Blog Archive

November, 2021

Supporting Students with Down Syndrome In The Classroom


By Hina Mahmood, M.OT and Arianna Coles, M.OT

Reprinted from 3.21: Canada's Down Syndrome Magazine (Issue #8: Back to School, Back to Life). Click here to download the full magazine.

The beginning of the school year can be an exciting yet stressful process at the best of times. While teachers and school staff are working to prepare lesson plans and organize the classroom, parents are rushing to purchase supplies and get kids back into a routine. Meanwhile, students with Down syndrome may be experiencing their own sense of excitement, anticipation, and anxiety.

The uncertainty of the COVID-19 pandemic has disrupted the school routine and impeded the learning process for many students. As we gradually return to a sense of normalcy, it is vital to maximize every opportunity to increase success in the classroom, and occupational therapy can provide the framework to do just that.

Occupational therapy is a client-centered, holistic health discipline that empowers and enables individuals of all ages and abilities to live functional and independent lives doing the things that are most meaningful to them. OT’s can help individuals increase independence in the areas of 1) self-care (feeding, grooming, toileting, sleep), 2) productivity (school, work, volunteering) and 3) leisure (hobbies, exercise, social participation).

Occupational therapists can use a variety of approaches to help clients become more independent. According to the Person-Environment-Occupation framework, to achieve optimal performance in any given task, there must be a suitable interaction between three components: 1) the person, 2) the environment, and 3) the occupation or task. As OTs, we often use the PEO model not only to assess and create learning goals, but to problem solve when challenges arise. The PEO model can serve as a good visual reminder that if all three components are in balance, the opportunity for learning and progress are increased.

Below, we break down the PEO in relation to how we support our clients with Down syndrome.

This domain can include self-concept, health, cultural background, and cognition

Medical Factors
From frequent coughs and colds to more chronic conditions such as obstructive sleep apnea and stomach issues, individuals with Down syndrome must contend with multiple medical challenges throughout their lives. These health conditions can impact day to day functioning, resulting in difficulties with behaviour including the abilities to listen and focus, follow directions, and self-regulate. When our students are having a typically difficult day in the classroom, we must take into consideration how they are feeling on that day. Did they have a poor sleep the night before? Are they just getting over a stomach bug? Often, there may be another reason why they are struggling in the classroom.

Physical Factors
We must also consider the physical characteristics of Down syndrome. Low tone, hypermobility, and decreased strength and endurance can make learning even the most basic skill a challenge. As OTs we take these factors into consideration when creating an intervention plan or providing strategies. Many times, our students might have difficulties with completing schoolwork because they fatigue more quickly than their typically developing peers.

Another key component when considering the person is cognition. We know that individuals with Down syndrome have certain challenges with learning, but they also have many strengths. Understanding the full scope of how they take in, process, and use information can be extremely valuable in assisting with learning and development. Are we using enough visuals? Are we providing them with too much verbal input?

This domain includes the task, how it is structured, and the steps required to complete it successfully

First, ask yourself what are the steps of a task and how many are required?

  • Depending on the student, being provided with too many steps can be overwhelming and difficult to process.
  • Task analysis involves breaking down the steps of a task, identifying where the student is having difficulties and beginning your support there. The goal will be to go from maximal support fading into minimal support/independence.

Next, we need to consider the subskills required to complete a particular task.

  • E.g. You are asking your student to clean up their desk and change their shoes to go outside for recess. Factors to consider include:
    • Can your student effectively process multistep verbal instructions?
    • Does your student know how to take off/put on their shoes?
    • Does your student know to untie/tie their shoes?

Finally, think about how a task is structured.

  • Is it broken down into manageable pieces where each step is clearly laid out, or are the expectations unclear?
  • Students with Down syndrome are strong visual learners. Using visuals to lay out the sequence for a task can support successful task completion.
  • Providing your student with the just-right-challenge means you are meeting your student where they are at, adapting an activity to where they are still being challenged, but not too much that it seems unachievable and can lead to frustration.

This domain includes the physical, cultural, socio-economic, and institutional environment

What is occurring in your student’s immediate environment also impacts their levels of anxiety and their performance. Aspects of the environment to consider include:

  • Classroom
    • Is there a lot of noise or activity?
    • Are the lights too bright or too dim?
    • Are there many visual distractions around the classroom? (i.e. bright colours, cluttered desk space, decorations)
  • Supports – Equipment
    • Is your student set up with supportive seating? (i.e. feet flat on the floor, hips and knees at 90 degrees, table or desk at an appropriate height, back support)
    • Are your student’s sensory needs being met? (e.g. providing a wiggle cushion to allow your student to move and stay regulated)
  • Supports – People
    • Are teachers and/or other students aware of your student’s needs/how best to support their learning?
    • Is there additional support in the classroom if needed?

As occupational therapists we encourage parents, caregivers, teachers, and school support staff to also use the PEO framework to help assess and problem solve challenging situations for your loved ones and students with Down syndrome at home and in the classroom. Examining the interaction between each of these components can help provide a holistic understanding of your student's learning needs, and ultimately provide tools that can help to set them up for success!

For more information please contact DSRF OTs Hina Mahmood, M.OT ( and Arianna Coles, M.OT (

The Wonder of Words


By Adelle Purdham

Reprinted from 3.21: Canada's Down Syndrome Magazine (Issue #8: Back to School, Back to Life). Click here to download the full magazine.

Before I had kids, as a young and eager French Immersion teacher starting out, I used to believe that the French immersion program and second language learning was for everyone—with the exception being, perhaps, if the child had some sort of language delay. Several of my colleagues believed that a child requiring additional support shouldn’t be receiving instruction in a second language. I hadn’t considered second language learning as a privilege, but looking back now I see that’s what it was: a privilege only afforded to certain children.

Enter Elyse. Becoming the parent of a child who would experience language delays forced me to challenge my own assumptions. From the time I received her prenatal diagnosis, I thought—and if I’m being honest, worried—about what Down syndrome would mean for her future education. Would she go to the same school as her big sister? Was a French immersion program feasible for a child with Down syndrome? Did learning a second language make sense for a child with cognitive, developmental, and communication delays?

My own experiences with second language learning and the benefits of bilingualism up to that point had been extensive. After going through a French immersion program as a child, I was able to study French in university, live and work in a French community, meet a French boyfriend, secure a job, be interviewed by CBC Radio in French, and engage in meaningful conversations when encountering French speakers around the world. As a new parent, I understood intuitively I wanted these experiences and opportunities to be available to my own children.

The benefits of second language learning are well documented and supported by research. Learning a second language helps to develop problem-solving skills, critical-thinking and listening skills, as well as improving memory, concentration, and our ability to multitask. Children who are proficient in other languages show signs of enhanced creativity, mental flexibility, and academic achievement. But perhaps most importantly, learning a second language helps children develop positive attitudes, empathy, and understanding for other cultures, and fosters cultural sensitivity and tolerance. Second language learning helps children develop a curiosity about the world and become global citizens.

In knowing the benefits of bilingualism, I balanced my desire for Elyse to be able to learn a second language with my fear that I may be wasting years of her education by not focusing on her first language, where I saw areas of concern. Thankfully I remembered that, years before, I’d completed a research project where I asked that exact question: does learning a second language create a deficit in one’s first language? The answer was a resounding no.

But what about for kids with Down syndrome? As renowned researcher Dr. Sue Buckley reported more than twenty years ago, “There is no evidence of a detrimental effect of bilingualism for children with Down syndrome or that learning two languages has any negative effects on the development of the child’s first language.” Dr. Buckley was clear on one matter, though: “No matter what language of instruction you are using, early reading is a key tool in speech and language development.”

Language learning in one language does not take away from language learning in another language, it adds to and expands our cognitive capacities. The learning strategies Elyse would encounter in French, say in decoding while reading, would be the same strategies she would use in English. She would learn to think in French, and the skills she developed in French school would serve her well in English. What did it matter if Elyse was learning concepts in French or English, once she’s acquired the language? The question was, would she acquire the language?

Children who learn another language before the age of five use the same part of their brain to acquire a second language that they use to learn their mother tongue. I couldn’t think of a good reason why Elyse shouldn’t learn French. Why shouldn’t she have the privilege of learning a second language? The same privilege that I had, that her dad and extended family had, and that her sisters would have? I had to acknowledge that perhaps it was only preconceived notions—my own, and societal—that might hold her back.

We decided to go for it.

A year before Elyse was eligible to be registered for school, I met with our local French Immersion school. I had one simple question. “What supports are available in the French Immersion program for a child with Down syndrome?” I met with the school’s resource teacher whose job it is to ensure each student has the supports they need.

“That’s a good question,” the resource teacher said, as in, who knows? That was not the answer I was looking for. I came to understand that perhaps the idea of French Immersion programs being “elite” or for a certain type of learner still held some ground and that there remains work to be done and stereotypes to be broken down. Perhaps certain school boards, like me before I did my research, had yet to get the message that second language learning is for everyone.

I turned to the French First language boards. I reasoned that if Elyse was placed in a French First Language school where she would learn exclusively in French, there would be no alternative but for her to learn French. When a family speaks more than one language in the home, a family member with Down syndrome learns those languages. And guess what? That’s exactly what happened with Elyse at school.

Second language learning requires an investment of time. Initially, it takes time for a child to develop the vocabulary and grammatical awareness of a second language, and this may be at the expense of learning other skills typical of that age group for a period. For example, English spelling may lag. But that gap all but disappears before high school. As parents, it’s important to be patient—a child’s first language won’t suffer in the long term. The earlier and the more exposure to the second language the child is given, the better, especially if the goal is to achieve some level of mastery and reap the benefits of bilingualism.

While expert consensus is that the ability to acquire a second language becomes more difficult after the age of 8 or 9 years old for the majority of us, and an individual becomes less likely to acquire the language proficiency of a native speaker after childhood, it is never too late to learn a new language.

Elyse entered French First language school at three years old and receives 100% support from an educational assistant. Five years later, as an eight-year-old, she reads short books in French confidently. Her comprehension and receptive language in French is fluid, while her expressive capabilities remain a challenge in French and English. The concepts she learns in French hold the same meaning as if they were taught in English. As a native English speaker, Elyse is working towards becoming a bilingual French speaker. Her ability to tell a joke in any language still holds.

While the gift of being able to speak two languages is nice, the possible health benefits are even nicer. As I alluded to earlier, there may be life-long health benefits for second language learners, especially for individuals with Down syndrome who have a higher incidence of developing Alzheimer’s dementia. Alzheimer’s is a progressive disease that begins with mild memory loss and can seriously affect a person’s ability to carry out daily activities. As the most common type of dementia, Alzheimer’s involves parts of the brain that control thought, memory, and language.

Second language learning helps with the brain’s plasticity, which researchers are confirming can help to stave off Alzheimer’s. One study reported that being able to speak two languages could delay Alzheimer’s by as much as 4.5 years.

By the age of 40, most people with Down syndrome have beta-amyloid plaques[1], which is one of the hallmarks of Alzheimer’s disease. A staggering estimated 50% of people with Down syndrome will develop dementia due to Alzheimer’s. By comparison, 11% of the general population will experience Alzheimer’s dementia. A 2018 research team lead by Natalie Phillips at Concordia University reported that bilingualism, or proficiency in two languages, creates changes in brain structure that are linked with resilience against Alzheimer’s disease and for delaying or preventing the mild cognitive impairment that often precedes Alzheimer’s[2]. Bilingualism may also contribute to the development of certain brain areas that control executive function and attention tasks, which are areas of need for many learners with Down syndrome.

While many of the numerable benefits of second language learning remain unseen, the greatest joy for me as a parent has been watching my girls use their second language to connect with French speakers on our travels. Elyse befriended a little boy from France while playing at the pool; they splashed and laughed together at a resort we stayed at in Thailand. The little boy asked after Elyse every time he saw me and passed along sweets to give to his new friend. I like to think kids speak a universal language—the language of the heart—and that perhaps those two would have become friends no matter what languages they spoke aloud, but when it comes to making new friends, comprehending, and speaking their language certainly doesn’t hurt. Language is an essential form of connection.

Through language we connect with others, but there is also the reward of learning a second language for the exquisiteness of its expressions: the simple beauty of the language itself—a beauty that should be made accessible to all. As Charlemagne put it, “To have another language is to possess a second soul.” While an appreciation for language comes with time, Elyse has shown me that individuals with Down syndrome are more than capable of learning a second language and are ready to do so with joie de vivre.

[1] According to the U.S. Department of Health & Human Services’ National Institute on Aging

[2] Research published in the scientific journal Neuropsychologia


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