How Theory of Mind Develops in Children with Down Syndrome |
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This study examines the development of Theory of Mind (ToM) in individuals with Down syndrome (DS) between the ages of 2 and 9. A cross sectional analysis will allow us to assess to what extent ToM skills have emerged at three ages: group 1 = age 2/3 (n=14), group 2 = ages 4/5 (n=8) and group 3 = ages 6-9 (n=15). A range of assessments have been used for analysis; semi-structured play based tasks (groups 1 and 2), and traditional ToM tests (group 3). Groups 2 and 3 have also undergone a language comprehension assessment, a working memory test and observational data has been gathered from caregivers and teachers. We have focussed on enabling the participants in the study to show their understanding through visual and physical means; as such we have modified assessment tasks to be used specifically with children with Down syndrome. This research will contribute to describing the cognitive phenotype associated with DS and add to the on going development of specific approaches in teaching and supporting young people with DS. Our work will be linked with the EYFS curriculum and will engage educators and academics in discussion about the educational future of young people with DS.
Study Outline
Aims
Our study will first and foremost examine the emergence of ToM in children with Down syndrome. We hypothesise that children with DS develop ToM strategies more slowly and with less stability than their typically developing peers and that this may be due, in part, to difficulties in receptive language and working memory.
Our findings will contribute to the development of teaching and learning approaches designed specifically for children with Down syndrome. We will also contribute to the wider clinical and academic discussions regarding a behavioural phenotype in children with Down syndrome. We hope to prepare the groundwork for more extensive research into how and when ToM develops in children with Down syndrome.
Methodology
This project will consider ToM at three different points of development. Firstly at a chronological age of 2-3 years to examine skills which are considered to be precursors to developing a ToM. Object permanence and joint attention activities have been administered to establish whether, by the age of 3, these skills are well embedded and securely executed in our cohort.
At age 4-5 years children have been assessed through contrived tasks to examine the development of their pretend and symbolic play skills. The connection between the development of symbolic play and the ability to conceive of otherness, be that other people’s feeling and thoughts, or other places (imaginary or real), or transforming one object into another, has been well established. ToM necessitates a clear sense of otherness and the ability to hold in mind more than one reality. Children have completed a pretend play and a symbolic play task, based on those by O'Toole and Chiat (2006), designed to assess their ability to imagine and transform objects.
Typically developing children are able to pass traditional ToM tasks, such as false belief tasks, unexpected contents tasks and false reality tasks at around 4 - 5 years of age. In our final assessments we have examined whether children with Down syndrome of age 6-9 are able to pass a range of these tests. The assessments have taken place in schools or at home, to address some concerns we have over the strangeness effect. It is our hypothesis that children with Down syndrome at this age will be inconsistent in their performance in these tests and will fail more often than younger typically developing children; our challenge will be to determine why this outcome may occur.
At each point of testing the participants in groups 2 and 3 have also undertaken a language comprehension assessment (BPVS) to determine receptive vocabulary and have completed a working memory task. The link between ToM development and language development has been explored by a number of theorists; since children with Down syndrome very often have significant language impairments in both receptive and expressive language, we theorise that this may have an impact on their ability to develop a ToM. The connection between working memory and language impairment in children with DS has been discussed in more recent years and some studies have examined how these aspects may connect to general cognitive development in Down syndrome (Lanfranchi et al., 2010, Paterson, 2001). Our research will attempt to examine some of the relationships between working memory, language development and ToM skills in children with Down syndrome.
From analysis of test results and exploration of case studies we hope to be able to draw a picture of how ToM develops in children with Down syndrome and to what extent it is similar and/or different to their typically developing peers. Whilst drawing cohort conclusions from such small groups may be difficult, and clearly any generalisations will be speculative, we will be able to show in depth case studies of a number of children with Down syndrome at three different ages. We hope to be able to identify where further studies will be most prescient and to suggest how intervention could be targeted to improve some aspects of cognitive development.
Methodological concerns
Research by Wishart and Duffy (1990) has suggested that performance in test situations by children with Down syndrome is inconsistent and often unreliable when repeated for accuracy. Furthermore children with Down syndrome often employ a range of strategies to disengage with the task, or engage with the tester rather than the task, so a simple pass/fail scale of marking may not be appropriate for this group . Our tasks will need to be carefully managed to cancel out as much of this effect as possible, although it is recognised that this is a challenge.
Outcomes
In compiling our results from this study we hope to be able to impact in three areas. Firstly, our data will be used to help in the creation of targeted interventions for children with Down syndrome in the home, nursery and school settings. We aim to ensure that our findings are shared first and foremost with our participants, their families and the schools and other organisations we work with during the course of our research, and that our findings are transformed into suggestions, practical ideas and recommendations. Although we will not be able to produce a fully formed strategy for intervention - not only are we time-limited, but we are doubtful our results will be clear cut enough to allow for this - we will ensure that our findings are disseminated in an accessible and practical format.
Secondly, our findings will contribute to the wide ranging academic and clinical discussions regarding the behavioural phenotype associated with Down syndrome (Fidler, 2005, Buckley et al., 2006, Hodapp et al., 2003). Our research will be published in relevant academic journals and will be presented at conferences to ensure a wide critique and discussion of our conclusions. We will link our findings with the existing model of the cognitive phenotype for individuals with Down syndrome, and discuss how they contribute to further shaping the model.
Our final outcome is to lead the way to further research in this area and to prepare the ground work for other studies. From our conclusions we will determine a range of appropriate areas for further research and we will attempt to secure funding and support for these studies.
With thanks to all the children, their caregivers and their teachers who participated in the study, the parent support groups who supported this work, my supervisors and the University of Leeds for awarding me the Frank Stell scholarship.
References
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CEBULA, K. R., MOORE, D. G. & WISHART, J. G. 2010. Social cognition in children with Down's syndrome: challenges to research and theory building. J Intellect Disabil Res, 54, 113-34.
FIDLER, D. J. 2005. The emerging down syndrome behavioral phenotype in early childhood - Implications for practice. Infants and Young Children, 18, 86-103.
FIDLER, D. J., MOST, D. E., BOOTH-LAFORCE, C. & KELLY, J. F. 2008. Emerging social strengths in young children with Down syndrome. Infants and Young Children, 21, 207-220.
HODAPP, R. M., DESJARDIN, J. L. & RICCI, L. A. 2003. Genetic syndromes of mental retardation - Should they matter for the early interventionist? Infants and Young Children, 16, 152-160.
LANFRANCHI, S., JERMAN, O., DAL PONT, E., ALBERTI, A. & VIANELLO, R. 2010. Executive function in adolescents with Down Syndrome. J Intellect Disabil Res, 54, 308-19.
O'TOOLE, C. & CHIAT, S. 2006. Symbolic functioning and language development in children with Down syndrome. Int J Lang Commun Disord, 41, 155-71.
PATERSON, S. 2001. Language and number in Down syndrome: the complex developmental trajectory from infancy to adulthood. Downs Syndr Res Pract, 7, 79-86.
WISHART, J. 2001. Motivation and learning styles in young children with Down syndrome. Downs Syndr Res Pract, 7, 47-51.
WISHART, J. G. 1995. Cognitive abilities in children with Down syndrome: developmental instability and motivational deficits. Prog Clin Biol Res, 393, 57-91.
WISHART, J. G. & DUFFY, L. 1990. Instability of performance on cognitive tests in infants and young children with Down's syndrome. Br J Educ Psychol, 60 ( Pt 1), 10-22.