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Down Syndrome & Cognition

Understanding the Relevance and Significance of Cognitive Function

by Bob Doman

The key to understanding and improving global function in children and adults with Down syndrome is determining and developing their cognitive function.

Whether we are looking at a two-year-old or an adult with Down syndrome, their level of function, their ability to learn, think, and communicate is a reflection of their cognitive level. 

Cognition is the mental function that permits us to process information, to acquire knowledge, to understand, think, and communicate. Cognition is not reading, math, or specific knowledge per se; it involves the neurodevelopmental pieces that comprise auditory and visual short-term memory, working memory, and eventually executive function. 

Cognition, or intelligence, is partially a reflection of what we were born with, but primarily it is something that develops. Anything that develops can be developed, impacted, improved. Unfortunately addressing cognition, how we process and manipulate what we see and hear, is missing almost universally from all education. For children with developmental issues, this leads to inappropriate, untargeted* input, low and unrealistic expectations, and poor outcomes.

Case in point

I recently received a report from a school outlining their curriculum for a twelve-year-old child with Down syndrome. Her curriculum includes the following:

  • Science – forces and magnets
  • Geography – comparing Australia, Greenland, and Africa, including significant historical events
  • History – Stone age to Iron age
  • Reading – creating and writing sentences about what they did over the weekend
  • Math – shapes, positions, directions, statistics
  • Computing – the pros and cons for social media advertising
  • and a project to research, create, and launch a campaign to encourage others to be healthy.

Sounds wonderful—what a great opportunity for this child. This curriculum would be appropriate for perhaps a typical or gifted child, and even a few children with Down syndrome who have been given the opportunity to develop typical or better processing skills and who had a commensurate educational foundation. Unfortunately, the child in this classroom is functioning at the cognitive development level of a two-going-on-three-year-old. She is just putting two to three words together, learning to feed and dress herself, and developing the ability to process two to three step directions. She’s not twelve, she is two going on three. This is perhaps an extreme example, but it’s real! However, it would not be at all unusual for a twelve-year-old, but functional two to three, to be taught phonics and printing and other inappropriate things, based on their functional level. Would you think it appropriate to teach a typical two-year-old phonics and printing? How successful would you be, and how much of a waste of their time would it be? And what about all the things that would have been appropriate for them? The point is that when targeting the needs of children, it is their level of function, their cognitive level, their ability to process information and their complexity of thought that should determine what is appropriate and targeted.

Children develop when we provide them with what is targeted and appropriate for them. This targeted input is what develops their global function, helps build cognition, and leads to good outcomes. Where they are is more a reflection of their processing level than their chronological age. You don’t try to teach algebra to a child who can’t add.

Looking at a child with Down syndrome primarily through the lens of their chronological age does them a great disservice and results in inappropriate, ineffective education and therapies, and poor outcomes. Such historic failures have resulted in a poor perception of potential. The foundation of all development is neuroplasticity, and the first fundamental rule of neuroplasticity is to provide the child with input that is targeted to them.

We have been fortunate to have worked with many thousands of children and adults with Down syndrome, and in the case of many individuals, we have worked with them for decades. We have seen what is possible if we, along with the family, work with an understanding of the whole child and work diligently to build cognition. Without exception, those who develop processing abilities in the “normal” range can become the adults who have good jobs, drive, have good social relationships, and enjoy good lives. After these years and thousands of individuals with Down syndrome, we have never seen one reach these high global functional levels without having developed the commensurate level of cognition. 

Optimally we start working on processing and cognition virtually from birth; and the sooner we start the process, the more we begin funneling in the pieces that help produce global knowledge and functional intelligence. Years lost are gone. Can we start working on this function later? Absolutely. Addressing the foundational pieces of cognition, short-term memory, working memory, and executive function even starting with adults can produce dramatic change; but time lost is time lost in teaching that brain how to learn and think and filling that brain with the knowledge and experience that builds full lives.

Developmental and educational priority number one is developing the ability to learn and think—cognition/processing power. 

To learn more about processing power, watch our video below

Reprinted by permission of The NACD Foundation, Volume 37 No. 2 , 2024 ©NACD

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