2016 Gatlinburg Conference Poster
PS-3
Title: The Impact of Challenging Behavior on School Function in Children with Down Syndrome
Authors: Elizabeth Will, Deborah Fidler, Lisa Daunhauer
Introduction: Individuals with Down syndrome (DS) are at an increased risk for certain maladaptive and challenging behaviors
throughout the lifespan (Dykens, 2007; Feeley & Jones, 2006; Will & Hepburn, 2015). In particular, existing studies indicate
specific challenges in the areas of attention, noncompliance, and task avoidant behavior (Dykens, 2007; Feeley & Jones, 2006;
Fidler et al., 2005). This pattern of maladaptive behavior is likely to impact the educational experiences of school-aged children
with DS, perhaps leading to fewer learning opportunities relative to same-aged peers. However, to date there has been little
systematic examination of the presentation of maladaptive behavior in school-aged children with DS, and how this presentation
impacts success in the school setting. The purpose of this study was to characterize the profile of maladaptive behavior observed
in a sample of school-aged children with DS, and to describe the extent to which maladaptive behaviors are associated with areas
of school function.
Method: Participants were 24 students with DS, (mean nonverbal mental age (NVMA)=43.72 months; mean chronological age
(CA)=77.36 months). The Leiter-R (Roid & Miller, 1997) was administered as a measure of NVMA. Teachers completed the
Behavior Assessment System for Children, version 2 (BASC-2; Reynolds & Kamphaus, 2004) as a measure of teacher-reported
maladaptive behavior, and the School Function Assessment (SFA; Coster et al., 1998) as a measure of teacher-reported functional
performance in the school setting.
Results: Repeated measures multivariate analysis of variance (RM-MANOVA) was performed to assess the profile of maladaptive
subscales of the BASC-2, including Hyperactivity, Aggression, Anxiety, Depression, Somatization, Withdrawal, and Attention
Problems, in participants with DS. Three subscales emerged as the most problematic: Aggression, Somatization, and Attention
Problems. Significant negative associations between all three maladaptive subscales and SFA domains were found, indicating
that higher maladaptive behavior was associated with lower Task Completion and Compliance. Aggression, Somatization, and
Attention Problems were regressed on both Task Completion and Compliance in a multivariate multiple regression. Results
indicated that these domains collectively accounted for 76% of the variance in School Function outcomes, and Attention
Problems F(2, 17)=5.51; p<.05, and Aggression F(2,17)=4.29; p<.05, significantly predicted collective outcomes for Task
Completion and Compliance. Individual parameter estimates revealed that Attention Problems significantly predicted Task
Completion (b=-2.16; p=.004), but not Compliance; whereas Aggression significantly predicted compliance (b=-1.09; p=.008), but
not Task Completion. Somatization did not significantly predict either School Function outcome.
Discussion: Children with DS in this sample demonstrated a specific maladaptive behavior profile, with primary areas of difficulty
involving Aggression, Somatization, and Attention Problems. These areas were found to significantly predict Task Completion and
Compliance in the school setting. Considerations regarding teacher training around appropriate behavioral expectations for
students with DS relative to developmental status and the DS behavioral phenotype may provide critical support for students'
success in the school setting.
References/Citations:
• Dykens, E.M. (2007). Psychiatric and behavioral disorders in persons with Down syndrome. Mental Retardation and
Developmental Disabilities Research Reviews, 13, 272-278.
• Feeley, K.M., & Jones, E.A. (2006). Addressing challenging behavior in children with Down syndrome: The use of applied
behavior analysis for assessment and intervention. Down Syndrome Research and Practice, 11, 64-77.
• Fidler, D., Philofsky, A., Hepburn, S., & Roger, S.J. (2005). Nonverbal requesting and problem-solving by toddlers with
Down syndrome. American Journal on Mental Retardation, 110, 312-322.
• Will, E., & Hepburn, S. (2015). Chapter Six-Applied Behavior Analysis for Children with Neurogenetic Disorders.
International Review of Research in Developmental Disabilities, 49, 229-259