People with Down syndrome (DS) are predisposed to specific areas of relative developmental strength and challenge, but it is unclear whether and how this profile affects participation in school and community settings.
In this study we characterized the nature of school participation and performance of functional tasks in the school context for 26 elementary students with DS (mean age = 7.86 yr; standard deviation = 1.75).
Students participated in assessments of cognitive status and language development. Their teachers completed the School Function Assessment (Coster, Deeney, Haltiwanger, & Haley, 1998) questionnaire and a standardized questionnaire on executive functioning (EF).
Students demonstrated a pronounced pattern of assistance- and adaptation-related needs across various domains of school function.
The strongest predictor of school function was EF skills, as reported by teachers (adjusted R2 = .47, p = .003). Findings from this study should inform future intervention and school-related planning for elementary school students with DS.
Over the past decade, calls have increased for improving quality-of-life outcomes for people with Down syndrome (DS), the most common neurogenetic cause of intellectual disability with a prevalence of 1 in 732 live births (Canfield et al., 2006).
DS has been linked with intellectual disability in the scientific literature for more than 150 yr and has been studied by developmental researchers for decades (see Danaher & Fiddler, 2011, for a review).
Yet, few comprehensive behavioral intervention studies have aimed at promoting participation and adaptation in home and school environments for people with DS. In fact, little is currently known about the nature of school function in students with DS.
Understanding the nature of school function in students with DS is critical so that targeted, evidence-based intervention can be developed to promote optimal outcomes in this population.
Most people with DS experience mild to moderate intellectual disability (IQs ranging from 40 to 70; Hodapp, Evans, & Gray, 1999).
However, as in many other neurogenetic syndromes, outcomes associated with DS are more complex than global delayed cognitive development.
Several decades of research indicate that DS predisposes people to a specific phenotypic pattern of relative strengths and challenges in various areas of development that are likely related to atypical constraints on neurodevelopment (for a review, see Dykens, 1995; Dykens, Hodapp, & Finucane, 2000; Hodapp & Dykens, 1994; Nadel, 2003).
In DS, this pattern includes relative strengths or mental age (MA)–appropriate performance in the areas of receptive language.
some aspects of socioemotional functioning, and visual processing and relative challenges in expressive language, motor development, and verbal processing (see Danaher & Fidler, 2011, for a review).
Additionally, pertinent to school function, evidence indicates that challenges performing daily living skills (Danaher, 2011) and specific challenges in aspects of executive functioning (EF; Danaher & Fidler, 2013; Lee et al., 2011; Rowe, Lavender, & Turk, 2006) contribute to this phenotypic profile.
It is unclear whether and how specific areas of challenge may affect school function for students with DS.
Identifying and understanding patterns of school function in DS and other neurogenetic disorders may be critical because effective engagement in functional school tasks serves as a foundation for further academic instruction.
School function involves “a student’s ability to perform important functional activities that support or enable participation in the academic and related social aspects of an educational program” (Coster, Deeney, Haltiwanger, & Haley, 1998, p. 2).
Examples of school function abilities include using school-related materials appropriately (such as writing tools and books).
the ability to move around the school environment, the ability to manage self-care and personal needs, and requesting assistance when needed (Coster et al., 1998).
A distinction is made between school function and the academic aspects of schooling, which involve class instruction and homework assignments focused on acquisition of knowledge in specific content areas such as reading, mathematics, and science (Coster et al., 1998).
With foundational school function skills, students are able to engage in academic-related activities without the need for assistance or accommodations.
Existing research on students with other disabilities has shown that specific areas of developmental functioning may be foundational for optimal function in the school environment. For example, Leung, Chan, Chung, and Pang (2011) reported that social, motor, and attentional factors significantly predicted school participation outcomes in 5-yr-old Chinese students with heterogeneous developmental disabilities.
The combination of these variables accounted for approximately 35% of the variance in scores on the Chinese versions of the School Function Assessment (SFA; Coster et al., 1998) and the Vineland Adaptive Behavior Scales (Wu, Chang, Lu, & Chiu, 2004).
In another study, Zingerevich and LaVesser (2009) examined the relationship between school function (as measured by the SFA) and both sensory processing (as measured by the Sensory Profile; Dunn, 1999) and EF (as measured by the Behavior Rating Inventory of Executive Function [BRIEF]; Gioia, Espy, & Isquith, 2003) in a group of 24 children with autism spectrum disorders.
Zingerevich and LaVesser (2009) found a strong association between EF and participation in school activities even when controlling for the effects of sensory processing dysfunction in this sample.
Similarly, other researchers (e.g., McClelland, Morrison, & Holmes, 2000) who have examined children with typical development or children at risk for developmental delays have also reported a relationship between EF and functional performance in the school context.
Thus, various domains have been linked to school function in children with different disabilities, and existing work in this area suggests that an array of domains may be critical to school function in different disability groups.
In one of the only existing studies of school function in DS, Wuang and Su (2011) found moderate correlations (rs between .31 and .33) between participation scores on the School Function Assessment–Chinese version (SFA–C) and IQ as measured by the Wechsler Intelligence Scale for Children—Third Edition (WISC–III; Wechsler, 1991) composite score.
Associations between SFA–C participation and sensory processing (Sensory Profile; rs between .38 and .40) and with a standardized measure of visual perception (rs between .17 and .40) were similar in magnitude.
No measure of EF was reported in the Wuang and Su (2011) study; it therefore remains unclear whether the strong relationship between EF skills and school function reported in the Zingerevich and LaVesser (2009) and McClelland et al.
(2000) studies is observed in students with DS as well. Examining how EF relates to school function in students with DS is important given the evidence supporting specific challenges associated with EF in the DS phenotype (e.g., Lee et al., 2011).
At present, little descriptive work has been conducted to examine the specific school function profile associated with DS.
Although more extensive work has been conducted on the various developmental and behavioral components of the DS phenotypic profile.
it is not yet known how these patterns of strength and challenge influence the foundations necessary for participation or engagement in various contexts (classroom, playground–recess, transportation, and bathroom–toileting, transitions, and meal–snack time) in the school environment.
Therefore, in this study, we examined the profile of school-based function (participation, use of task supports, and activity performance) in a sample of school-age children with DS.
We also characterized the extent to which task supports were used in the domains of physical activity and cognitive–behavioral tasks for students with DS in this sample.
In addition, we examined the predictors of within-DS variability in school function by examining the relationship between IQ scores, language functioning, EF, and school functioning composite measures.
As such, this study presents the first set of descriptive findings related to school function for students with DS in the United States.