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Early identification and assessment of various health problems often associated with Down syndrome Understanding the developmental characteristics of young children with Down syndrome When assessing young children with Down syndrome, it is important to understand that young children with Down syndrome share some common developmental characteristics that differ from typically developing children and/or from children with other developmental disabilities. Understanding some of these common characteristics makes it possible to more accurately assess the developmental status and measure the progress of a child with Down syndrome compared with other children with Down syndrome. Understanding some of the developmental characteristics of young children with Down syndrome makes it possible to plan more appropriate assessments, to provide anticipatory guidance, and to develop more specific and effective interventions. The assessment chapter of this guideline, therefore, focuses primarily on developmental assessments of young children with Down syndrome, assessing the strengths and needs of the family, and general health assessments. This section of the assessment chapter presents general considerations for these assessments. Recommendations (General Considerations for Assessing Children With Down Syndrome) Importance of early identification and intervention 1. It is important to identify children with Down syndrome and begin appropriate intervention as soon as possible. When Down syndrome is diagnosed, it is important to initiate an assessment process to determine appropriate interventions to address all developmental domains. It is not necessary to wait for a demonstrated developmental delay to initiate an ongoing assessment and intervention process for young children with Down syndrome. It is recommended that the assessment materials and strategies be developmentally appropriate. It is important that the assessment be viewed as an ongoing process that follows the child over time rather than as a single event. It is recommended that the setting in which the assessment is performed be appropriate to the developmental stage of the child and be comfortable for both parent and child. It is important for all parents and other primary caregivers to receive accurate information about their child with Down syndrome to allow them to: Participate as active partners with health-care providers in monitoring the overall development and health of their child. The multidisciplinary evaluation team should also provide the family with information about the development of children with Down syndrome for example, by discussing information in these clinical practice guidelines and other sources of information. As such, it is likely that there will be many different professionals involved in an ongoing process of assessment and intervention for these children. This section includes general consideration recommendations for the professionals who work with children with Down syndrome and their families. It is important that early childhood professionals (teachers, administrators, and paraprofessionals working in day care, preschool, and other early childhood settings) and therapists receive information about children with Down syndrome in order to: It is important that professionals assessing young infants with Down syndrome be knowledgeable and experienced.

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We are also beginning to devise strategies to help them find and keep enjoyable and productive employment. However, there are strategies, services and resources that facilitate successful employment. This will include cognitive abilities, personality, motivation, interests and interpersonal skills. A vocational abilities assessment should be conducted some time before the person graduates from school, college or university to provide an opportunity to improve specific abilities before seeking employment. There will need to be careful consideration with regard to choosing a particular career path. The person may have had a specific career ambition for some time and need guidance as to whether the ambition is realistic, and advice as to the necessary qualifications and experience. Advanced visual reasoning abilities and a decade of playing with construction toys and engines can lead to a successful career as an engineer or mechanic. The ability to draw, sing, play an instrument, compose music and write fantasy novels can indicate a career in the arts. A sense of social justice and being a naturally kind and considerate person can lead to a career in the caring and justice professions, especially teaching, the police force, medicine and related disciplines, and caring for animals. An interest in languages, the law and mathematics can be the basis of a career as a translator, lawyer or accountant. Parents may suggest a variety of work experience while the teenager is still attending school, in order to identify potential careers. For some trades and professions, there may be greater success in learning specific vocational skills using the traditional master and apprentice training rather than classroom-based learning. This is very much a personal decision, based on many factors, and there are two recent publications that can provide guidance regarding disclosure (Murray 2006; Shore 2004). The person may need to rehearse having a job interview and discuss with someone who knows him or her well whether to accept a particular offer of employment. The line manager may need to supplement spoken instructions with written instructions to avoid problems with auditory memory, and remember not to explain the next task until the last one is completed, to avoid confusion. To address this problem, a supported employment service has been developed and evaluated in the United Kingdom. The majority of employment was in the areas of office work and technical and computer industries, with employment primarily in large private companies but also in the government and public sector, small enterprises and charitable organizations. The cost of the scheme was several thousand pounds for each person employed, but once employed, the benefits to the government were a reduction in welfare payments and an increase in tax revenue from the person employed. The evaluation study of Prospects found agreement between the employers and employees that both parties could not have managed without the services of a specialist employment consultant (Howlin et al. The employment consultant has many roles: teacher, social worker and psychologist, as well as being an advocate and translator between two cultures with different languages and expectations. The consultant also has to provide emotional and practical support and monitor the ongoing work situation as a trouble shooter, in order to resolve any areas of potential conflict or disappointment.

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The most common apIn rare cases of hyperacusis, exposure to proach is to advise patients to avoid sound normal, everyday sound can evoke vestibular and use ear protection. This is called the Tullio susceptible to sound exposure and consequently phenomenon (sometimes vestibular hyperacusis), require extra protection. Patients readily emand it is one of the common symptoms of brace this advice and begin to protect their ears, superior canal dehiscence syndrome and may even to the extent of using earplugs in quiet be successfully treated by surgery. Unfortunately, this well-inAs discussed previously, hyperacusis results tended approach makes the auditory system from enhanced gain within the auditory system, even more sensitive to sound and further exparticularly the central part of the auditory 13,50?53 acerbates hyperacusis. The sensory systems work according the opposite approach to treating hyperto the principle of automatic gain control; acusis involves desensitization wherein patients depending on the strength of the signal, the are exposed to a variety of sounds. Consitization approach has been promoted for some sequently, the lack of sensory input results in an time with several protocols and types of sounds increase of gain within the auditory system, 13 used. For example, sounds with certain freyielding a corresponding enhancement of neuquencies removed, short exposure to moderateronal activity representing a sound, whereas ly loud sound, or prolonged exposure to exposure to louder sound yields a decrease in relatively low-level sounds have been gain. In proposed mechanisms of hyperacusis, auditory some cases, it is possible to achieve a cure for and toughening. The approach must be used for misophonia that sound used in sound therapy for hyperacusis includes speci? Note the similarity time, the sound should not be too high as to between the mechanisms of misophonia and make it dif? Stochastic resonance might en(internally generated neuronal activity in the hance a loudness match of coexisting tinnitus case of tinnitus and neuronal activity evoked by 61 by $10%, and anecdotal reports indicate the an external sound for misophonia), but the possibility of inducing tinnitus in patients remaining proposed mechanisms are the treated with sound generators set close to same. There is no need to initially set neuronal activity within the auditory pathways; the sound to a lower level, nor are patients asked in turn, this signal is further enhanced while to change the sound level of the devices in a conveyed to the limbic and autonomic nervous 62 systematic manner during treatment. In pracsystems via connections that are tuned to the tical terms, it is recommended that patients use speci? In practice, the increase in volume will be Presumably, misophonia becomes even stron$2 dB or a little more. During the third week, ger, which keeps the strength of the negative the patient is asked to increase the initial reactions the same. Due to the principle of misophonia and all of them contain a compostimulus generalization, the positive associations nent whereby positive associations are formed that are formed will spread to include other, with sound. This protocol is completely extent of control the patient has over the safe, as the patient fully controls the type, level, environment, the sounds used, and the length and duration of sound he or she is listening to. Additionally, for protocol category Protocol category 1 is not aimed at exposing the 4, complex conditioned stimuli are created by patient to a variety of sounds or to offensive combining offensive sounds with sounds that sounds, but at creating a positive association have highly positive connotations, and then with sound in general. In cases of coexisting gradually modifying the relative levels of those hyperacusis, this is the only protocol used.

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