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The COVID-19 pandemic profoundly impacted daily life, including the educational experiences of school-age children with and without disabilities and their families who supported them. This descriptive qualitative study examined the experiences of families with children with extensive support needs and complex communication needs during the COVID-19 pandemic, specifically in relation to their (a) supports and (b) feelings of empowerment related to their child. Participants were 37 parents of children with disabilities who had extensive support needs and complex communication needs, with most families having a child with either autism or Down syndrome. Interviews were conducted with each family at three time points during the 2020-2021 school year. Results indicated that the supports families received varied widely, as did their feelings of empowerment--including empowerment related to advocacy and to supporting their child's learning and well-being at home. The supports that families received from providers (e.g., teachers, service providers) impacted their feelings of empowerment, sometimes acting as facilitators and sometimes as barriers. Implications for future research and practice are discussed related to how teachers and other providers might better partner with families during crises like the COVID-19 pandemic and beyond.

This multiple baseline across-participants single case desgin study examined the effect of small group, phonological awareness intervention on the phonological awareness skills of three school-age children with Down syndrome. Each child with Down syndrome was paired with a typical peer to participate in small group intervention, three sessions per week for seven weeks. Lessons from a single unit in the Intensive Phonological Awareness Program were adapted to incorporate repeated exposure to the curriculum and increased opportunities for practice. A functional relation between the intervention and improved phonological awareness skills was not established based on visual analysis of the probe data across the three participants. However, an increasing therapeutic trend following delayed treatment effects as well as an increase in phase means from baseline to intervention was observed for each participant. This investigation provides preliminary guidance for adapting phonological awareness standard treatment protocols for children with Down syndrome by providing repeated opportunities for practice and including peers in small group intervention.

The purpose of this study was to examine the primary and secondary color preferences of students with special needs as well as their color preference for an object regarding their disability types, school levels, and gender. The study employed a survey research design with quantitative methodology. It was conducted with the participation of 549 students with Intellectual Disability, Autism Spectrum Disorder, Down Syndrome and Learning Disability. The researchers collected the data by using a car visual together with the geometric shapes used by Ece and Çelik (2009). The collected data were entered into the Excel program, and the frequency and percentage values were obtained. The results revealed that according to their school level, students' primary and secondary color preference changed. When the geometric shape was changed, students' color preferences changed, accordingly. With respect to their disability types, students preferred red as the primary color and blue as the secondary color, and they chose blue for the car visual. It was found that while primary and secondary color preferences of male and female students differed but they preferred blue for the car visual.

The study was aimed to define swallowing related problems of toddlers with Down syndrome (DS) by comparing toddlers with typically developing children (TDC). A total of 127 children (96 DS, 31 TDC), and their mothers included in the study. The presence of chewing disorders, food selectivity, drooling, coughing during swallowing was scored as 'absent' or 'present'. The Pediatric version of the Eating Assessment Tool-10 (PEDI EAT-10) was used to determine dysphagia symptom severity, and the Turkish version of the Feeding/Swallowing Impact Survey (T-FS-IS) was used to measure the impact of swallowing disorders on caregivers. Mothers of DS reported higher rates of chewing disorders (n = 39, 40.6%), drooling (n = 30, 31.3%) and coughing during swallowing (n = 50, 41.7%) than mothers of TDC (p < 0.01). The mean PEDI-EAT-10 score of children with DS was higher than TDC (p = 0.006). There were significant differences between groups in terms of T-FS-IS. Moderate to strong correlations were detected between PEDI-EAT-10 and total and subscale scores from T-FS-IS (p < 0.001). This prospective study defines swallowing related problems of toddlers with DS. The study results highlight the importance of early investigation of (i) swallowing concerns in children with DS, and (ii) caregivers' quality of life to define swallowing problems and plan an appropriate swallowing related management program.

Background: Previous studies have focused mostly on the negative experiences of parents of children with Down syndrome. We aimed to explore both the stressful experiences and coping strategies of parents from a non-Western country. Methods: Twenty-six parents of children aged 8-48 months with Down syndrome were included. Semi-structured interviews were conducted, and the data were analysed using thematic analysis. Results: The main themes of the stressful experiences were emotional burdens, caregiving burdens, struggle against stigma and discrimination, concerns about the future, challenges related to health, education, and financial issues. Parents used a variety of coping strategies to overcome the challenges by seeking support and help, searching for information, accepting and adapting, and adopting optimistic attitudes. Conclusion: Although being a parent of a child with Down syndrome has many challenges, most parents effectively used coping strategies and adapted their lives to their new parental roles in their child's early years.

This review aimed to investigate the use of the Cambridge Neuropsychological Automated Testing Battery (CANTAB) for people at risk of cognitive impairment, especially those born with Down syndrome and those born preterm. Six databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, in addition to the bibliography index listed in the CANTAB site. Twenty four studies regarding Down syndrome and 17 regarding prematurity were reviewed and are here described. Both cognitive profiles were described, and their performance was compared on specific tasks and CANTAB tests. In this battery of tests, people with Down syndrome usually present impaired key cognitive domains, such as episodic memory and recognition memory. Results were presented considering general aspects described in the studies, specific findings such as dementia, the role of genetics, and cognitive profile, among other descriptions. Comparability between both populations in future studies is discussed.

Background: Life expectancy for people with Down syndrome is increasing, but older adults with Down syndrome are at greater risk of developing certain pathologies associated with ageing. When ageing parents can no longer look after their child with Down syndrome, their other children are often expected to shoulder this responsibility. Method: We asked 120 adult siblings of a person with Down syndrome to complete a questionnaire on their current and anticipated relationships. Results: Most respondents considered these relationships to be positive, but they expressed concerns about the effects of ageing and about having to organise their sibling with Down syndrome's future life. We investigated the impact of factors relating to the respondents and to their sibling with Down syndrome (age, gender, social inclusion, protection regime) on these general tendencies. Conclusion: Siblings need to be given support, for example, "via" discussion groups, to facilitate the transition to becoming caregivers.

The high prevalence of sleep-related disorders is well documented in individuals with Down syndrome (DS). Given the association between physical activity (PA) and sleep in the typical populations, this study was the pilot study to examine this association through the parental report in this population. The total of forty-three individuals with DS (aged 14-55) participated in the present study. Parents reported on the questionnaires to measure different levels of PA and four factors of sleep-related disorders in adolescents and adults with DS. Our results indicate that age was positively associated with the frequency of "disorders of initiating and maintaining sleep". In addition, the levels of moderate-to-vigorous PA (MVPA) were negatively associated with the severity of "Features associated with obstructive sleep apnea (OSA)". Further, the active group had lower parental reports of features associated with OSA compared with the insufficiently active group after controlling for anthropometric measures. Our study suggests moderate-to-vigorous exercise may reduce OSA severity in individuals with DS. Therefore, future support for recreational services should be provided to promote physical leisure activity that may reduce the onset of sleep disorders in this population.

Purpose: Many aided augmentative and alternative communication (AAC) systems require the use of an external display that is represented via a visual modality. It is critical to evaluate and understand visual-perceptual processing in individuals with disabilities who could benefit from AAC. One way to evaluate how individuals process visual materials is through research-based automated eye-tracking technologies that obtain a fine-grained stream of data concerning gaze paths of visual attention. Method: The current study examined how individuals with autism spectrum disorder (n = 13), Down syndrome (n = 13), intellectual and developmental disabilities (n = 9), or typical development (n = 20) responded to a spoken prompt to find a thumbnail-sized navigation key within a complex AAC display, including a main visual scene display (VSD) and a navigation bar of four thumbnail-sized VSDs. Stimuli were presented on a monitor containing automated eye-tracking research technology that recorded patterns of visual attention. Results: Participants across groups spent more time fixating on a target thumbnail VSD navigation image after the presentation of the spoken cue to look at the target, compared to before the presentation of the spoken cue; they also spent more time looking at the target thumbnail VSD than the other thumbnail-sized VSDs in the navigation bar after the cue. Discussion: Participants were able to locate the target thumbnail VSDs, even within the context of a visually complex AAC display. Implications for the design of AAC displays and for assessment of comprehension are discussed.

This preliminary study investigated the effects of using picture-based task analyses and an iPad to teach students with intellectual disability how to send and reply to emails. Three middle-school-aged students with intellectual disability as well as three peers without disabilities participated in this investigation. The intervention consisted of two 15-step task analyses: one for sending an email, and the second for replying to an email, least to most prompting, and constant time delay. Results showed students' improved ability to send and reply to emails on an iPad with the support of picture-based task analyses. Implications for practice and future research are discussed.

Phonological awareness (PA) is defined as a child's ability to hear and manipulate parts of spoken language (National Early Literacy Panel [NELP], 2009; National Institute of Child Health and Human Development [NICHD], 2000). Ensuring that children develop PA increases the likelihood that they are successful with later reading instruction. Two types of PA skills are most important to future reading readiness (NICHD, 2000). These include the ability to "blend" smaller sound units into words (/b/ /a/ /t/ [right arrow] "bat") and "segment" spoken words into smaller sound units ("milk" [right arrow] /m/ /ilk/). Young children with Down Syndrome (DS) often struggle to develop PA skills, particularly in comparison with peers without disabilities (Lemons & Fuchs, 2010; Martin, Klusek, Estigarribia, & Roberts, 2009; Naess, 2016). Nonetheless, there is a significant relation between PA, current reading abilities, and later reading skills for children with DS (Lemons & Fuchs, 2010). This makes early PA interventions especially important. Furthermore, many children with DS exhibit potentially problematic behaviors, such as work avoidance (Fidler & Nadel, 2007). Therefore, early childhood educators must consider comprehensive PA interventions that address the academic and behavioral needs of their children with DS. Explicit instruction is especially important for children with DS who often demonstrate deficits in PA-related concepts and are at risk for later reading difficulties (Lemons & Fuchs, 2010; Martin et al., 2009; Naess, 2016). With explicit instruction, children with disabilities broadly (see Gillon, 2000) and DS specifically (see Lemons & Fuchs, 2010; van Bysterveldt, Gillon, & Foster-Cohen, 2010) show improved PA skills, which support later reading development. This article describes "Boost," a brief, explicit PA intervention designed for preschoolers with DS.

Background: Down syndrome is the most common liveborn genetic condition. However, there are no surveys measuring societal services and supports for people with Down syndrome. We developed a questionnaire so that initiatives could be targeted towards countries most in need of assistance. Method: We formed a geographically diverse group of physicians, family members of people with Down syndrome, and members of Down syndrome not-for-profit organisations to create a survey of societal services and supports. We used a modified Delphi method and disseminated the survey to Down syndrome non-profit organisations worldwide. Results: Our survey consists of 61 items categorised within five domains: Education, Community Inclusion, Independence, Healthcare, and Social and Policy Issues. Conclusions: We developed a survey to measure societal services and supports available to people with Down syndrome as perceived by organisational leaders. Our methods might serve as a blueprint for other populations of people with intellectual and developmental disabilities.

The unprecedented school closures in response to COVID-19 have been associated with a number of negative impacts on students and their families. In addition to these difficulties, parents of students with disabilities are faced with prepandemic stresses and challenges that may be exacerbated by the school closures. This qualitative study aimed to investigate the experiences and struggles of parents of children identified with a disability during the COVID-19 school closures. The 15 participants were parents of children with a range of disabilities, including Autism, Down Syndrome, ADHD, and learning disabilities. The analyses revealed four major themes: school connection, virtual learning, potential impacts for students, and managing change. The experiences of these caregivers during the COVID-19 school closures and subsequent shift to remote learning have implications for educational and treatment planning. Recommendations for how school psychologists and school teams may best support students with disabilities and their families are included.

The present study explored the effects of the pandemic on individuals with Down Syndrome (DS; n = 67) compared to other groups with Special Education Needs and Disabilities (SEND; n = 48) and their Typically Developing Siblings (TDS; n = 56). In total, 115 caregivers reported on their own anxiety and worries and of their children. Anxiety levels for individuals with DS appeared to be lower compared to other SEND populations and to TDS. In terms of worries, individuals with DS worried more about social-related worries but worried less about family-related aspects compared to the other groups. In sum, individuals with DS might show less anxiety but still worried more about specific aspects related to the impact of COVID-19 pandemic on their lives.

Purpose: Atypical vowel production contributes to reduced speech intelligibility in children and adults with Down syndrome (DS). This study compares the acoustic data of the corner vowels /i/, /u/, /ae/, and /[open back unrounded vowel]/ from speakers with DS against typically developing/developed (TD) speakers. Method: Measurements of the fundamental frequency (f[subscript o]) and first four formant frequencies (F1-F4) were obtained from single word recordings containing the target vowels from 81 participants with DS (ages 3-54 years) and 293 TD speakers (ages 4-92 years), all native speakers of English. The data were used to construct developmental trajectories and to determine interspeaker and intraspeaker variability. Results: Trajectories for DS differed from TD based on age and sex, but the groups were similar with the striking change in f[subscript o] and F1-F4 frequencies around age 10 years. Findings confirm higher f[subscript o] in DS, and vowel-specific differences between DS and TD in F1 and F2 frequencies, but not F3 and F4. The measure of F2 differences of front-versus-back vowels was more sensitive of compression than reduced vowel space area/centralization across age and sex. Low vowels had more pronounced F2 compression as related to reduced speech intelligibility. Intraspeaker variability was significantly greater for DS than TD for nearly all frequency values across age. Discussion: Vowel production differences between DS and TD are age- and sex-specific, which helps explain contradictory results in previous studies. Increased intraspeaker variability across age in DS confirms the presence of a persisting motor speech disorder. Atypical vowel production in DS is common and related to dysmorphology, delayed development, and disordered motor control.

The current study presents a rhythmic music program to acquire some motor skills for children with Down syndrome. The research sample was taken from one of the specialized Down syndrome learning centers for children, and the sample was taken in a random manner. The sample of children consisted of 20 boys and girls and divided into experimental and control groups. The researcher also prepared a list of the appropriate motor skills for these children (walking, running, jumping, throwing), in addition to the motor skills scale to determine the effectiveness of the proposed program. The results were statistically analyzed using the analysis of covariance, where pre-test serving as a covariate. The results indicated an improvement in the performance of all motor activities under study for the children of the experimental group compared to the control group, and this confirms the extent of the positive impact of the musical rhythmic program for these children, which affects the children positively in the performance of their motor.

Background: Down syndrome has a unique medical and psychological profile. To date, few studies have asked individuals with Down syndrome about their views of health. Methods: Eight focus groups of 20 parents and 8 individuals with Down syndrome, were conducted virtually via videoconferencing to obtain participants' views of health indicators. Focus group moderators employed some modifications for individuals with Down syndrome, including simplified language and use of graphics. Transcripts were coded using a hybrid inductive/deductive framework and thematically analysed using the Framework Method. Results: We describe lessons learned in conducting virtual focus groups of individuals with Down syndrome and their parents. Individuals with Down syndrome could describe their views of health indicators and identified many of the same topics as their parents. Both groups discussed physical, mental, and social health components. However, people with Down syndrome gave a more restricted range of examples, but with different nuances than parents. Conclusion: Participants discussed physical, social, and mental well-being components of health in Down syndrome. Interviewing individuals with Down syndrome in virtual focus groups with appropriate modifications added important self-report health information.

Background: COVID-19 has resulted in some educators and allied health practitioners transitioning to online delivery of literacy instruction. As far as we are aware, no studies have investigated online delivery of comprehensive literacy instruction for children with Down syndrome. Aims: In this pilot study, we explore the efficacy of online delivery of ABRACADABRA (a free literacy web application) for children with Down syndrome, alongside supplementary parent-led shared book reading, during the COVID-19 pandemic. Sample: Six children with Down syndrome, aged 8-12 years, participated in this within-participants design study. Methods: Participants acted as their own controls with outcome variables measured at three timepoints: baseline, pre-instruction and post-instruction. Children participated in 16-18 hrs of one-to-one literacy instruction online over a 6-week instruction phase, along with twice weekly parent-led shared book reading activities. Results: Outcomes from standardized assessments revealed statistically significant improvements in word- and passage-level reading accuracy skills over the instruction phase (pre-instruction to post-instruction) compared with the no-instruction control phase (baseline to pre-instruction). Improvements in reading comprehension skills were inconsistent across assessment measures and statistical analyses. Conclusion: Children with Down syndrome can benefit from comprehensive literacy instruction delivered via telepractice. Our study provides critical initial evidence of successful service delivery during a global pandemic and beyond.

Parents of children with Down syndrome (DS) were interviewed about if their experiences raising their children matched their initial assumptions about parenting a child with DS. A dominant narrative was identified, wherein most parents described initially having negative assumptions, which did not come to fruition; parenting their child was not very different from parenting a typical child. There was also a sub-group of participants who disputed the dominant narrative; parenting their child was challenging and the dominant narrative marginalizes that experience. The findings indicate that although for many parents, having a child with DS is like "taking the scenic route" (i.e., it involves a few more hurdles, but often more rewards), this framing is not always applicable. Therefore, health care providers and support organizations should promote a narrative that encompasses the diversity of parenting a child with DS.

Down syndrome (DS) is a chromosomal condition that is affecting an increasing number of infants born in Saudi Arabia. This study investigates the needs of families with children with DS in Saudi Arabia from mothers' perspectives and in a cultural and religious context. An exploratory qualitative research design was used, and semi-structured interviews were conducted with 14 mothers of children with DS. Interview data were thematically analyzed. The most important need was found to be financial or tangible support. An increase in benefits or monthly financial allowances and social security insurance would address these concerns. Societal support is also needed; mothers want DS to be perceived differently and require more support, including better rehabilitation and education services. Informational support is needed to improve the conditions of children with DS. Recommendations for improving the quality of life of children with DS are discussed.

The aim of this study was to investigate the oral health status and quality of life (QOL) of the parental caregivers of individuals with Down syndrome (DS), and to evaluate whether there is an association between these variables. The sample of this cross-sectional study was composed by parental caregivers of children with DS (CCDS) and parental caregivers of children without DS (CNDSC). Oral examination was undertaken and a questionnaire was given to participants. QOL was evaluated by WHOQOL-Bref. CCDS presented a higher number of dental prosthesis users and higher gingival bleeding index compared to CNDSC. When oral health was associated with QOL, the use of dental prosthesis was associated with physical domain and the variables having chronic disease and family income were associated with the social domain for both caregivers. The results suggest that caregivers of children with DS have similar oral health and QOL compared to caregivers of children without DS. In both caregivers, oral health status is associated with QOL.

Background: People with Down syndrome often present with balance deficits, which compromise safety during daily activity. While evidence shows that exercise can improve balance in the Down syndrome population, it is unclear if a telehealth method will elicit similar benefits. We aimed to examine the effects of a virtual exercise program on balance in adults with Down syndrome. Methods: Eighteen low-active participants with Down syndrome completed a 12-week telehealth exercise program based on the Mann Method. Balance testing took place before and after the intervention, which included: TUG, MCTSIB, FICSIT-4, and FRT. This study was registered as a clinical trial on ClinicalTrials.gov, identifier: NCT04647851. Results: Significant improvement was seen in the TUG (p = 0.043), FICSIT-4 (p = 0.019) and FRT (p = 0.019). All participants achieved maximum scores on the MCTSIB in pre- and post-testing. Conclusions: Balance in low-active adults with Down syndrome significantly improved following the telehealth exercise program, which we attribute to the tailored exercises that address visual/vestibular deficits and hip muscle weakness.

Background: Individuals with Down syndrome are known to have high rates of hearing loss, but it is unclear how this impacts their ability to communicate and function in real-world environments. Methods: Sixteen English-speaking and Spanish-speaking mothers of individuals with Down syndrome ages 6-40 years participated in individual, semi-structured interviews using a videoconferencing platform. Session transcripts were analysed using applied thematic analysis. Results: Mothers described listening environments, the impact of hearing on daily life, barriers to successful listening, and strategies to overcome communication barriers for their children with Down syndrome. Conclusions: Hearing was largely discussed in terms of challenges and detriments, suggesting that hearing experiences are predominately considered to negatively impact the functional abilities of individuals with Down syndrome. Background noise and hearing loss were sources of communication difficulties. Parent-reported barriers and strategies can inform ecologically valid research priorities aimed at improving outcomes for individuals with Down syndrome.

Background: Individuals with Down syndrome are particularly vulnerable to COVID-19 because they are recognised as significantly immunocompromised. Yet their voices regarding their lived experiences of pandemic lockdowns have not been sought or heard. Aim: This study aims to describe the lived experiences of people with Down syndrome during the pandemic lockdowns in Aotearoa New Zealand to add evidence in order to inform systemic advocacy. Method: A mixed-methods approach positioned within an inclusive research paradigm was used, in which a group of self-advocates with Down syndrome co-designed a structured interview schedule and conducted 40 face-to-face interviews. Key themes were identified by using content analysis. Results: Despite the difficulties associated with lockdowns and participants not receiving their usual supports and having to make significant adjustments, they remained positive, adapted well, and demonstrated a high level of resilience and adaptability. Conclusions: The findings add to the limited research on the lived experiences of people with Down syndrome during pandemic lockdowns. This research has given them a voice to contribute to policy, government initiatives, and service providers; particularly on issues around support during lockdown and staying connected with others.

Introduction: The main focus of early intervention is to strengthen the interaction of parents with young children with disabilities, and to ensure that parents become active participants in the development and education of their children. The purpose of this study is to examine the effectiveness of an Early Intervention Program based on Naturalistic Teaching (DÖDEM), which has been developed in order to strengthen the interaction of parents with their children with Down syndrome and to introduce naturalistic teaching strategies to them. Methods: The DÖDEM program was provided face-to-face through group family training sessions and home visits for a group of participants, while it was followed remotely by another group of participants via a tablet computer. The study was conducted with 10 parents and their children with Down syndrome aged 25-48 months. A mixed method research design was used in this study. Results: The findings demonstrate that the parents in both groups made significant progress in interactional behaviours and increased the usage frequency of naturalistic teaching strategies. Furthermore, parents think that the program contributes positively to their interactions with their children and support the development of their children. Conclusion: The results obtained demonstrated that following the DÖDEM program in both ways contributed to significant improvement in the parents' interactional behaviours and the frequency of use of naturalistic teaching strategies. Thus, it can be said that this process has led to a change in both the parents' and children's behaviours.

In several shows prepared for children and adults in the media, the representation of "individuals with special needs" can ensure that other members of the society empathize with disability and the characteristics of disabled people, and make it easier that prejudices are replaced by social acceptance through gaining information. Finding a place frequently used in children's literature, children's reality satisfies the curiosity and experience-gaining demands of children about the cases they encounter for the first time using various examples, and helps them internalize the information and experience they gain. Children's shows and cartoons have an effective power in influencing the viewpoint of children as target group for disabled people within the framework of "children's reality" by means of the representation of children with special needs who are socially disadvantaged. In this context, the purpose of this study is to evaluate and examine in terms of various factors the social representation style of main characters with Down Syndrome represented in "My Brother Ozi" and "Punky" cartoons broadcasted on local children television channels and internet sites where cartoons for children can be found. 51 episodes of both cartoons (26 and 25) were viewed in the framework of the study and findings were analyzed using "document analysis" method which is a qualitative research method.

The study aims to determine rural families' experiences regarding sexual development of their adolescents with neurodevelopmental disorders. Thus, semi-structured interviews were conducted with 14 parents. Since the interviews included privacy issues, they were conducted one-to-one with the parents. The phenomenological method was used, depending on the research purpose. Inductive analysis was utilised in the analysis of the data obtained from the semistructured interviews. Validity and reliability were included in all stages of data collection, breakdown and analysis. As a result, the families stated that their children exhibited inappropriate socio-sexual behaviours during adolescence; they strive to teach their children sexuality issues, although they do not know how and they generally prefer carrying their children along to prevent sexual abuse. Also, due to not knowing much about sexuality, they generally received their relatives' support and requested comprehensive sexuality education (CSE) from special education teachers and other experts, especially about distinguishing good and bad people, menstruation and hiding sanitary pads. Although the literature reports that sexuality and its education are generally taboo, families in this study explained their thoughts on sexuality in full detail without tabooing. This makes the study different and meaningful, when compared to similar ones. The study was conducted in an eastern Turkey city with difficult access to special education. Thus, experts in rural areas are recommended to prepare and give necessary CSE programmes to families and individuals with special needs by conducting similar studies. These studies can be conducted not only with special education perspective but also in different disciplines. It is a basic human right for all individuals to receive CSE, thus as another recommendation, experts should give all children these courses in schools.

It is rare for the characters in cartoons to be chosen among individuals who are considered minorities in society. Disabled characters are also among these minorities. In this context, the cartoon 'My Brother Ozi' which shows a characteristic of being the first Tv show for children in Turkey that give part to a disabled character in it, has been considered valuable for scientific research. The purpose of this research is to show how "the other" characters are represented in the cartoon named "My Brother Ozi". In the research, parts of the cartoon were subjected to document review. Afterward, the sections of the cartoon were scanned by watching it through the content analysis method. At the end of the study, it was concluded that the Ozi character reflects the appearance and speech of children with Down syndrome. Ozi's inclusive training, constant medical visits, and exercise for development are also unique to children with Down syndrome. In many media outlets, disabled people are depicted in a pitiful situation, while Ozi is portrayed as a strong character in the cartoon and it has been shown that children with Down syndrome can improve when they are given adequate support.

The COVID-19 outbreak affected the daily lives of individuals with Down syndrome, who were considered to have a higher risk of severe infection. While several studies have reported mental health issues in children and/or parents in the general population, no study has focused on people with Down syndrome and their caregivers. This study investigated the disinfection behaviors of individuals with Down syndrome and their caregivers' stress. A cross-sectional retrospective survey was conducted in October 2020. Caregivers of children and adults with Down syndrome were administered questionnaires including measures for practiced disinfection behavior in children, caregiver's child-related stress, and psychological distress. About half of the respondents' children practiced hand hygiene and mask-wearing behaviors, while physical distancing was performed less frequently. Habitual practices in physical distancing are affected by intellectual function. Logistic regression showed that caregivers' stress was associated with the irritability of individuals with the disorder (adjusted odds ratio [OR] = 8.44, 95% confidence interval [CI] 1.69-42.09) and the burden of infection-prevention behaviors for people with Down syndrome (adjusted OR = 4.26, 95% CI 1.88-9.65). This study showed the characteristics of disinfection behaviors in individuals with Down syndrome and associated factors for serious caregiver stress.

Background: Residential transitions have long been recognised as challenging for people with learning disabilities and can be packed with problem stories. Narrative Therapy practices have the potential to centre the voice of people with learning disabilities; to enable alternative stories to be told; and to shine a light on their own and their support system's resources for change. Methods: Colin, a 36-year-old man with Down syndrome and a learning disability, met with the first author for nine sessions. Narrative Therapy practices (also drawing on systemic ideas) were used, including the Tree of Life, Outsider Witness Practice, Therapeutic Documentation and Definitional Ceremony. Feedback from Colin and the staff team was gathered through qualitative and quantitative means. Findings: Colin was keen to share his life stories and explored ideas about his "new life", wanting to "stay strong" and "stay happy". Staff noted an improvement in household stress and perceived ability to support Colin. An improvement in quality of life was also demonstrated with a self-report questionnaire. Conclusions: By acknowledging the power of language, narrative practices offer tools to help people with learning disabilities and their support system in making sense of and navigating important life transitions.

Background: Children with Down syndrome have speech and language difficulties that are disproportionate to their overall intellectual ability and relative strengths in the use of gesture. Shared book reading between parents and their children provides an effective context in which language development can be facilitated. However, children with Down syndrome often take a passive role in shared book reading and the use of key word signing (KWS) as a shared book reading technique has never been investigated. Aims: This study aimed to compare children with Down syndrome's participation and use of KWS across two methods of shared book reading -- one in which a book had key-word sign prompts embedded (signed condition) and the other in which a book was read as normal (unsigned condition). Measures of child and parent communicative behaviour were taken in each condition to establish if differences emerged. Methods & Procedures: A total of 36 children with Down syndrome (aged between 18 and 61 months) and their mothers took part in the study. Parent-child dyads were videoed at home reading two books, one in a signed and one in an unsigned condition. Child measures included total number of signs produced in each condition and levels of attention and initiation as measured by the Pivotal Behaviour Rating Scale. Parent measures included total number of utterances, mean length of utterance (MLU) in morphemes and vocabulary diversity (VOCD). Parental measures were transcribed using the Codes for Human Analysis Transcripts (CHAT) software and analysed by the Computerised Language Analysis software (CLAN). Contrasts in outcomes between the signed and unsigned conditions were estimated using Poisson and linear mixed-effects models, determined by the type of data. Outcomes & Results: Results showed that children attempted to sign significantly more in the signed than unsigned condition, as well as showing significant increases in their levels of attention and initiation. There was also a significant increase in the total number of utterances used by parents in the signed versus unsigned condition and a decrease in MLU. VOCD was similar in both conditions. Conclusions & Implications: This study shows that the simple act of embedding key word signs into commercially available books, during shared book reading between parents and young children with Down syndrome, positively affects children's participation (initiation and attention) and use of KWS. The use of KWS as a core shared book reading technique may therefore be a fruitful avenue to facilitate growth in the language abilities of young children with Down syndrome.

This paper explores the nature of copula omission in Cypriot Greek individuals with Down Syndrome (DS). Previous studies on DS have attributed high rates of copula omission to an overall grammatical/inflectional impairment without offering further analysis. In order to identify relevant conditioning factors, we examined copula productions and omissions from spontaneous and elicited experimental tasks under five levels of analysis: categorial type of the predicate (nominal vs. adjectival), aspectual interpretation of the predicate (permanent vs. temporary), and a combination of these first two, as well as subject status (overt vs. covert) and experimental design (spontaneous vs. elicited). Results showed that adults with DS had significantly higher rates of copula omission than TD children. We found subject overtness to be the most reliable predictor of copula omission. A comparison of the two experimental methods of data collection also revealed a significant effect. Following an analysis based on the Unique Checking Constraint, we propose that copula omission is facilitated by the restriction that only one EPP feature (either the one in TP or the one in TopicP) can be checked. We discuss the implications of these results in the context of a distinction across a delayed vs. deviant development of the DS grammar.

This study looked into the experience of a group of elementary school students as well as their parents from Hong Kong, in a service-learning programme that aimed at facilitating the social-emotional development among gifted students. A total of 51 students and 72 parents participated in the focus group interview three months after the service-learning programme for working with children who have Down Syndrome. Transcripts of all interviews were reviewed using thematic analysis. Four broad themes were identified. These were: knowledge enhancement on Down Syndrome, improvement in interpersonal skills, facilitation of personal growth, and enhanced empathy, were identified. Our findings provided support for the benefits and impact of a short-term service-learning programme on improving multiple aspects of gifted students' personal and social growth. As students and parents endorsed the value of this experiential learning opportunity, such a service-learning programme can be promoted as an educational option addressing gifted students' socio-emotional needs and facilitating their psychosocial development.

Objectives: To describe the clinical and epidemiological characteristics of adult patients with Down syndrome admitted to Spanish hospitals between 1997 and 2014. Secondary goals were to study trend changes over time, and to analyse differences between patients admitted to medical and surgical departments. Patients and Methods: Retrospective observational study on data collected from the Minimum Basic Dataset (MBDS, Conjunto Mínimo Básico de Datos [CMBD]) of admissions of adults with Down syndrome to hospitals belonging to the Spanish National Health System from 1 January 1997 through 31 December 2014. We analysed epidemiological and clinical variables. Results: We analysed 28,716 admissions of 16,874 adult patients with Down syndrome. Men accounted for 58.2% of the sample, and the mean age on admission was 41 ± 13 years, with an 11-year increase in mean age during the study period. Admissions among persons with Down syndrome increased by 5% during the study period, with a noticeable rise in admissions of older adults and to medical departments. Almost one-third of patients (31.8%) were admitted more than once. Age-adjusted mortality was 15.7%. The most common comorbid conditions were chronic obstructive pulmonary disease (25%), hypothyroidism (18.6%), and epilepsy (14.3%). The departments with the highest numbers of admissions were internal medicine (26.3%), pulmonary medicine (6.9%), and general surgery (5.25%). Conclusion: Hospital admissions among Spanish adults with Down syndrome have increased in recent decades, especially in older patients. We identified substantial differences between patients admitted to medical and surgical departments.

Background: Rates of death and avoidable deaths are reportedly higher among people with intellectual and developmental disabilities. This study contributes to our understanding of how mortality and intellectual and development disabilities are associated. Method: General population and intellectual and developmental disabilities adult cohorts were defined using linked administrative data. All-cause and amenable deaths between 2010 and 2015 were reported for these cohorts and subcohorts with and without Down syndrome. Cox proportional hazards models evaluated the impact of potential contributors to amenable deaths. Results: Adults with intellectual and developmental disabilities had higher all-cause (6.1 vs. 1.6%) and amenable death percentages (21.4 vs. 14.1%) than general population comparators. Within intellectual and developmental disabilities, those with Down syndrome had higher all-cause (12.0 vs. 6.0%) but lower amenable death percentages (19.2 vs. 21.8%) than those without. Conclusions: Results suggest that interventions to reduce amenable deaths target provider-care-recipient interactions and coordination across care and support sectors.

Over 8 million children under the age of 14 live with a disability in Latin American and Caribbean (LAC) countries. These children are often denied educational opportunities and related services that have the potential to enhance their quality of life. In this qualitative study, we conducted a secondary analysis of interviews with eight parents of individuals with disabilities living in the Republic of Panama. The aim of this study was to examine the parental perceptions of disability, communication supports afforded to individuals with disabilities, and enablers and barriers families face when raising, educating, and finding services for their children. Four general themes emerged from the analysis of the transcript: child characteristics, child communication, sources of support, and barriers to inclusion. Implications and possible solutions are discussed.

Background: Raising a child with developmental disorder is often related to higher stress levels for both mothers and fathers. The aim of the present study was to investigate relationships between resilience, family hardiness, life satisfaction and parental stress among parents of children with and without disabilities. Method: Twenty-eight pairs of parents of a child with Autism Spectrum Disorder, 15 of a child with Down Syndrome and 25 of a child without disability took part in the study. All parents completed four questionnaires independently. Results: Significant differences between groups emerged in parental resilience, stress, and life satisfaction. Correlational analyses showed that parental hardiness and resilience were negatively related to parental stress through all the three groups. Conclusions: These findings point to increased evidence that the presence of a disability may not directly affect the sense of family hardiness. Practical implications were discussed.

Background: There is a need for promoting exercise practice among people with intellectual disabilities (ID). Aquatic exercise (AE) could be a viable option in this regard.Objective: To identify and critically analyze the best available evidence concerning the effects of AE in the physical and mental health of people with ID. Methods: A systematic review of randomized controlled trials (RCTs) and comparative studies was performed after searching within several databases up to March 2021. Results: A total of 4 RCTs and 3 comparative studies were found. Their methodological quality ranged from high to low. Aquatic interventions had positive effects on cardiorespiratory, muscular fitness and balance. Mixed effects were seen on parameters related to obesity and cognition. Scant information regarding feasibility and intervention fidelity was provided. In general, interventions details were not discussed in deep. Conclusion: Preliminary evidence shows that aquatic exercise can be prescribed to people with ID in order to improve their physical health. The impact of aquatic exercise on motor skills, cognitive function and mental health remains unclear. Further research on this topic should provide a detailed description of the interventions carried out, including information on the feasibility and intervention fidelity.

Down syndrome is acknowledged to be the most common neurogenetic cause for intellectual disability. It is a multisystem disorder which results in multiple lifelong health problems. At present, students with Down syndrome can receive education in inclusive mainstream education settings. However, this is not without its accompanying challenges. The present study aimed to investigate the challenges that teachers face in implementing Individualised Education Plans (IEPs) for children with Down syndrome in mainstream schools in Riyadh, Saudi Arabia. A customised questionnaire was utilised to obtain the perceptions of 100 special education teachers from four mainstream schools in Riyadh. The results revealed that the teachers did not have a robust understanding of the different aspects of children with Down syndrome. They also encountered significant challenges in IEP implementation at individual or group level. In addition, the teachers indicated that there were solutions to the challenges they encountered in IEP implementation. Recommendations are discussed in the light of these findings.

Functional communication training (FCT) is an evidence-based intervention that while often effective, can result in rote responding, reduced generalizability of target behavior, and resurgence of challenging behavior (CB) during treatment lapses. Lag schedules of reinforcement have been successfully used to address these concerns. We applied an increasing lag schedule within FCT to increase the variability and persistence of appropriate responding of four young children with disabilities while maintaining low levels of CB during treatment. Our results provide evidence regarding the effects of lag reinforcement on appropriate communication and CB during treatment and lapses in treatment with children with autism and Down syndrome. This research provides a new perspective to the field given, we assessed functional communication during baseline, assessed generalization to new contexts, and assessed social validity via both masked raters and participants' mothers. We discuss the implications of this work and provide future directions for researcher and practice.

Home Literacy Environment (HLE) plays a fundamental role in the development of reading and writing skills in children. Evidence suggests differences in HLE components based on cultural and idiosyncratic characteristics. Most studies show a relationship between contextual variables with the quality of HLE in typically developing (TD) children. There are HLE studies with families of children with Down syndrome (DS) that show similar results, but the characteristics of HLE for Latin-American families of children with DS remain unexplored. This study analyses the HLE in a group of 161 families of children with DS, between 3 and 12 years of age, living in urban areas of Chile. Data were collected using an online survey. Results showed differences on the amount of literacy materials, linguistic environment, and beliefs and expectations of parents. Better HLE was observed in families with parents with high educational levels. In the context of previous studies from developed countries with families of children with DS and from Chile with families of TD children, the HLE of families with children with DS in Chile seems poor. This descriptive evidence is necessary to raise concerns in policy makers and national funding agencies to open a way to conduct experimental studies.

Scant research exists regarding how family cohesion is related to relationships among siblings with and without disabilities. The purpose of this study, based upon the Double ABCX Model of Adaptation, was to investigate cohesion and sibling relationships in families raising typically developing siblings (TDC) and families raising children with some type of disability. Mothers and fathers of 221 sibling pairs completed demographic, family cohesion, and sibling relationships questionnaires. Paired t-tests, correlations, and structural equation modeling were used to analyze the data. Mothers reported higher levels of family cohesion than fathers. Comparing families raising TDC with families raising a child with some type of disability, parents of TDC reported higher cohesion than parents of children with autism spectrum disorder (ASD); fathers of TDC reported higher cohesion than fathers of children with Down syndrome (DS). However, parents of TDC reported less positive sibling relationships than parents of DS. Higher levels of cohesion correlated with more positive sibling relationships. It was concluded that relationships exist between family cohesion and sibling relationships, and these perceptions differ between families raising children with or without disabilities. Implications for research and practice are discussed.

People with Down syndrome (DS) commonly experience challenges with sleep, executive functioning, everyday memory, and symptoms of attention deficit hyperactivity disorder (ADHD). A path analysis was conducted to determine if executive function mediated the relationship between sleep problems and both everyday memory and ADHD symptoms. Parents of 96 children and youth with DS completed questionnaires related to sleep, executive functioning, everyday memory, and ADHD symptoms. Results showed that executive functioning fully mediated the relation between sleep and both everyday memory and ADHD symptoms. Implications for education and intervention for children and youth with DS are discussed.

Background: Previous studies have explored the size and word type composition (nouns, predicates, etc.) of expressive vocabularies of preschool children with Down syndrome, both spoken and signed. Separately, overall preferences for modality of expression have also been explored. Aims: To extend previous findings by describing the relationships between expressive vocabulary size and both word type and modality of expression in the preschool period including changes to modality preference over time. Methods & Procedures: Mothers of 35 children with Down syndrome, aged 36-66 months and attending the same early intervention programme, completed a version -- with both spoken word and sign options -- of the New Zealand MacArthur-Bates Communicative Development Inventory (CDI): Words and Sentences. Most mothers completed the CDI on multiple occasions across the duration of the study. Completions (n = 114) were analysed cross-sectionally and longitudinally in terms of (1) word type relative to vocabulary size, (2) modality of expression relative to word type and vocabulary size, and (3) individual trajectories in vocabulary size and modality of expression. Outcomes & Results: (1) Word type relative to vocabulary size was similar to previous studies with a greater proportion of the SOCIAL words being present in the children's vocabularies throughout, followed by NOUNS, PREDICATES and CLOSED class words, with proportions converging as vocabulary sizes increase. (2) An initial spoken word preference for SOCIAL and CLOSED class words and sign preference for NOUNS and PREDICATES was found, with more spoken words in larger vocabularies overall. (3) Individual trajectories were highly variable and also revealed temporary points of regression in overall expressive vocabulary size in some children. Children who shifted from reliance on sign to predominantly spoken word expression did so at different ages and at different vocabulary sizes. At school entry, while most of the children used both modalities, some children continued to rely on sign for most vocabulary items whereas others used only spoken words. Conclusions & Implications: An appreciation of both the general trends and potential for individual variation in vocabulary structure, modality of expression and change over time will better position clinicians and education specialists to provide individually tailored support to both preschool and school-aged children with Down syndrome.

This meta-analytic review demonstrates that language interventions can improve oral language in children with neurodevelopmental disorders. We assessed interventions that target language skills in children with neurodevelopmental disorders. The interventions had to use techniques ranging from explicit and structured activities (explicit instruction of vocabulary, narrative structure or grammatical rules) to implicit and broad activities (shared book reading, general language stimulation). We examined whether the interventions had an impact on language in general, or on more specific aspects of language in both receptive and expressive modalities. This review examines 42 publications reporting on the effects of oral language interventions in children with neurodevelopmental disorders.

Background: To document whether the sociocognitive peculiarities of people with Down Syndrome impact the construction of attachment at different ages, a systematic review of the literature was carried out. Method: This review followed the Preferred Reporting Items for Systematic Reviews and MetaAnalyses, was conducted on three databases: psycINFO, MEDLINE, and Psychology and Behavioural Sciences Collection (1975-2021). Twelve studies were included. Results: Most children with Down syndrome develop specific attachment patterns in infancy and childhood, and around half of them become secure. However, the risk of exhibiting atypical/ unclassifiable or disorganised attachment is higher among children with Down syndrome compared to typically developing children. Findings are mixed regarding the specific role of cognitive disability. Conclusion: These findings highlight the fact that Down syndrome does not preclude the establishment of secure attachment. However, more research is needed to understand what the unclassifiable category represents in terms of attachment.

A child with Down syndrome (DS) is physically characterized by muscle hypotonia, joint instability, and poor motor coordination. Here, we tested whether Dohsa-hou training could improve motor coordination among children with DS, compared to a control condition. Forty children with DS were randomly assigned either to Dohsa-hou training or to a control condition. All participants completed a bimanual coordination test, at the following time points: baseline, seven weeks later at completion of the intervention, and again 4 weeks later at follow-up. Bimanual coordination accuracy and consistency improved from baseline to intervention completion and to follow-up, but only in the Dohsa-hou training, compared to the control group. The findings suggest that among children with DS and compared to a control condition, Dohsa-hou training has the potential to enhance the bimanual coordination, thus contributing to improved motor control of children with DS.