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Eastern Michigan University Eastern Michigan University [email protected] [email protected] Senior Honors Theses & Projects Honors College 2018 The impact of communication skills on the social interaction of The impact of communication skills on the social interaction of students with Down syndrome: Special education teachers' students with Down syndrome: Special education teachers' perspectives perspectives Tara Poikey Follow this and additional works at: https://commons.emich.edu/honors Part of the Special Education and Teaching Commons Recommended Citation Recommended Citation Poikey, Tara, "The impact of communication skills on the social interaction of students with Down syndrome: Special education teachers' perspectives" (2018). Senior Honors Theses & Projects. 581. https://commons.emich.edu/honors/581 This Open Access Senior Honors Thesis is brought to you for free and open access by the Honors College at [email protected] It has been accepted for inclusion in Senior Honors Theses & Projects by an authorized administrator of [email protected] For more information, please contact [email protected]  The impact of communication skills on the social interaction of students with The impact of communication skills on the social interaction of students with Down syndrome: Special education teachers' perspectives Down syndrome: Special education teachers' perspectives Abstract Abstract It is important for children to have effective socialization, no matter what type of disability they may have when it comes to communication. Friendship and play opportunities with others usually provide cognitive learning opportunities as well as social learning opportunities. For most children, school is a key setting for them to engage in friendships and develop social interactions. This study investigated eight special education teachers' perspectives on the communication needs of children with Down syndrome within the school context, as well as the teachers' knowledge and resources needed to facilitate their students' social interactions. The participants reported having little knowledge about specific speech and language skills needed to assist their students with Down syndrome to better communicate and interact with others. Even though most teachers felt they lacked specific training, some identified ways to facilitate communication in their classrooms. Among the teachers, those who reported more consistent collaboration with school speech-language pathologists (SLPs) felt better equipped to facilitate communication and social interactions with this population. Finally, the results of this study highlight the importance of interprofessional collaboration between special education teachers and SLPs to address the communication needs of students with Down syndrome. Degree Type Degree Type Open Access Senior Honors Thesis Department Department Special Education First Advisor First Advisor Ana Claudia Harten Second Advisor Second Advisor David Winters, Ph.D. Keywords Keywords Inerprofessional Collaboration, Interaction, Articulation, Down Syndrome, Training Subject Categories Subject Categories Special Education and Teaching This open access senior honors thesis is available at [email protected]: https://commons.emich.edu/honors/ 581  THE IMPACT OF COMMUNICATION SKILLS ON THE SOCIAL INTERACTION OF STUDENTS WITH DOWN SYNDROME: SPECIAL EDUCATION TEACHERS' PERSPECTIVES By Tara Poikey A Senior Thesis Submitted to the Eastern Michigan University Honors College in Partial Fulfillment of the Requirements for Graduation with Honors in Special Education: Speech-Language Pathology Approved at Ypsilanti, Michigan, on this date _ __....lf' � 1"""� � ---dl-t) ........ ;;.&..v .... 8� S 1 Honors Advisor (Print Name and have signed)  The Impact of Communication Skills on the Social Interaction of Students with Down Syndrome: Special Education Teachers' Perspectives By Tara Poikey Abstract It is important for children to have effective socializ.ation, no matter what type of disability they may have when it comes to communication. Friendship and play opportunities with others usually provide cognitive learning opportunities as well as social learning opportunities. For most children, school is a key setting for them to engage in friendships and develop social interactions. This study investigated eight special education teachers' perspectives on the communication needs of children with Down syndrome within the school context, as well as the teachers' knowledge and resources needed to facilitate their students' social interactions. The participants reported having little knowledge about specific speech and language skills needed to assist their students with Down syndrome to better communicate and interact with others. Even though most teachers felt they lacked specific training, some identified ways to facilitate communication in their classrooms. Among the teachers, those who reported more consistent collaboration with school speech-language pathologists (SLPs) felt better equipped to facilitate communication and social interactions with this population. Finally, the results of this study highlight the importance of interprofessional collaboration between special education teachers and SLPs to address the communication needs of students with Down syndrome. Introduction Background and Problem Statement 1  Down syndrome (DS) is a genetic disorder associated with the presence of an extra copy of chromosome 21, resulting in intellectual disabilities and language development delays (Zampini, Fasolo, Spinelli, Zanchi, Suttora, & Salemi, 2015). Because of this extra genetic material, individuals with OS face numerous physical abnormalities and cognitive problems, all of which may affect their speech and communication skills. For individuals who have this condition, school is a primary place to participate in interactions with others and receive services. Among the different professionals in the school setting who work with students with Down syndrome, special education teachers and speech-language pathologists (SLPs) are of particular interest, as they can both potentially foster communication skills and social interactions among students with Down syndrome. While SLPs provide therapeutic services to students with Down syndrome, many times in a pull-out context, special education teachers are the ones working directly with these students throughout the day, especially for those in self­ contained classrooms. Children with Down syndrome are at a disadvantage in establishing relationships because of their cognitive and communicative difficulties, often missing out on early opportunities to engage in social interactions with peers. Special education teachers have a vested responsibility to their students to better them in all areas of education, including participation in social interactions; However, many times teachers have to deal with aspects of a disability that are not necessarily part of their area of expertise; for instance, some of the physical conditions associated with Down syndrome that affect communication skills. The present study intended to explore special education teachers' 2  perspectives on the communication needs of students with Down syndrome and how they foster interaction and communication within the school setting. Purpose of the Study Having grown up around an individual with Down syndrome, the researcher has observed numerous aspects of communication that are affected by the extra genetic material. Although special educations teachers have to deal with and witness the daily communication struggles of students with Down syndrome, little is known about how they address the specific communication needs of their students. The purpose of the study was to investigate the perspectives of special education teachers as they relate to the communication needs of students with Down syndrome, as well as factors of their practice that can help better facilitate social interactions among students with Down syndrome. Research Question This study aimed to address 3 main research questions: 1. How speech and communication difficulties hinder social interactions in individuals with Down syndrome in the school setting? 2. How do special education teachers deal with the physical aspects of the DS that affect, among other things, students' articulation and communication skills? 3. What kind of interprofessional practice do special education teachers and SLPs participate to facilitate students with DS social interactions? Justification and Significance In most schools, special education teachers are the professionals who work directly with students with OS and observe closely their communication needs and struggles as they interact with classmates throughout the day. Understanding how these 3  professionals deal with these students' communication needs is important to delineate practices that foster students' social interactions. Review of the Literature The impact of Hearing Loss on Communication Skills in Individuals with Down Syndrome Those who are born with Down syndrome are at a higher risk for ear infections, which can result in hearing loss and need for hearing aids. To assess the impact of hearing loss on language skills among individuals with Down syndrome, Laws and Hall (2014) conducted a study comparing early hearing loss and language abilities in children between the ages of two and four, with and without the genetic abnormality. The participants in the study were given language assessments to test for receptive vocabulary, language abilities, mean length of utterance, and articulation. Participants with Down syndrome scored much lower than those without in speech accuracy and language tests. As for receptive language and the results, the researchers concluded that the children with Down syndrome were seven months behind the typically developing children. These children were also three years behind in the vocabulary category. The researchers pointed out that the lower performance among those with Down syndrome could be a direct consequence of their hearing loss. The researchers also emphasized that the young age of the participants was a critical period for language development, and that they would most likely have additional language issues in the future because of this. Articulatory Space in Individuals with Down Syndrome and How It Affects Language and Communication 4  Other physical attributes associated with Down syndrome are having a smaller articulatory space, larger tongue, and a higher arched hard palate. Such physical attributes have been associated with significant articulation difficulties among individuals with Down syndrome (Bunton & Leddy, 2011; Blagalakshmi, Renukarya, & Ranjangam, 2007). For instance, Bunton and Leddy (2011), measured and compared the acoustic vowel area in two adults with Down syndrome and two typically developed adults, and linked their speech intelligibility to measures of articulation. The researchers used pellets to track movement on various places of the mouth when speaking, including tongue, lips, and jaw. In addition, they also recorded sound pressure for analysis. They found that the articulatory space in individuals with Down syndrome was smaller in area than in those with a typical space, some up to 30%. They also found that the subjects with Down syndrome spoke slower and had longer vowel durations. In a study by Blagalakshmi, Renukarya, & Ranjangam (2007), the palate-lingual contact of individuals with Down syndrome was compared to those of typically developing children. For that, the researchers took the impressions of the mouths of 88 children with Down syndrome and 48 typically developing children and compared for palatal arch length, average antero posterior length, volume, and palatal index. The researchers found that the palate-lingual contact in individuals with Down syndrome was weaker than those in typical children. They also found that in those with Down syndrome, the hard palate is higher arched and more narrow. These differences have a significant impact on the communication in individuals with Down syndrome, as they physically cannot make certain articulations or if they can, they are much weaker and less intelligible than those who do not have the genetic disorder. Moreover, the researchers 5  pointed out that those with Down syndrome are more likely to have their language affected by their articulatory space because of a smaller workspace, larger tongue, higher arched and a more narrow hard palate. Cognition and Socialization in Individuals with Down Syndrome Cognitive and communicative difficulties associated with Down syndrome can have a significant impact on an individual's social and emotional wellbeing. Children's relationships with others of their own age play an important role in the child's development. Early opportunities to engage in communication with others lay the foundations for learning to communicate in more complex ways, to co-operate with others, to play together, and to make friends. Unfortunately, children with Down syndrome are at a disadvantage in establishing relationships with other chi1dren because of their cognitive and communicative difficulties. Studies of children with Down syndrome across the age range from preschool to teenage years have highlighted the fact that these children usually have less play contact with friends than their typically developing counterparts (Buckley & Sacks, 2002; Cuckle & Wilson, 2002). The cognitive aspect in those with Down syndrome affects their day-to-day life, more importantly, their language. A study was conducted by Zambini, et al. (2015) to test the prosodic skills in those with Down syndrome and compare them to typically developing children. The researchers set up a 20-minute play session with the child and their mother and structured it in a way so most of them would be presented at the same time with new toys and during this play session only spontaneous utterances were analyzed. When the session was completed, the researchers split the utterances into categories: word combinations, simple sentences, non-finite complex sentences and finite 6  complex sentences, and then further broke them up even more to show pragmatic function: declarative utterances, imperative utterances and interrogative utterances. Prosody was then analyzed using the fundamental frequency, highest and lowest pitches, and number of movements. Their final results showed that typical children produced a total of718 multi-word utterances and children with Down syndrome only produced 388. The researchers highlighted that the production of single word combinations were high in those with Down syndrome; however, these children produced no finite complex sentences. In both groups, the single intonation utterances were very similar reflecting that both groups were able to show some aspects of prosody. The results also showed that those single intonation utterances produced by participants with Down syndrome had a lower fundamental frequency. A more noteworthy issue observed was that those with Down syndrome were less able to produce interrogative utterances because of the rising edge of the phrase. Being that individuals with Down syndrome are already at a disadvantage when communicating with others, the friendships they make are extremely important. A study conducted by Watt, Johnson, &Virji-Babul (2010) identified that children with Down syndrome are more likely to name an adult as a friend, rather than a child or someone their own age, which probably reflects the dynamic they are used to, given their more frequent interactions with caregivers and adults. The researchers used a two-step research process where children with Down syndrome were shown pictures, and first had to decide which one best showed friendship and then had to answer whether or not what was being portrayed was acceptable to do in a friendship. The pictures involved both adults and children as potential participants in different activities. These findings are very valuable 7  as they indicate that communication in the school setting should be improved so that students can make friends around their same age rather than looking at a parent or authority figure as a friend. In addition, individuals with Down syndrome may have problems with apraxia of speech, voice quality, and dysarthria (Martin, Klusek, Estigarribia & Roberts, 2009). Each of these may affect communication in individuals with Down syndrome. Methodology Study Design This study adopted a qualitative research approach. Data was collected via semi­ structured face-to-face interviews consisting of open-ended questions paired with follow­ up inquiries to expand on and clarify participant response. The interviews were audio­ recorded with the permission of each participant, then transcribed to allow for analysis and interpretation. Participants Eight special education teachers volunteered to participate, all of which worked in schools located in Michigan in self-contained classrooms. The participants were recruited through email and signed informed consent forms before being interviewed. Two teachers taught in schools where the population of students was both general education and special education (P7 and PS); however, the other six worked in center-based programs where the entire school consisted of special education students (PI, P2, P3, P4, P5, and P6). One special education teacher provided services to students who were nonverbal (P3). Three of the teachers taught students ages 18-26 (Pl, P2, and P4), two teachers taught younger children ages three to five (P3 and P5), one teacher taught 8  students ages 13-26 (P6) and one teacher taught high school age students, 14-18 (P7). In each classroom, there were students with a variety of disabilities, and all of which had at least one student with Down syndrome. Data Analysis and Results The interviews were transcribed and analyzed with respect to common themes and perspectives. Participant responses were cross-referenced to assist with the identification of common themes. Analysis of interviews revealed eight main themes, which are discussed in the following sections. Theme 1: Training Six special education teachers mentioned specific topics that they felt they are not adequately trained. The topics consisted of: articulation, anatomy, and discipline. Articulation is one of the main aspects the participants felt they were lacking in training. In individuals with Down syndrome, articulation is a physical piece of the genetic disorder that can directly affect communication with others. One teacher stated, "/ do not know enough about speech to help him reach his fall potentiaf' (Pl), and another said, "/ don 'tfee/ super confident in any articulation stuff' (P3).0ne participant said, "/ guess in that way I felt I wasn't really prepared for school it was more through experience and learning from my speech therapist ways to help them" (PS). Lastly, it was stated, "I would love to know more about how to demonstrate to them and what exercises to use to facilitate and strengthen those muscles you use in speech" (P8). Although some teachers stated they did not know enough about the articulation aspects to aid their students' speech, some refuted with statements such as, "In this population, the severe population, [we] aren't picky about articulation at all, we are just 9  looking for any communication or communicative intent" (P3) and, "I work with high school age and a lot of times when they get to that age, there is not a whole lot of change in articulation so we didn't stress that a ton" (P7). Participants identified during the interview different physical attributes among children with Down syndrome that can have an impact on their communication skills. For instance, one participant stated, "[What] stands out to me in children with Down syndrome is their larger tongues" (P3), and "You see a lot of tongue thrusting forward" (P3). It is important to note that participants also pointed out lack of training in key areas related to communication. For instance, one participant made a point about lack of training when it came to medical conditions and how those conditions can affect articulation. This participant said, "Most of my students with Down syndrome have the same medical concerns or physical restrictions and if I had learned about them earlier I would have picked up by now strategies to help them physically and with speech, as well" (PS). Individuals with Down syndrome have many more characteristics than just having an enlarged tongue. Being trained in all aspects of the syndrome are equally important to provide the best of care for those students affected by the condition and promote social interaction. The topic of discipline was brought up numerous times during the interviews. Three teachers stated that training in this area would be beneficial, as exemplified in the following quote: "[He is] physically aggressive, he does not want to do his work ... so I think just {learning] a better way to communicate [with their student] all together" (Pl). When it came to what they do for discipline, a special education teacher stated, "You have to trick them into the illusion of control. You have to give them just enough control 10  so that they feel they are making decisions for themselves, and this participant also claimed, "You need to get more creative [with consequences], like restricting access to things they really like, because your typical kid with Down syndrome is perfectly happy to sit away from the group in a chair by themselves" (P3). Another participant stated, "/ do a lot of discipline nonverbal and I act like I don't care, and when they see they are not getting a reaction out of you, they change their tone" (P7). Theme 2: Behavior Behavior in individuals with Down syndrome was a common theme and the participants spoke about difficult behaviors among their students. An example is "stubbornness", which could hinder their students' communication, in addition to affecting how they provide services to their students. Five out of the eight participants stated in their interview that they have had a student with Down syndrome who was stubborn, using a stereotypic terminology, which matches to stereotypes commonly known in the society, as exemplified in these quotes, "Oh man, kids with Down syndrome are super stubborn" (P3), and "/don't know if il's true for all of them but it's true for those I've worked with, and they are very stubborn and will do things on their own time " (P7). Two participants spoke about how stereotyping students with Down syndrome can affect the type of service delivery they are providing to their students. During the interview, a participant stated, "Well I think that people usually with students with Down syndrome they kind of have this mentality that every kid with Down syndrome is really happy all the time and likes to go hug everybody and socialize. It's a stereotype that comes with the syndrome and it is not true" (P5). This particular teacher also mentioned, 11  "With Down syndrome, there's a lot of stereotypes that come with the syndrome that people kind of assume that every student with Down syndrome is going to be really friendly or really stubborn, but Jhey are just all really differenl" (P5). Theme 3: Service Provision During the interview a question was asked about what sounds that the participants believe their students with Down syndrome have trouble saying. In answering, five participants commented on how difficult they thought this question was, or they simply could not fonnulate an answer. One said, "/ have no idea, I would say most of their speech is vowel sounds and a lot of times they have trouble making consonant sounds" (PS). This participant also stated, "They usually have trouble saying multiple syllable words" (P5). One teacher believes her students have trouble "With the blending of sounds" (PS). Specifically, on the topic of service provision, the participants were asked about how often and how long their students with Down syndrome see the school speech­ language pathologist and if they believe this time is sufficient enough to help their students' speech and communication problems. Two of the three participants who reported having older students in their classrooms, ages 18-26 years-old, thought that once a week for half an hour was enough, stating "Because they are adults now, yes I think its sufficient enough" (P2), and "/ think at this point with their age, I think it's enough, and they can also go see her {the SLP] at any time" (P4). However, one of the other special education teachers who serviced older students stated, "The speech teacher that we had this last year only did whole group lessons, so even if kids didn 't gel speech she would still come into the class and teach a lesson to the entire class" (P7). Because 12