Archives: Lessons

Pregnancy screening tests do not exclusively look for Down syndrome, and they usually include a number of other conditions. Some conditions commonly included in the prenatal screening panel include:

• Trisomy 18
• Trisomy 13
• Trisomy 16
• Trisomy 22
• Triploidy
• Sex chromosome aneuploidy, such as Turner syndrome and Klinefelter’s syndrome (47, XXY)
• Certain disorders caused by a chromosomal deletion (microdeletion syndrome), such as Prader-Willi syndrome and Jacobsen syndrome
• Certain single-gene disorders associated with abnormalities of the skeleton or bones, such as sickle cell disease and cystic fibrosis

Therefore, we will give a basic overview of a few conditions commonly included in the non-invasive prenatal screening panel and also address some outdated information related to those conditions to emphasize the importance of staying up-to-date about all conditions.

Keep in mind that the American College of Medical Genetics and Genomics does not recommend NIPS to screen for autosomal aneuploidies other than those involving chromosomes 13, 18, and 21, and ACMG advises clinicians to inform patients that there are increased chances for false-positive results for the other conditions caused by sex chromosome aneuploidies and copy number variants (CNVs).

References

Gregg AR, Gross SJ, Best RG, et al. ACMG statement on noninvasive prenatal screening for fetal aneuploidy. Genet Med. 2013;15(5):395–398

Next, we will explore how improved social support and services have impacted different areas of life for people with Down syndrome. While we are looking at Down syndrome specifically, many of these principles can also be applied to other genetic conditions as well.

To prevent center-initiated external transition, there must be support from all decision-makers. For example,

• Teachers
• Directors
• Parents
• The community
• State-government and beyond.

Preventing center-initiated transitions requires a comprehensive approach and an inclusive philosophy.  Developing and implementing state and program level policies are important first steps. Increasing the quality of child care programs is vital.  

In rare situations, center-initiated external transition may be the best option for a child with challenging behaviors. In these cases, supporting families will reduce the negative impacts of the transition. A well-designed transition plan may assist the family through the process. A transition plan should clearly outline the steps each person will take to support the child and family during the change.

Creating a plan and working with families through the transition may better support the child’s needs. In addition, a well-developed plan:

• Promotes awareness of important social, emotional, and behavioral skills
• Increases the likelihood families will connect with the support they need
• May reduce the need for future center-initiated transitions
  
  

ECE professionals understand that children use behavior to communicate. There are prevention and intervention approaches that can be used in the classroom. These approaches help children work through the cause of challenging behaviors.

Taking steps to identify the cause for a child’s challenging behavior helps professionals better understand the reasons behind the behavior. It also helps the caregiver(s) and child successfully work through the challenging behavior.

Successful approaches may include:

• policy development
• quality programs
• professional development
• and positive social/emotional and behavioral supports.

Choosing a comprehensive approach may eliminate center-initiated external transitions and the associated long-term impacts.

Developing and maintaining high-quality ECE programs requires:

• Creating and maintaining healthy and safe spaces,
• Implementing quality programs and practices that address children’s cognitive, learning, social/emotional, developmental, and behavioral skill development needs. 
• Utilizing Professional Development and Training to create and develop a skilled staff of teachers.  

Early care and education professionals must be well trained in all aspects of a program’s policies, philosophies and practices and must have a solid understanding of child development and early learning.  Early care and education professionals must be equipped with the dispositions and skills necessary for:

1. Understanding all aspects of healthy and safe quality programs.
2. Valuing continuous improvement efforts through self-assessment of environments and practices.
3. Managing challenging behaviors in children using developmentally appropriate practices.
4. Promoting children’s social-emotional development and forming nurturing relationships.
5. Identifying children in need of additional support and working cooperatively with external resources such as child protective services (DCBS), mental health providers, early intervention specialists and other supports a child may require.
6. Having a strong understanding of culture, diversity, implicit bias, ACES, protective factors, and trauma-informed care.
7. Understanding and utilizing center policies and programs implementing positive social/emotional and behavioral supports.

Creating and using individualized behavior plans in all classrooms can help parents work with children on behaviors at home. Using the same practices to work through challenging behaviors at both home and school has additional benefits for the child because they will know what is expected.  Creating a successful plan for preventing challenging behaviors requires a program-wide commitment by administrators and staff and will be more successful with family input and support. Using a comprehensive approach to prevention planning will reduce, if not eliminate, the need for center-initiated external transitions. If, after implementing these supports, a center finds that a child cannot be served in the child care setting, families will have information, resources and supports to help during the transition.

To be successful at intervention, ECE programs will want to develop and implement evidence-based policies that promote quality in all aspects of their programs. Comprehensive, evidence-based policies on quality may reduce or eliminate external transitions. Successful policies are developed, implemented, and reviewed on a regular basis.

ECE programs will want to train teachers on program policies and help them understand why they are important. Impactful training for ECE professionals will focus on the benefits of following program policy, including improved continuity in philosophy and practices and greater consistency in environments, educational experiences, routines, behavioral expectations, and more.

ECE Teachers can support children by learning policies and working with other teachers to promote continuity in their program. Communication amongst directors and teachers regarding policy strengths and gaps is also important.

Research by Gilliam & Shabar (2006) found that common challenging behaviors in the ECE setting such as biting, tantrums, non-compliance, and physical aggression are not likely to decrease over time without intervention and teaching of appropriate behaviors.  This means challenging behaviors are best addressed in ECE settings prior to moving on to elementary school. Addressing behaviors early may reduce risk of suspension and expulsion in higher grades.

ECE programs should have policies for addressing behavior by:

• Using developmentally appropriate strategies.
• Working with community-based supports outside the child care setting.
• Setting goals to prevent external transition when possible and viewing it as a last resort.

There are times when center-initiated transition may be the best option, for example:

• There is a serious safety concern that cannot be reduced or eliminated with reasonable changes in practice or approach (“Spotlighting Progress in Policy and Supports,” 2016).
• It is in the best interest of the child.
• The program lacks necessary resources to address the behavior.
• There are serious issues contributing to the behavior that are beyond the program’s control, and the family is unwilling to partner with the program to address the issues.