Correlations of sensory processing and visual organization ability with participation in school-aged children with Down syndrome
Highlights
► We characterized the developmental profile of sensory processing and visual organization ability of school-age children with DS. ► Body functions are closely related to activity participation classified by ICF model in DS. ► Interventions focused on improving body functions is needed while stressing the acquisition of functional skills that increase participation in age-appropriate activities.
Introduction
Down syndrome (DS) is a chromosomal anomaly characterized by the presence of an extra copy of genetic material on the 21st chromosome, and the incidence is estimated at 1 per 700–800 births (Roizen, 2002). DS is the most common single cause of intellectual disabilities, with between 70% and 75% of individuals with DS attaining an IQ of between 25 and 50 by the first decade of life (Menkes & Falk, 2005).
Sensory processing involves the neural processes of receiving, registering, modulating, organizing, and integrating sensory input in order to execute successful adaptive behaviors for daily activities. A child who has difficulties in processing sensory information from the environment in an efficient manner may react or respond with inappropriate behavior, ranging from over-responsivity to under-responsivity (Miller, Anzalone, Lane, Cermak, & Osten, 2007). Children with over-responsivity tend to respond to sensations strongly and often negatively than those with typical sensory responsivity. They are often described as having sensory defensiveness (i.e., avoidance and withdrawal behavior) because of their strong negative reactions to non-harmful stimuli. Children with under-responsivity fail to react to the intensity of frequency of sensory stimuli in the expected way. This lack of initial awareness may lead them to apathy, lethargy and a lack of inner drive to initiate exploration. They may seek stronger sensation and are prone to danger or injury due to their underresponsiveness and underreactivity (Miller, Schosen, James, & Schaaf, 2007). There is a group of children who may either over- or underrespond to environmental sensation, but there are also children who fall consistently into one category or the other (Lane, 2002). SPD may impair social skills, decrease self-esteem, reduce quality of life, and impose limitations on the child's meaningful participation (Bundy et al., 2007, Engel-Yeger, 2008).
Bruni, Cameron, Dua, and Noy (2010) suggested that 49% of children with DS aged 3–10 years experience definite differences and 25% probably experience differences from population normative values in their processing of sensory experiences. Discussions about the impact of sensory processing on children with DS in the broader aspects of daily life are just beginning to emerge (Sutton, 2005).
In addition to significant limitations in cognitive functioning, children with DS also showed specific cognitive deficits on tasks requiring certain visual perception abilities including visual-spatial, visual memory, and visual sequencing abilities (Vicari et al., 2005, Visu-Perta et al., 2007, Wuang et al., 2008). Difficulties with these visual perceptual tasks will interfere with their participation in academic learning, school-related activities, and in daily living, and these unsuccessful live experiences may further hamper psychosocial development in these children (Di Blasi, Elia, Buono, Ramakers, & Di Nuovo, 2007).
Visual organization ability, one form of the visual-perceptual functions, is defined as the capacity to mentally synthesize and construct pieces of visual information for recognition or use (Schulthesis, Caplan, Ricker, & Woessner, 2000). The building blocks of visual synthesis are established during infancy, and the pattern recognition and organization undergoes development across childhood (Kirk, 1992). Older children could use a more holistic and synthetic strategy to organize fragments of visual information whereas younger children only focus on specific features for identification. Visual organization ability is well-developed and automatic in adults and a deficit in this capacity might indicate brain dysfunction (Kellman, Guttman, & Wickens, 2001). To date, visual organization ability specific to the children with DS has not been properly investigated and remains largely unknown.
Medical paradigms have undergone major changes during the past decades, and the concept of participation and function is becoming increasingly important in the field of childhood disability (King et al., 2007). The International Classification of Functioning, Disability and Health (ICF) model endorsed by the World Health Organization (WHO, 2001) defines participation as “involvement in life situations” resulting from the interaction of individuals with their social and physical environments. Participation in the everyday occupations of life is a vital part of human development and life experience through which children acquire skills and competencies, connect with others and find purpose and meaning in life (Law, 2002). Despite these shifts, there has been limited investigation into the activity performance and participation in children with DS, as measured by their body functions and their impacts on activity engagement.
Studies investigating the developmental profile and activity participation of DS often incorporate mixed-sex study groups (Leonard et al., 2002, van Duijn et al., 2010), resulting in inconclusive evidence about sex differences in areas vital to participation. Besides, few studies have measured specific skills appropriate to the wide range of abilities presented by children with DS or reported attainment levels for children of different age groups (Turner & Alborz, 2003). To guide professionals and parents with regard to reasonable expectations, it is crucial to investigate the functioning and participation of children with DS based on gender-, age-appropriate and socially acceptable activities.
On the basis of international health paradigms, the purposes of this study were as follows: (1) to investigate the developmental continuum on measures of body function (i.e., sensory processing and visual organization abilities) of children with DS; (2) to determine whether body functions and activity participation of DS differ based on age and sex; and (3) to examine the association between body function variables (sensory processing ability and visual organization ability) and participation in activities of DS.
Section snippets
Participants
Purposive sampling was employed to ensure that sensory processing and visual organization ability were represented from participants of differing age and gender of DS. The inclusion criteria were: (1) a diagnosis of DS determined by board-certified physicians; (2) between 6 and 13 years of age; (3) absence of cataracts or strabismus at the time of assessment; and (4), no serious emotional and/or behavioral problems. In an attempt to minimize confounding of data, participants who carried
Demographic data
Of the total study sample (n = 206), 58 children (28%) had no congenital anomalies, 72 (35%) had cardiac anomalies, 40 (19%) had noncardiac anomalies, and 36 (17%) had both cardiac and noncardiac anomalies.
Confirmation of sensory processing and visual organization abilities
Difference in sensory processing abilities of children with DS was manifested in SP sections with definite differences in both sensory processing (mean = 124.4, typical performance range: 256–325), modulation (mean = 72.2, typical performance range: 134–170), and probable difference in behavior and
Discussion
The present study characterized the sensory processing, visual organization abilities and activity participation of children with DS. This study also examined the relationships between body functions (sensory processing and visual organization abilities) and participation (in daily living and school scenarios) of children with DS.
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