New Parents | Ways to Give | Membership | Affiliation Links

Educational Resources



Birth to 3: Early Intervention

The first years of life are a critical time in a child’s development. All young children go through the most rapid and developmentally significant changes during this time. During these early years, they achieve the basic physical, cognitive, language, social and self-help skills that lay the foundation for future progress, and these abilities are attained according to predictable developmental patterns. Children with Down syndrome typically face delays in certain areas of development, so early intervention is highly recommended. It can begin anytime after birth, but the sooner it starts, the better.

This section provides details on the various kinds of early intervention available, and how to access services.

What is early intervention?

Early intervention is a systematic program of therapy, exercises and activities designed to address developmental delays that may be experienced by children with Down syndrome or other disabilities. These services are mandated by a federal law called the Individuals with Disabilities Education Act (IDEA). The law requires that states provide early intervention services for all children who qualify, with the goal of enhancing the development of infants and toddlers and helping families understand and meet the needs of their children. The most common early intervention services for babies with Down syndrome are physical therapy, speech and language therapy, and occupational therapy.

When should early intervention start?

Early Intervention should begin any time shortly after birth, and usually continue until the child reaches age three. An amendment to IDEA in 2004 allows States to have early intervention programs that may continue until the child enters, or is eligible to enter, kindergarten. The sooner early intervention begins, the better, however, it’s never too late to start.

How can early intervention benefit a baby?

Development is a continuous process that begins at conception and proceeds stage by stage in an orderly sequence. There are specific milestones in each of the four areas of development (gross and fine motor abilities, language skills, social development and self-help skills) that serve as prerequisites for the stages that follow. Most children are expected to achieve each milestone at a designated time, also referred to as a “key age,” which can be calculated in terms of weeks, months or years. Because of specific challenges associated with Down syndrome, babies will likely experience delays in certain areas of development. However, they will achieve each of the same milestones as other children, just on their own timetable. In monitoring the development of a child with Down syndrome, it is more useful to look at the sequence of milestones achieved, rather than the age at which the milestone is reached.

Each type of early intervention addresses specific aspects of a baby’s development.

Physical therapy focuses on motor development.

For example, during the first three to four months of life, an infant is expected to gain head control and the ability to pull to a sitting positions (with help) with no head lags and enough strength in the upper torso to maintain an erect posture. Appropriate physical therapy may assist a baby with Down syndrome, who may have low muscle tone, in achieving this milestone.

Before birth and in the first months of life, physical development remains the underlying foundation for all future progress. Babies learn through interaction with their environment. In order to do so, an infant must have the ability to move freely and purposefully. The ability to explore one’s surroundings, the ability to reach and grasp toys, to turn one’s head in order to follow a moving object with one’s eyes, the ability to roll over, to crawl in pursuit of a desired objective, all of these behaviors are dependent upon gross as well as fine motor development. These physical, interactive activities foster understanding and mastery of the environment, stimulating cognitive, language and social development.

Another long term benefit of physical therapy is that it helps prevent compensatory movement patterns that individuals with Down syndrome are prone to developing. This can lead to orthopedic and functional problems if not corrected.

Speech and language therapy is a critical component of early intervention.

Even though babies with Down syndrome may not say first words until 2 or 3 years of age, there are many pre-speech and pre-language skills that must be acquired first. These include the ability to imitate and echo sounds; turn taking skills (learned through games like “peek-a-boo”); visual skills (looking at the speaker and objects); auditory skills (listening to music and speech for lengthening periods of time, or listening to speech sounds); tactile skills (learning about touch, exploring objects in the mouth); oral motor skills (using the tongue, moving the lips); and cognitive skills (understanding object permanence, and cause and effect relationships).

A speech and language therapist can help with these and other skills, including breastfeeding. Because breastfeeding employs the same anatomical structures used for speech, it can help strengthen a baby’s jaw and facial muscles and lay the foundation for future communication skills.

Occupational therapy helps children develop and master skills for independence.

Occupational therapy can help with abilities such as opening and closing things, picking up and releasing toys of various sizes and shapes, stacking and building, manipulating knobs and buttons, experimenting with crayons etc. Therapists also help children learn to feed and dress themselves, and teach skills for playing and interacting with other children.

Early intervention can also prevent a child with Down syndrome from reaching a plateau at some point in development. Thus, the goal of early intervention programs is to enhance and accelerate development by building on a child’s strengths and by strengthening those areas that are weaker, in all areas of development.

How can parents benefit from early intervention programs?

Programs of early intervention have a great deal to offer to parents in terms of support, encouragement and information. The programs teach parents how to interact with their infant and toddler, how to meet their child’s specific needs and how to enhance development.

How do I sign up for early intervention services?

Each state has its own set of laws governing early intervention services. Parents can get a referral from the baby’s doctor, or find a local agency by visiting Once a referral has been made, the program staff must schedule and complete an initial evaluation within a specified time. Once the assessment is done, a caseworker is assigned to coordinate the various services for which the baby and family qualifies. Early intervention services are individualized to mete the specific needs of each individual baby. The caseworker, therapists and family will determine the areas of focus and set goals based on the developmental milestones. These will be recorded in a document called the Individualized Family Service Plan or IFSP.

Who pays for early intervention?

The evaluation to determine whether your child is eligible for early intervention is free of charge if performed by a state authorized entity. No child deemed eligible can be denied services based on ability to pay, but insurance companies may be billed and/or a sliding scale payment may be required, depending on what state you reside in. Check with your state’s early intervention center for information about authorized service providers and financial obligations. Frequently, there is little or no cost to parents for these services.

What happens after age 3?

IDEA, which regulates early intervention, also mandates that local school districts provide a free, appropriate, public education for preschool-age children with disabilities starting at the age of 3, unless that would be inconsistent with State law or practice, or the order of any court, respecting the provision of public education to children between the ages of 3 and 5.

back to top»


Schooling from Preschool to Age 21: A Child’s Right to a Free and Appropriate Education


Federal laws protect the rights of every child, including children with Down syndrome, to receive a free, appropriate public education.

Unfortunately, this has not always been the case. Until the late 1970s, students with disabilities were routinely placed in often inappropriate segregated educational settings, such as separate specialized schools or institutions. This still occurs but with less frequency. In 1970, schools in the United States served only one in five students with special needs.

The Education for All Handicapped Children Act was instituted in 1975 and later renamed the Individuals with Disabilities Education Act (IDEA). IDEA mandated that a “free and appropriate public education” be available to all school-age children with special needs, regardless of disability. An amendment added children three to five years of age.


A free and appropriate public education (FAPE) requires that students receive special education and related services that meet their unique needs and prepare them for independent living, employment or post-secondary education once their secondary education is complete.

Related services are transportation, and such developmental, corrective, and other supportive services (including speech-language pathology and audiology services, interpreting services, psychological services, physical and occupational therapy, recreation, including therapeutic recreation, social work services, school nurse services designed to enable a child with a disability to receive FAPE, counseling services, including rehabilitation counseling, orientation and mobility services, and medical services, except that such medical services shall be for diagnostic and evaluation purposes only) as may be required to assist a child with a disability to benefit from special education, and includes the early identification and assessment of disabling conditions in children.

IDEA mandates that an Individualized Education Program (IEP) be developed for each student by an IEP team, which includes the student’s parents. When developing the IEP, the team should consider the entire range of the student’s abilities and goals, including non-academic goals. The IEP contains a description of the special education services, related services and any other supports, modifications and accommodations that the student may need.

The FAPE and least restrictive environment (LRE) mandates are related. The LRE provision in IDEA states: “Each state must establish procedures to assure that, to the maximum extent appropriate, children with disabilities … are educated with children who are not disabled and that special education, separate schooling or other removal of children with disabilities from the regular educational environment occurs only when the nature or severity of the disability is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily” [20 U.S.C 1412(a)(5)(A)].

Through the LRE provision, Congress has expressed a strong preference in favor of general education classes. IDEA does not permit the IEP team to select another educational setting UNLESS the child cannot get an appropriate education in general education classes, even after all the supports and services that are on the IEP have been provided. Therefore, the starting point in any IEP discussion of where a student should be educated is the age-appropriate general education classroom in the school that the student would attend if not disabled (called the “neighborhood school”)

The LRE continuum has a hierarchy that starts with general education classes and progresses in order of the restrictiveness of the setting to special education classes, special day schools, special education residential schools and hospital settings. Restrictiveness is determined by the amount of time spent with non-disabled peers. The IEP team is supposed to consider each placement along LRE continuum until the appropriate educational setting for that particular child is identified. This process was designed by Congress to ensure that the child is educated to the maximum extent possible with non-disabled peers.

For a variety of reasons, some parents have concluded that a general education setting is inappropriate for their child needs. It is important for them to know that IDEA requires the IEP team to follow the LRE process described above. However, it will not prevent the child from being educated in special education classes if the IEP team agrees with their conclusion. In spite of the Congressional preference for the general education class, it is still much more difficult to get the IEP team to agree that the general education setting is appropriate, than it is to get your child in special education classes. Many IEP teams do not even follow the process required by IDEA. That is why it is necessary to provide so much information to parents about LRE and inclusion. Of course, parents always have the right to unilaterally place their child in a private school or to home-school their child. Both these choices fall outside the scope of the LRE process.


The FAPE and LRE provisions generally also apply to pre-school age children. LRE for preschool gets complicated by the fact that many districts do not have general education classes for that age group unless they have “universal preschool” for all children with and without disabilities. Some districts use their Head Start classes as general education preschool options for LRE, which creates another set of issues.

The law does not require public school to create general education preschools just to meet the LRE requirements. However, if an IEP team determines that placement in a private preschool program is necessary as a means of providing special education and related services to a child with a disability in the LRE, the program (and transportation as a related service) should be provided at no cost to the parent. This language is in the introduction to the IDEA regulations, but does not appear in the regulatory provisions or the statute. During the next reauthorization of IDEA (the next time it comes up for major amendments) it will be important to get this clearly stated in the law.

AGES 18-21

Not long ago the only options for 18-21 year old students with intellectual disabilities (some states provide IDEA services even longer) was to stay in high school in order to receive services under the Act. However, now there are many colleges and universities that provide postsecondary programs for students with intellectual disabilities. See .  In some cases, students are dual enrolled in both the high school and the college even though they receive their IDEA services on the college campus.  The introduction to the IDEA regulations states that IDEA funds can be used for transitional programs on college campuses if a student’s IEP team determines that his or her needs can best be met through participation in such a program and includes such services on the IEP.

back to top»


To better understand how students with Down syndrome learn, it would be helpful to examine six areas: attention, memory, concept attainment, mediational strategies, transfer of learning and motivation.


Attention is the ability of an individual to focus on a specific stimulus. Classic research in this area involves discrimination learning tasks (Zeaman and House, 1963; 1979). In this study, a learning problem was presented through a series of visual stimuli, and the subjects (mentally challenged and typical individuals) were asked to choose the correct stimuli using feedback from previous trials. When the data were plotted, the learning curves of mentally challenged individuals showed a large difference in learning style. Those with typical intelligence showed a smooth learning curve, indicating that they are incidental learners, who can select relevant information from a variety of stimuli, form hypotheses and logically choose a response. The subjects who were mentally challenged showed more of a box-like learning curve with a flat line in the beginning of the graph. This indicates that it took them a longer time to identify the correct or relevant information in the problem, and form a hypothesis relating the concepts. However, once they “got it,” they performed just as well as the typical learners.

With these results, Zearnan and House developed the two-stage theory of attention: stage one is the ability to attend to the task, while stage two is the ability to identify the relevant stimulus to the problem. They concluded that individuals who are mentally challenged enter the learning situation with a lower capacity to attend to the relevant (as opposed to distracting) stimuli than typical learners. The lower the mental age of the individual, the longer stage one is present. However, once they have mastered the attention stage and have identified the relevant stimulus, they can learn the task, and perform as well. Later attention theorists have pointed out the importance of training students to focus their attention and actively self-monitor its occurrence (Howell, Rueda and Rutherford, 1983; Kneeder and Hallahan, 1981). From these theories some practical methods can be applied to maximize attention for learning.

Suggestions for Classroom Practice

  1. Present stimuli or objects that have clear and obvious dimensions, and vary on as few dimensions as possible (e.g. color or size or texture). Otherwise, the student may be responding to a dimension other than what the teacher is expecting.
  2. Use attention-getting techniques such as prompts, cues or lighting. You can even make a secret signal with the student for fun.
  3. Placing work on a different background color or texture may enhance attention.
  4. Remove extraneous distracting stimuli such as pictures on walls, or too many problems on a page. Do not sit the students next to a window, door or high traffic area.
  5. Reward correct responses immediately, to ensure that students are associating the reward to what was correctly done.


Memory has been defined as “the ability to store and retrieve (upon demand) previously experienced sensations and perceptions, even when the stimulus that originally evoked them is no longer present” (Lerner, 1971). There are four basic components of memory: 1) processes, 2) knowledge, 3) strategies and 4) metamemory. The basic processes of memory are the actual hardware of the system, or organic structure, which develops by age two. Coincidentally, around two years of age, language abilities expand greatly, and some theorists believe that memory is a factor influencing this growth (Spitz, 1966). The second aspect of memory, knowledge, is made up of an individual’s past experiences. What one already knows influences what one learns and remembers, because we interpret what we see. For example, think of the different descriptions a police officer, doctor or teacher would give about a car accident. Their varied training and interests may give them each a different perspective about the same occurrence. The strategies component of memory are activities that people use to facilitate “memorizing,” or storage and retrieval of information in the brain. These range from the very simple and direct, such as rehearsal and repetition, to the complex and sophisticated, such as the development of acronyms. Metamemory is the supervisory or regulating mechanism that determines when to use which strategy. It organizes a person’s ability to memorize or remember.

Memory theorists for a long time have generally agreed that there are two types of memory, short-term and long-term (Ellis, 1963). Once a stimulus passes through the sensory register, it impacts on the short-term memory, which is heavily based on language. An individual’s short-term memory can handle between five and nine bits of information, which last from 30 seconds to a couple of minutes. From then on, the individual must act with the stimulus, either by performing a behavior or skill, or actively seeking to enter it into long-term memory, through the use of a memory strategy. These strategies can either be spontaneously applied, as in the case of an individual with a good memory, or can be improved by training to increase the repertoire of strategies, as in the case of individuals with poor memories. Long-term memory is based on meaningful impressions or relationships, that can last a lifetime. Individuals with Down syndrome typically have poor memory ability for three reasons: they are at a disadvantage for adequate short term memory due to language delays; they have a limited repertoire of memory strategies; and they tend to be “inactive” learners, when it comes to memory (Baumeister, 1981).

Suggestions for Classroom Practice

  1. Use labeling or verbal associations to make up for any language deficits related to memory and learning. Use smaller clusters of information and sequence ideas.
  2. Repeat and practice skills to promote learning.
  3. Select interesting and meaningful tasks which individuals will enjoy repeating.
  4. Teach the learner to use rehearsal strategies and practice them.
  5. Provide opportunities to practice skills in many contexts and use multisensory approaches, involving hands-on activities.
  6. Show patterns in things to be memorized and teach more sophisticated memory tricks.

Concept Attainment

Concepts are used to organize diverse stimuli in a meaningful order. A concept is an expression of a rule by which diversity is brought together and reduced for the efficiency of adaptation to the environment. The use or application of a concept means that relearning is bypassed.

According to Jean Piaget (1977), each child progresses through stages of development where various cognitive skills are acquired. These are: the sensorimotor stage (birth – 2 years), the preoperational stage (2 – 6 years), concrete operations, (7-11 years), and formal operations (12 years and older). In the sensorimotor stage, the infant experiences the environment through sensory experiences and motor activities, and learns to distinguish between him/herself and the world. The preoperational stage involves the use of language and intuitive thought to assimilate culture and concepts. Also, note that memory hardware is now in place, which helps to make sense of the world and how things are represented by language and symbols. A child remembers previous experiences and develops expectations. In the stage of concrete operations, logic develops and the child learns to organize his/her thoughts by ordering and classifying objects. The child must manipulate objects and needs hands-on activities to solve problems, and learn cause and effect relationships. The final stage, formal operations, involves abstract reasoning and the linkage of concepts. The individual is able to mentally manipulate symbols, rather than concrete manipulatives, and can hypothesize and predict events and consequences.

Individuals with Down syndrome take longer to learn, but show the same sequence of stages of concept attainment. However, their patterns develop at a slower rate, which necessitates attention to the mental age of Piaget’s stages, rather than chronological age as he originally discussed. Mental age has been explained as IQ = Mental Age/ Chronological Age × 100. For example, a 13 year old child with Down syndrome could be expected to need tokens, rods or other concrete items to help solve math problems, because he is still operating in the stage of concrete operations, even though his chronological age would fall in the formal operations stage.

Suggestions for Classroom Practice

  1. Children with Down syndrome learn best by active participation, rather than sitting and listening.
  2. Allow for manipulation of concrete materials to solve problems and maintain interest.
  3. As learning occurs in an ordered sequence, tasks should be presented step by step, making sure that the child has the pre-requisite concepts for the next step or level.
  4. Be guided by the individual’s mental age: his/her logic, interpretation of the problem and expression of an answer may be different than what is expected from chronological age.

Mediational Strategies and Paired Associates

Every individual varies on his/her ability to organize thought processes, store information and recall it as needed. As mentioned in the discussion on memory, individuals with Down syndrome have difficulty in this area, which is heavily based on language and ability to categorize. Research has documented that slower learners will approach learning and memorization activities in the same way or style as younger peers do, relating expectations for this ability to mental age instead of chronological age (Brown, 1974; Spitz, 1966). Presenting new material to be learned in groups or clustering material in an organized fashion helps to facilitate learning. Spontaneous, or good learners, do this automatically, while poor learners need more structure or help in this area.

The most common type of grouping arrangements are according to physical similarities (same color or shape), functional categories (food or clothing), concepts (object permanence) and sequence or equivalence (pattern arrangement or order). A mediator is some prompt or cue that connects or links a stimulus and response to be learned. Paired associate learning is the ability to link concepts, ideas or words, such as people or places. Repetition, rehearsal or drill is then used for memory. Serial learning of concepts is when you pair concept A to B (e.g. If you touch a stove, it is hot), then B to C (if you touch something hot, you get burned). The final conclusion is A to C (if you touch a stove, you get burned).

Sometimes when we teach slower learners, we need to introduce a mediator, (or concept B) to break down a concept that may be too abstract to grasp on its own. In this example, concept B, or the mediator, is the concept of “hot.” Other elaboration strategies include prepositional mediators (e.g. book “on the” table), interrogative mediators (“where is the” book? On the table.), and visual imagery (imagine a book on a table). Research has indicated that students who are educationally challenged have difficulty producing these mediational strategies to help them break down and combine concepts, but these can be developed and learned (Robinson and Robinson, 1976; Bray, 1979).

Suggestions for Classroom Practice

  1. Restructure or organize visual and/or auditory presentations to break down the relationships to basic concepts, such as size, shape, pattern or categories.
  2. Sequence activities from simple to complex with time lapses to facilitate responding from language or cognitive processing delays. Increasing response time allowed has been shown to improve learning abilities of slow learners (Judd and Bilsky, 1989).
  3. Verbalize and repeat the instructional links between concepts.
  4. Use meaningful and familiar, relevant materials.
  5. Repeat, rehearse and drill often.
  6. Employ and train mediational strategies.

Transfer of Learning

The learning abilities of individuals with Down syndrome can be improved through highly structured, meaningful activities that are analyzed and sequenced from simple to complex. However, transfer of learning, or generalization of the learned concepts to different situations, materials and environments is very difficult. Individuals with Down syndrome typically show deficiencies in the ability to apply old knowledge or skills to new tasks or places (Stephens, 1972). Such difficulties usually come from the inability to recognize similarities between problems and situations (Stevenson, 1972). For example, some students who have learned to add numbers in school, would not be able to compute simple addition in a shopping situation. These students would not associate the learning in the classroom to the store environment. Also, these individuals do not use previous experiences to help solve future problems (Robinson, and Robinson, 1976), which leads to the phenomena that teachers often report, that their students learn something one day but forget it the next.

Suggestions for Classroom Practice

  1. Use meaningful materials and experiences, to cut down on novelty which could confuse the learner.
  2. Teach concepts in a variety of different learning environments and with different people, pointing out similarities and differences between them.
  3. Use frequent review and repetition.
  4. Practice newly learned skills with different people, materials and environments.
  5. Use both verbal explanations and performance activities.


Students with Down syndrome often seem stubborn or “passive” and uninterested in learning, but this can be misleading! Even before schooling begins, children with Down syndrome have frequently experienced failure due to delays with developmental milestones such as walking and talking. They may have also experienced negative responses from other adults and children. Because slower learners have a history of lower performance levels, they sometimes devote their energy to avoiding another failure rather than striving for success. Slower learners also settle for smaller degrees of success than their potential or capabilities allow. Typical behaviors that can be expected of slower learners are: they learn to expect corrections or criticism and are not surprised; they react passively or impulsively by making stereotyped responses, such as select the first choice, or say “I don’t know;” they avoid situations prone for failure by asking to go to the bathroom, or by cutting class; and they sometimes accept a lower level of success, such as doing one problem correctly, without striving for a higher grade.

Zigler (1973) has documented that some slower learners have a dependency on external cues (called “outer directedness” or “external locus of control”) and work less independently. They also attribute success or failure to outside cues (it was too noisy, the question was bad, I was lucky), and not themselves or their ability. If they experience constant correction and criticism, they may give up and wait for someone else to answer the problem or perform the task, a situation called “learned helplessness.” Thus, individuals with Down syndrome will probably need much more encouragement and positive feedback than the average learner. They will also need an accepting environment in which they can feel free to make mistakes and attempt to become more independent. Self-monitoring of performance should be encouraged.

Suggestions for Classroom Practice

  1. Assign tasks that are appropriate to developmental level and are well explained.
  2. Create a success-oriented atmosphere.
  3. Use attractive, meaningful, familiar materials.
  4. Allow students to participate in developing the rules or the design of the lessons.
  5. Provide external cues and rewards, then gradually fade them so the rewards become internally based, and the student remains motivated.
  6. Discourage the students from constantly seeking help, and reward independence.
  7. Encourage social rewards and becoming buddies with peers.
  8. Use positive language like “try another way” or “think it through again,” rather than “you’re wrong.”


East Stroudsburg Acceptance

PSE Scholarships

back to top»

Website designed by Blu Echo Design