92(c)

Upper-limb speed and dexterity 5.42 6.42(b)

(a) Significant at P=.05.

(b) Significant at P=.01.

(c) Significant at P=.005.

Table 3. Motor Skills of Early Intervention Group(a) (N=10)

Second Follow-up Study(21) Present Study

Upper-limb coordination Strength

Strength Upper-limb coordinationBilateral coordination Upper-limb speed and dexterity

Upper-limb speed and dexterity Bilateral coordination

Balance Visual motor coordination

Visual motor coordination Running speed

Running speed Balance

Response time Response time

(a) Ranked highest to lowest.

Table 4 illustrates the changes in the rate of development that occurred since the last assessment ofthe EI group subjects in the areas of gross motor, fine motor, and cognitive functioning cognitive

function Neurology Any mental process that involves symbolic operationseg, perception, memory,creation of imagery, and thinking; CFs encompasses awareness and capacity for judgment . Asnoted, the ratio of gross motor skill development to mental age improved in 8 of the 10 children.The ratio of fine motor skill development to mental age improved in 7 of the 10 children.Additionally, using the Pearson correlation coefficient Correlation Coefficient

A measure that determines the degree to which two variable's movements are associated.

The correlation coefficient is calculated as: , no significant correlations were found between changesin motor skill levels and changes in cognitive functioning of the children using the mean grossmotor composite, fine motor composite, and mental age data (r=.04-.43).Table 4. Ratios of Gross Motor Age and Fine Motor Age to Mental Age for the

Early Intervention Group (N=10)

Child Gross Motor Age/Mental Age Fine Motor Age/Mental Age

1

1984 1.46 1.17

1989 1.38 1.44

2

1984 0.89 0.81

1989 0.54 0.65

3(a)

1984 0.96 0.89
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1989 1.17 1.00

4

1984 1.08 0.92

1989 1.56 1.78

5(a)

1984 0.89 0.89

1989 1.08 0.85

6(a)

1984 1.00 1.001989 1.27 1.03

7(a)

1984 1.04 1.17

1989 1.15 0.85

8

1984 1.11 0.94

1989 1.18 1.06

9(a)

1984 0.84 1.02

1989 1.03 1.24

10

1984 0.72 0.76

1989 0.89 1.00

(a) Involved in organized physical education program.

Intellectual and Adaptive Skills

Table 5 shows the comparison between the EI group and the comparison group in terms ofchronological age, IQ, and SQ. Although the two groups were comparable in age at the time oftesting for this study, the differences in scores should be used only for rough comparative purposesbecause of the previously noted uncontrolled variables. As in each of our previous studies,[21,27,28]the EI group showed significantly higher IQs and SQs than did the comparison group. The mean IQfor the EI group was about 10 points higher than that for the comparison group, a difference that isstatistically significant (t=2.18, df=18, P


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Table 6 compares the EI and comparison groups with regard to percentage of children at each levelofmental retardation mental retardation, below average level of intellectual functioning, usuallydefined by an IQ of below 70 to 75, combined with limitations in the skills necessary for dailyliving. as defined by IQ range. The majority (70%) of the EI group subjects were at the mild and

moderate levels, whereas the majority (60%) of the comparison group subjects were at the severeand profound levels. Moreover, none of the EI group subjects were at the profound level, whereas20% of the comparison group subjects were at this level.Table 6. Percentage of Children at Each Mental Retardation Level in Early

Intervention (EI) and Comparison Groups

Mental Retardation

Level(a) EI Group (n=10) Comparison Group (n=10

Mild (IQ=52-67) 10 0

Moderate (IQ=36-51) 60 40

Severe (IQ=20-35) 30 40

Profound (IQ


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advanced motor skills for the children.[21] These skills were also found to be high in this study.Areas of deficit continued to be running speed, balance, and reaction times.

As previously stated, running speed and balance continued to be problematic for these children.[16]Our results are consistent with previous reports of balance problems in other studies of children withDown syndrome.[18,19] The neuropathology neuropathology /neuropathology/ (-pah-tholah-je)

pathology of diseases of the nervous system.

neuropathologyn.

The study of diseases of the nervous system. associated with children with Down syndromeincluded delayedcerebellarcerebellar /cerebellar/ (ser?e-belar) pertaining to the cerebellum.

CerebellarInvolving the part of the brain (cerebellum), which controls walking, balance, and coordination.maturation maturation /maturation/ (mach-u-rashun)1. the process of becoming mature.

2. attainment of emotional and intellectual maturity.

3. and a relatively small cerebellumcerebellum (sr'bl`m), portion of the brain that coordinatesmovements of voluntary (skeletal) muscles. It contains about half of the brain's neurons, but theseparticular nerve cells are so small that the cerebellum accounts for andbrain stem brain stem, lowerpart of the brain, adjoining and structurally continuous with the spinal cord. The upper segment ofthe human brain stem, the pons, contains nerve fibers that connect the two halves of the cerebellum..[32] Wehypothesize hypothesizev.hypothesized, hypothesizing , hypothesizes

v.tr.

To assert as a hypothesis.

v.intr.

To form a hypothesis. that the problems noted in balance, running speed (as related to motorplanning), and coordination (as measured by reaction times) in the children with Down syndromemay be related to neuropathological causes.

Although we did not perform specific sensory evaluations on the EI group subjects during thisstudy, we suspected problems in the somatosensory somatosensory /somatosensory/ (so?mah-to-senso-re) pertaining to sensations received in the skin and deep tissues.

somatosensoryadj. andvestibularvestibularadj.

Of, relating to, or serving as a vestibule, especially of the ear.

VestibularPertaining to the vestibule; regarding the vestibular nerve of the ear which is linked to the ability tohear sounds. systems because of the deficits identified. Previous research supports our suppositionsabout improper integration of sensory information in children with Down syndrome. Anwar and
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Hermelin[33] reported that children with Down syndrome had more difficulty than control groups inmaking directionalIn one direction. Contrast with omnidirectional. judgments after participation inasymmetrical asymmetrical orasymmetricadj. Abbr. aLacking symmetry between two or more like parts; not symmetrical. pointing. These authorssuggested that the children with Down syndrome experienced a disruption of their spatial frame of

reference because of the kinesthetickinesthesian.The sense that detects bodily position, weight, or movement of the muscles, tendons, and joints.

[Greekk aftereffects aftereffects afternpl Nachwirkungenpl of the asymmetrical pointing and

that the use ofproprioceptive ProprioceptivePertaining to proprioception, or the awareness of posture, movement, and changes in equilibriumand the knowledge of position, weight, and resistance of objects as they relate to the body.reafferent feedback might be beneficial in children with Down syndrome.

Henderson et al[15] found that tasks requiring the use of both proprioceptive and visual referencesystems (ie, drawing and copying) were deficientdeficientadj.

1. Lacking an essential quality or element.

2. Inadequate in amount or degree; insufficient.

deficient

a state of being in deficit. in children with Down syndrome. They speculated that children withDown syndrome have difficulty with integration of information across modalities Modalities

The factors and circumstances that cause a patient's symptoms to improve or worsen, includingweather, time of day, effects of food, and similar factors. . In support of the results reported byHenderson et al, we found that the EI group subjects had deficits in visual motor coordination andresponse time tasks on the BOTMP that could have resulted because they experienced difficulty inintegrating visual and proprioceptive information.

Butterworth and Cicchetti[34] reported that young children with Down syndrome needed longerperiods of visual cuing than did children without Down syndrome when they were placed in asituation in which the walls moved and the floor on which they were sitting remained stable. Theysuggested that infants with Down syndrome may require a higher level of vestibular input in order torespond to information from the environment. In view of these reported somatosensory deficits

noted in children with Down syndrome, the need for increased somatosensory input may becomeclinically important.

As a group, the children involved in the EIP continued to make gains in their gross and fine motorskills between the time of second follow-up study and this study. When comparisons were made ofthe ratios between their mental ages and their gross and fine motor skill ages, 8 of the 10 childrenhad motor ages that increased at a faster rate than their mental ages. When individual comparisonswere made, only 2 of the 10 children did not show this increase in gross motor skills. Both of thesechildren were overweight, although 2 of the other 8 children were also overweight. Additionally, 1
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child who did not show an increase in the ratio of gross motor skills to mental age had received acardiac pacemakercardiac pacemaker A device that delivers a small electric shock to the heart toeffect cardiac contraction at a pre-determined rate at 6 months of age. This particular child has hadseveral "demand" typepacemakers Pacemakers Definition

A pacemaker is a surgically-implanted electronic device that regulates a slow or erratic heartbeat.

Purpose

Pacemakers are implanted to regulate irregular contractions of the heart (arrhythmia). implantedimplantv.implanted, implanting, implants

v.tr.

1. To set in firmly, as into the ground: implant fence posts.

2. since the time of the originalpacemakerpacemaker

Source of rhythmic electrical impulses that trigger heart contractions. In the heart's electrical system,impulses generated at a natural pacemaker are conducted to the atria and ventricles. and has beenrestricted in her physical activities since her early teens.

On the average, the children who demonstrated the greatest increases in their gross motor skill levelswere children who were involved in organized physical education programs that culminated in theirparticipation in Special Olympics events. Participation of adolescents with mental retardation instructured physical training programs has been shown to be beneficial in several studies. Wright andCowden[35] reported that adolescents with mental retardation who participated in a SpecialOlympics swimming program had a significant improvement in self-concept and cardiovascularendurance after only a 10-week period. Skrobak-Kaczynkie and Vavik[36] reported that malesubjects with Down syndrome (ages 11-31 years) responded well to circuit-training programs thatwere aimed at increasingaerobic aerobic /aerobic/ (ar-obik)1. having molecular oxygen present.

2. growing, living, or occurring in the presence of molecular oxygen.

3. requiring oxygen for respiration.

4. capacity and muscular strength. Additionally, they stated that those subjects who participated inthe circuit-training programs had significant weight loss andsubcutaneous fatSubcutaneous fat isfound just beneath the skin as opposed to visceral fat which is found in the peritoneal cavity.Subcutaneous fat can be measured using body fat calipers giving a rough estimate of total bodyadiposity. loss as well as having a marked increase in muscle strength.

Observations during the administration of the subtests of the BOTMP in this study revealed that thechildren, as a group, were slow in their fine motor movements during the administration of the tests.Overall, the children were attuned attunetr.v.attuned, attuning, attunes1. To bring into a harmonious or responsive relationship: an industry that is not attuned to marketdemands.
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2. to accuracy and had increased error correction during the testing. For example, when abeadbead

Small object, usually pierced for stringing. It may be made of virtually any materialwood, shell,bone, seed, nut, metal, stone, glass, or plasticand is worn or affixed to another object fordecorative or, in some cultures, magical purposes. was dropped during the stringing of beads, mostof the children opted to pick up the dropped bead (even from the floor) and string it next rather than

taking another bead from the container. During pencil tracing inside a pathway, the children self-corrected and returned to the point at which they had exited the pathway in error with the pencilrather than continuing to the end of the pathway This increased attention to accuracy cost" thechildren valuable seconds during the testing and thus lowered their scores on the subtest.

Intelectual and Adaptive Skills

In view of uncontrolled variables between the two groups, the differences in intellectual andadaptive scores should be interpreted with great caution within the context of this descriptive study.Table 5 reveals the mean IQ for the EI group to be about 10 points higher than that for thecomparison group and the mean SQ to be almost 25 points higher. Furthermore, as shown in Table6, 70% of the El group subjects were at the mild or moderate level of retardation, with none at theprofound level. In contrast, 80% of the comparison group subjects were at the moderate or severelevel, and 20% were at the profound level.

Our findings are consistent with the hypothesis that early intervention has a beneficial effect onintellectual and adaptive skills that extends well into the adolescent years; however, the limitationsof the design allow for alternative explanations. We cannot conclude that the higher scores of the Elgroup were unequivocally due to early intervention. Because the EIP was open to any family andparticipation was voluntary, we were unable to randomly assign children to either a treatment groupor a control group. in the absence of arandomized randomizetr.v.randomized, randomizing, randomizesTo make random in arrangement, especially in order to control the variables in an experiment.groups design or a matched groups design, certain uncontrolled variables could well havecontributed to differences between the two groups.

Foremost among these variables is that of the cohort effect. Because the children in the comparisongroup were, on the average, 8 years older than the children in the EI group, there is the stronglikelihood that they did not have comparable educational opportunities and experiences as theiryounger counterparts. Another confounding variable that could conceivably conceivev.conceived, conceiving, conceives

v.tr.

1. To become pregnant with (offspring).

2. have contributed to the differences in scores is the possible differences in socioeconomic levelsbetween the two groups. Another significant variable that must be considered is the substantialattrition Attrition

The reduction in staff and employees in a company through normal means, such as retirement andresignation. This is natural in any business and industry.

Notes: that occurred in the EI group from the time of the original study. It is likely that this group
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represents a select group in terms of health as well as intellectual and adaptive functioning.Moreover, their parents probably constitute a select group in terms of motivation and interest, asreflected both in their pursuit of appropriate educational programs and in their participation in aseries of follow-up studies.

In interpreting differences between groups from one follow-up study to another, it should be kept in

mind that the same comparison group could not be used for the three studies. Examiner bias mayhave been present because only the El group was evaluated for gross motor and fine motor skillsacross the 16-year longitudinal study and the physical therapist was therefore not blinded to thestatus of the children. The scores obtained were either compared with normative data fromstandardized tests or from the children's own previous scores on the evaluative tool. Less chance ofexaminer bias was present in the IQ and SQ testing, as the psychological examinations wereperformed by psychologists who had not been involved in the EIP or in previous psychologicaltesting with the El group subjects. All of these design problems necessitate necessitatetr.v.necessitated, necessitating, necessitates1. To make necessary or unavoidable.

2. To require or compel. cautious interpretations of our findings and consideration of alternativeexplanations for the differences between the groups.

In this study, we also did a longitudinallongitudinaladj.

Running in the direction of the long axis of the body or any of its parts. comparison of IQs and SQsfor the 10 EI group subjects, who participated in all three of the follow-up studies. Although thisgroup showed similar mean IQs from the first follow-up study[28] (IQ=55.3) to the second follow-up study[21] (IQ=53.5), the group's mean IQ dropped to 40.1 during the 6.8 years from the secondfollow-up study to this study. Nevertheless, the mean IQ in this study was significantly higher thanthe mean IQ of 30.5 in the comparison group. These results suggest that the rate of deceleration inintellectual development shown in most children with Down syndrome was not as pronounced in theEI group subjects.[4] An encouraging finding was that the mean SQ, which serves as a measure ofadaptive functioning, demonstrated no corresponding decrease and remained fairly stable for thefirst (SQ = 59.8), second (SQ = 63.3), and third (SQ = 60.2) follow-up studies. This findingindicates that the El group subjects' adaptive skills were maintained at a relatively high level (mildretardation) and were less affected by increasing age than were their intellectual abilities.

Clinical Implications

The developmental therapist working with children with Down syndrome needs to be aware of grossmotor and fine motor skill deficits that are seen in children with Down syndrome during theadolescent years. Balance and visual motor tasks continue to be problem areas[12,18,19,34] forchildren with Down syndrome, and we believe EIPs should emphasize therapeutic interventions inthese areas as a means of decreasing functional deficits.[33,37-39] Functionally, balance may be aproblem for the older child with Down syndrome who must be able to perform in situations in whichhis or her center of gravity is routinelyperturbed perturbtr.v.perturbed, perturbing, perturbs1. To disturb greatly; make uneasy or anxious.

2. To throw into great confusion.
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3. (eg, crowded school hallways, shopping malls, city streets, playgrounds, and other recreationalareas). We concurCONCUR- ["CONCUR, A Language for Continuous Concurrent Processes",R.M. Salter et al, Comp Langs 5(3):163-189 (1981)]. with others who suggest that techniques thatinvolve proprioceptive, vestibular, and visual input may be beneficial to children with Downsyndrome.[33,37-39]

Based on the findings of the 10 EI group subjects, participation in an organized physical educationprogram even during the adolescent years may be important in order for the children to continue tomake optimal progress in their gross motor skill development. Physical therapists should play aconsultant role to physical educators in offering suggestions for activities that improve gross motorand fine motor functioning as well as physical fitness.

In the area of fine motor development, perhaps less emphasis should be placed on accuracy withadolescents with Down syndrome and more emphasis placed on speed if speed is needed in themotor tasks that are asked of them. This would be of particular functional importance if theadolescent is being prepared for a vocation that requires speed but not necessarily precision.

Conclusions

The overall results indicated that our sample of adolescents with Down syndrome continued to showdeficits in similar areas of gross motor and fine motor skills that were identified during their latechildhood. As a group, however, their gross motor and fine motor skills improved over time. The EIgroup subjects' intellectual and adaptive functional levels were found to be higher than expected at13 to 17 years of age in comparison with other children of comparable age with Down syndrome.Although there are threats to the validity of these findings and we cannot clearly attribute thesubjects' levels of functioning to the EIP, we continue to believe that early intervention with thechild and the family is a critical first step in the long-range educational program of children withDown syndrome. We also believe that the EIP served as a motivator for parents in securingappropriate programs and services for their children.

References

[1] Melyn MA, White DT. Mental and developmental milestonesDevelopmental milestones aretasks most children learn, or physical developments, that commonly appear in certain age ranges.For example:

Ability to lift and control the orientation of the head Crawling begins Walking begins Speech begins

of non-institutionalized Down's syndrome children. Pediatrics. 1973; 52:542-545. [2] Fishler K,Share J, Koch R. Adaptation of Gesell developmental scale of evaluation of development of childrenwith Down's syndrome (mongolism mongolism /mongolism/ (monggo-lizm) former (nowoffensive) name forDown syndrome.

mongolism orMongolismn.
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Down syndrome. No longer in technical use. ). Am J Ment Defic. 1964; 68:642-646. [3] CenterwallSA, Centerwall WR. A study of children with mongolism reared in the home compared to thosereared away from home. Pediatrics. 1960;25:678-685. [4] Morgan SB. Development and distributionof intellectual and adaptive skills in Down syndrome children. Ment Retard. 1979; 17:247-249. [5]Schnell RR. Psychomotor developmentNoun1.psychomotor development - progressiveacquisition of skills involving both mental and motor activities

growing, growth, ontogenesis, ontogeny, maturation, development - (biology) the process of anindividual organism growing organically; a purely biological . In: Pueschel SM, ed. The YoungChild with Down Syndrome.New YorkNew York, state, United StatesNew York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts,Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontarioand the Canadian province of , NY: Human Sciences Press Inc; 1984:207-226. [6] Carr J. Six weeksto twenty-one years old: a longitudinal study of children with Down's syndrome and their families. JChild PsycholPsychiatrypsychiatry (sk`tr, s), branch of medicine that concerns the diagnosisand treatment of mental, emotional, and behavioral disorders, including major depression,schizophrenia, and anxiety. . 1988;29:401-431. [7] Pueschel SM. The child with Down syndrome.In: Levine MD, Carey W, Crocker AC, Gross RT. Developmental Behavioral PediatricsPhiladelphia, Pa: WB Saunders Co; 1983: 353-362. [8] Zausmer EF, Shea AM. Motor development.In: Pueschel SM, ed. The Young Child with Down Syndrome. New York, NY: Human SciencesPress Inc; 1984:143-206. [9] LaVeck B, LaVeck GD. Sex differences in development among youngchildren with Down syndrome. J Pediatr. 1977;91:767-769. [10] Shea AM. Motor attainments inDown syndrome. In: Contemporary Management of Motor Control Problems Alexandria, Va:Foundation for Physical Therapy Inc; 1991:225-236. [11] Reed RB, Pueschel SM, Schnell RR, et al.Interrelationships of biological, environmental andcompetency COMPETENCY, evidence. Thelegal fitness or ability of a witness to be heard on the trial of a cause. This term is also applied towritten or other evidence which may be legally given on such trial, as, depositions, letters, account-books, and the like.

2. variables in young children with Down syndrome. Applied Research in Mental Retardation.1980;1:161-165. [12] Shumway-Cook A, Woollacott MH. Dynamics of postural control in the childwith Down syndrome. Phys Ther. 1985;65:1315-1322. [13]Frith frithn.ScotsA firth.

[Alteration offirth.]

Frith woods or wooded country collectively. See also forest. U, Frith CD. Specific motordisabilities in Down's syndrome. J Child Psychol Psychiatry. 1974;15:292-301. [14] Seyforth B,Spreen O. Two-plated tapping performance by Down's syndrome and non Down's syndromeretardates. J Child Psychol Psychiatry. 1979;20:351-355. [15] Henderson SE, Morris J, Frith U. Themotor deficit in Down's syndrome children: a problem of timing. J Child Psychol Psychiatry.1981;22:233-244. [16] Connolly BH, Michael BT. Performance ofretardedretardedadj.

1. Often Offensive Affected with mental retardation.

2. Occurring or developing later than desired or expected; delayed. children, with and withoutDown syndrome, on the Bruininks Oseretsky Test of Motor Proficiency. Phys Ther. 1986;66:344-348. [17] Henderson SE, Morris J, Ray S. Performance of Down syndrome and other retardedchildren on the Cratty Gross Motor Test. Am J Ment Defic. 1981;85:416-424. [18] Le Blanc D,French R, Schultz B. Static and dynamic balance skills of trainable children with Down syndrome.
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Percept percept /percept/ (persept?) the object perceived; the mental image of an object in spaceperceived by the senses.

perceptn.

1. The object of perception.

2. Mot Skills. 1977; 45:641-642. [19] Shea AM. Motor Development in Down Syndrome.Cambridge, Mass: Harvard University Harvard University, mainly at Cambridge, Mass., includingHarvard College, the oldest American college. Harvard College

Harvard College, originally for men, was founded in 1636 with a grant from the General Court ofthe Massachusetts Bay Colony. ; 1987. Dissertation dissertationn.

A lengthy, formal treatise, especially one written by a candidate for the doctoral degree at auniversity; a thesis.

dissertationNoun

1. . [20] Brinkworth R. Early treatment and training for the infant with Down's syndrome. RoyalSociety of Health. 1975;2:75-78. [21] Connolly BH, Morgan SB, Russell FF. Evaluation of childrenwith Down syndrome who participated in an early intervention program. Phys Ther. 1984;64:1515-1518. [22] Sharav T, Shlomo L. Stimulation of infants with Down syndrome: long-term effects.Ment Retard. 1986;24:81-86. [23] Piper MC, Pless IB. Early intervention for infants with Downsyndrome: a controlled trial controlled trial Clinical research A clinical study in which one group ofparticipants receives an experimental drug while the other receives either a placebo or anapproved'gold standard' therapy. See Blinding, Double-blinded. . Pediatrics. 1980;65:463-468. [24]Bricker D, Carlson L, Schwarz R. A discussion of early intervention for infants with Downsyndrome. Pediattics. 1981;67:45-46. [25] Simeonsson RJ, Cooper DH, Scheiner AP. A review andanalysis of the effectiveness of early intervention programs. Pediatrics. 1982; 69:635-640. [26]White KR: Efficacy of early intervention: National Institute of Child Health and HumanDevelopment Conference behavioral and educational intervention withhigh-risk infants high-riskinfant Neonatology An infant at risk of suffering co-morbidity and potentially fatal complicationsdue to fetal, maternal or placental anomalies or an otherwise compromised pregnancy. See High riskpreganancy. . Journal of Special Education. 1985-1986; 19: 401-416. [27] Connolly BH, Russell FF.Interdisciplinary early intervention program. Phys Ther. 1976;56: 155-158. [28] Connolly BH,Morgan SB, Russell FF, Richardson B. Early intervention with Down syndrome children: follow-upreport. Phys Ther. 1980;60:1405-1408. [29] Terman LM, Merrill MA. Stanford-Binet IntelligenceScale. Boston, Mass:Houghton MifflinHoughton Mifflin Company is a leading educationalpublisher in the United States. The company's headquarters is located in Boston's Back Bay. Itpublishes textbooks, instructional technology materials, assessments, reference works, and fictionand non-fiction for both young readers Co; 1960. [30] Doll EA. Vineland Social Maturity Scale.Circle Pines, Minn: American Guidance Service Inc; 1965. [31] Bruininks RH. Bruininks-OseretskyTest of Motor Proficiency: Examiner's Manual Circle Pines, Minn: American Guidance Service Inc;1978. [32] Crome L. Pathology of Down's disease. In: Hilliard LT, Kirman BD, eds. MentalDeficiency mental deficiencyn.
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See mental retardation. . 2nd ed. Boston, Mass: Little, Brown & Co Inc; 1965. [33] Anwar F,Hermelin B. Kinaesthetic Kin`aes`thetic

a.1. Of, pertaining to, or involving, kinaesthesia.

Adj.1.kinaesthetic - of or relating to kinesthesis

kinesthetic movement aftereffects in children with Down's syndrome. J Ment Defic Res.1979;23:287-297. [34] Butterworth G, Cicchetti D. Visualcalibration calibration /calibration/(kal?i-brashun) determination of the accuracy of an instrument, usually by measurement of itsvariation from a standard, to ascertain necessary correction factors. of posture in normal and motorretarded Down's syndrome infants. Perception. 1978;7: 513-525. [35] Wright J, Cowden J. Changesin self concept and cardiovascular endurance ofmentally retardedNoun1.mentally retarded -people collectively who are mentally retarded; "he started a school for the retarded"developmentally challenged, retarded youth in a Special Olympics swim training program. AdaptedPhysical Activity Quarterly, 1986;3:177-183. [36] Skrobak-Kaczynski J, Vavik T. Physical fitnessand trainability of young male patients with Down syndrome. In: Berg K, Eriksson BO, eds.Children and Exercise IX. Baltimore, Md: University Park Press; 1980:300-316. [37] Kantner RM,Clark DL, Allen LC, Chase MF. Effects of vestibular stimulation onnystagmusNystagmus Definition

Rhythmic, oscillating motions of the eyes are called nystagmus. The to-and-fro motion is generallyinvoluntary. Vertical nystagmus occurs much less frequently than horizontal nystagmus and is often,but not necessarily, a sign of response and motor performance in the developmentally delayedinfant. Phys Ther. 1976;56: 414-421. [38] Porter R. Sensory considerations in handling techniques.In: Connolly BH, Montgomery PC, eds. Therapeutic Exercise in the Developmental Disabilities.Chattanooga, Tenn: Chattanooga Corp; 1987:43-53. [39] Hanson MJ, Harris SR. Teaching theYoung Child with Motor Delays A Guide for Parents and Professionals. Austin, Tex: Pro-ed Inc;1986:75-93.

Commentary

The last two decades have witnessed extraordinary changes in the lives of individuals with Downsyndrome, beginning with the deinstitutionalization deinstitutionalizationn.

The release of institutionalized people, especially mental health patients, from an institution forplacement and care in the community. movement and continuing with the current effort towardinclusion in the mainstream of society. Connolly and colleagues have conducted an interdisciplinarystudy of the motor, mental, and social attainments of a group of children with Down syndrome whohad participated in an early intervention program in the 1970s. The current report is the fourth intheir series.[1-3] They are to be commended for theirperseverance PerseveranceSee also Determination.

Ainsworth

redid dictionary manuscript burnt in fire. [Br. Hist.: BrewerHandbook, 752]

Call of the Wild, The

dogs trail steadfastly through Alaskas tundra. [Am. Lit. in this difficult, but very worthwhile, task.
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to motor tasks and their participation in physical education programs.

Further studies of both younger and older children are needed to attempt to understand thecomponents of motor deficits in Down syndrome as well as motor learning styles. Motor controlstudies by physical therapists andoccupational therapists occupational therapist A person trained tohelp people manage daily activities of livingdressing, cooking, etc, and other activities that

promote recovery and regaining vocational skills Salary $51K + 4% bonus. See ADL. haveidentified some of these components and have pointed out that noting delays and deficits in motorskill development is the important first step, but that we must go on to look at factors such asstrength and stability and then to evaluate treatment efficacy.[11-13] Such an approach is givensome support by the earlier study by Harris[14] of the efficacy of early neurodevelopmentaltreatment in infants with Down syndrome, which found no differences in standardized test scoresbetween treatment and control groups, but some differences in attainment of motor behaviors thatwere part of the treatment objectives by the treatment group. Additional factors such as pulmonaryfunction, overweight, and body proportions and their relationship to posture and movement remainto be explored. Physical therapists and occupational therapists are in a unique position to approachthese tasks.

Although the authors have taken advantage of their longitudinal data to make comparisons of resultsat follow-up, it would also have been interesting to look at the progress of individual children overtime. One could examine, for example, whether good performance in motor skills in early lifecarried over into adolescence, even though we recognize the limitations of prediction of laterdevelopment for individual children.15 Of interest also would be some information from the parentsof the children, who are clearly an interested and motivated group, about their view of the childrenand their experiences in parenting a child with a disability. Perhaps information of this type, whichwould be valuable information for practitioners, is forthcoming.

Alice M Shea, ScD, PT Associate for Research and Education Department of Physical Therapy andOccupational Therapy ServicesChildren's Hospital A children's hospital is a hospital which offersits services exclusively to children. The number of children's hospitals proliferated in the 20thcentury, as pediatric medical and surgical specialties separated from internal medicine and adultsurgical specialties. 300 Longwood Ave Boston, MA 02115

References

[1] Connolly BH, Russell FF. Interdisciplinary early intervention program. Phys. Ther. 1976;56:155-158. [2] Connolly BH, Morgan SB, Russell FF, Richardson B. Early intervention with Downsyndrome children: follow-up report. Phys Ther. 1980;60:1405-1408. [3] Connolly BH, Morgan SB,Russell FF, Evaluation of children with Down syndrome who participated in an early interventionprogram. Phys ther. 1984;64:1515-1518. [4] Pueschel SM, ed. The Young Child with DownSyndrome. New York, NY: Human Sciences Press Inc; 1984. [5] Reed RB, Pueschel SM, SchnellRM,CronkVerb1.cronk- utter a hoarse sound, like a ravencroak

let loose, let out, utter, emit - express audibly; utter sounds (not necessarily words); "She let out abig heavy sigh"; "He uttered strange sounds that nobody could understand"

2. CE. Interrelationships of biological, environmental and competency variables in young childrenwith Down syndrome. Applied Research in Mental Retardation: 1980;1:161-174. [6] Zausmer EF,
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Shea AM. Motor development. In: Pueschel SM, ed. The Young Child with Down Syndrome. NewYork, NY: Human Sciences Press Inc; 1984:143-206. [7] Kurnit DM, Neve RL. Inborninborn /inborn/ (inborn?)1. genetically determined, and present at birth.

2. congenital.

inbornadj.

1. Possessed by an organism at birth.

2. errors ofmorphogenesis morphogenesis /morphogenesis/ (mor?fo-jene-sis) the evolution anddevelopment of form, as the development of the shape of a particular organ or part of the body, orthe development undergone by individuals who attain the type to in Down syndrome. In: PueschelSM, Tingey C, Rynders JE, et al, eds. New Perspectives on Down Syndrome. Baltimore, Md: PaulH Brookes Publishing Co; 1987:81-91. [8] Bruininks RH. Bruininks-Oseretsky Test of MotorProficiency: Examiner's Manual. Circle Pines, Minn: American Guidance Service Inc; 1978. [9]

Henderson SE, Morris J, Ray S. Performance of Down syndrome and other retarded children on theCratty Gross Motor Test. Am J Ment Defic. 1981;85:416-424. [10] Shea AM. Motor Developmentin Down Syndrome Cambridge, Mass: Harvard University; 1987. Dissertation. [11] Mac-Neill-SheaSH, Mezzomo JM. Relationship of ankle strength and hypermobility tosquattingsquatting /squatting/ (skwahting) a position with hips and knees flexed, the buttocks resting on theheels; sometimes adopted by the parturient at delivery or by children with certain types of cardiacdefects. skills of children with Down syndrome. Phys Ther. 1985;65:1658-1661. [12] Rast MM,Harris SR. Motor control in infants with Down syndrome. Dev Med Child Neurol. 1985;27:682-685.[13] Shumway-Cook A, Woollacott MH. Dynamics of postural control in the child with Downsyndrome. Phys Ther. 1985;65:1315-1322. [14] Harris SR. Effects of neurodevelopmental therapyon motor performance of infants with Down syndrome. Dev Med Child Neurol. 1981; 23:477-483.

[15] Shea AM, Leviton A, Reed RB, et al. Antecedents of gross motor achievement of children withDown syndrome. Dev Med Child Neurol. 1988;57(supp):S19. Abstract.COPYRIGHT 1993 American Physical Therapy Association, Inc.No portion of this article can be reproduced without the express written permission from thecopyright holder.Copyright 1993, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.
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a longitudinal study of children with down syndrome who experienced early intervention programming

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