Wouldn’t change a thing.........

What visual problems can people with DS have?

They are more prone to refractive errors (long-sight, short-sight, astigmatism); squint; accommodation (near-focusing) difficulties; difficulty seeing fine detail even when wearing corrective glasses, and difficulty seeing contrast. Refer to the download: Vision in Children with Down’s Syndrome

What special eye checks are needed?

In addition to standard assessments for refractive errors and squint, both Dr Maggie Woodhouse from Cardiff University, and the Down’s Syndrome Medical Interest Group recommend that dynamic retinoscopy is used to assess near-focusing (accommodation) at every eye assessment in a child or adult with DS.

I’ve heard about children with DS benefitting from bifocals, why is this?

Over 70% of children with DS have near-focusing difficulties, whether or not they have other visual problems. In trials at Cardiff University, these children have been found to benefit from bifocals.

Are these standard bifocals?

The top of the bifocal should lie across the centre of the pupil, which is higher than usual.

When should bifocals be prescribed?

Once any refractive error has been corrected, and at any age after the child has begun to engage in near tasks (ie looking down).

When should the bifocals be worn?

In school and/or during near activities. Once the child is used to them, they may choose to wear them full time.

Will my child always need bifocals if he needs them now?

Not necessarily; there is evidence that wearing bifocals for a year or two may train the eyes to focus better in close-up work (in 40%).

What is the difference between an Optometrist, an Optician, an Orthoptist and an Ophthalmologist?

  • Optometrists used to be called Ophthalmic opticians, so are still sometimes known as opticians. They are qualified to carry out eye examinations, advise on eye care and recognise eye problems. They prescribe and fit glasses, contact lenses and low vision appliances (such as magnifying aids). They work in private practices in high streets, hospital eye departments or health centres/community clinics.
  • Opticians (sometimes called dispensing opticians) are qualified to fit and adjust glasses. Some are also qualified to fit contact lenses. They also give out low vision appliances from a prescription supplied by an ophthalmologist or optometrist. They work in high street premises or hospital eye departments.
  • Orthoptists are trained in binocular vision problems (squints etc) and particularly in the development if vision in children. They usually work in hospital eye departments. Ophthalmologists are medical professionals specialising in eye problems, usually hospital-based.

What does a Behavioural Optometrist do?

A behavioural optometrist is a qualified optometrist who has chosen to specialise in this field. He/she will offer vision assessments beyond a conventional eye examination, looking at aspects of coordination, visual perception and so on. If deficits are found, he/she will offer therapy sessions. It is important to be aware that behavioural optometry is not available through the NHS, so there will be fees. The therapies are not considered to be evidence-based, so think of behavioural optometry as akin to complementary or alternative therapies.

My child is under a local hospital Eye Unit but they don’t routinely perform assessment of near-focusing. What do I do now?

There are High Street Optometrists able to provide services for those with learning disabilities.

Many are happy to see children, and to provide near-focusing testing through dynamic retinoscopy, and to provide bifocals. A list of those in the Sutton & Merton, and wider South East, area, who have agreed to appear on this website, can be found here. Alternatively, the Vision Research Unit at Cardiff University can arrange an appointment and free NHS assessment

What advantages do hospital eye units have over High Street Optometrists?

Staff at hospital clinics usually have a great deal of experience with young children, and, of course, offer treatment for eye conditions such as conjunctivitis, blepharitis or surgery for squint. Unless a child is being actively treated for an eye condition, there is nothing to be gained by older children staying with a hospital eye unit. Many hospital clinics will discharge children at around 7 years anyway. High Street Optometrists will refer back to the hospital if they detect an eye condition. Of course parents may wish to stay with both, which is fine. 

What happens if my child is very young, has speech difficulties, can’t read, or is unco-operative? 

A skilled optometrist specialising in learning disability should be able to measure how well someone can see whatever their age and ability.

What sort of frames would suit a child with DS? 

Most importantly, an optometrist / optician should spend the time to ensure glasses fit properly, as slipping can be a problem in those with DS, due to some differences in facial features. Curl sides and straps should generally be avoided, except in babies.

My child is reluctant to wear her glasses, what can I do? 

Refer to the download: Encouraging your child to wear glasses

What special measures need to be put in place in the classroom for any child with DS? 

Visual material must be made as clear as possible, and the teacher should acknowledge that, even then, a child may have difficulty with fine detail. Writing lines should be readily visible and pencil should not be used. Ideally, children should be registered with the LA’s Visual Impairment Support Service who can provide advice at home and at school.

How often should a person with DS have an eye assessment? 

Very young children may need to be seen quite frequently (6 monthly, depending on the findings). Older children who wear glasses should be seen annually. Older children and adults who have no eye defects may be seen every two years. These guidelines can vary quite a lot for individual children, especially if they are undergoing treatment, so take the advice of the optometrist / orthoptists. If your child wears glasses, call into the optometrist /optician regularly to check the fit and have adjustments

Maths Factor

Maths Factor is strongly recommended by a parent member as a fun and effective way in which to motivate a pupil with

Down’s syndrome to enjoy maths, make real progress from Reception to the present level and want to do a little every day.

The Maths Factor was created in 2010 by Carol Vorderman to encourage enjoyment of maths by ensuring progress, fun and achievement. Check out the Tower of Achievements on their website.

Working with pupils with Down’s syndrome

Summarised from a training by Leela Baksi of Symbol UK

Specific training is needed to support a child with Down’s syndrome in mainstream or Special schools.

Training should include:

1 The learning profile and speech, language and communication profile associated with DS.

2 Inclusion issues

3 Effective deployment of additional support

4 Differentiation and curriculum mapping including P levels.

5 Behaviour management.

6 Speech language and communication skills.

7 Teaching reading using whole word recognition as well as phonic approaches.

8 Number skills development.

9 The research base that supports recommended approaches.

Mainstream schools

Pupils friendships with non-disabled peers need more support.

Children in mainstream schools with DS need more opportunities to socialise with a peer group of children with similar levels of intellectual disability.  This can be achieved by including more children with LD in mainstream schools and/or giving children opportunities to attend activities for children with additional needs outside school.

Children educated in mainstream schools develop better language and academic skills (de Graaf)

No difference in outcome for self help skills

No difference for social networks, behaviour and social competence.

Key factors for good practice

1 involvement of a specialist teacher

2 Good assessment

3 Work tailored to challenge pupils sufficiently

4 School leaders commitment to ensure good progress for all

Benefits of inclusion

1 Age appropriate models of language and behaviour

2 High expectations

3 Social integration into local community

4 better and more natural support for pupils with additional needs

People with DS have jobs, get married and some have children.  Some drive, some are actors, artists and photographers, assistant teachers, a supermodel, business entrepreneurs and local councillors.

What physical structures and aspects of development are likely to be affected by DS

1 Sensory integration dysfunction: many young children with DS have difficulty tolerating loud noise, getting haircuts, having teeth brushed, handling mixed textures in their food.

2 Medical conditions: heart defects, intestinal tract, thyroid functioning

3  Sensory impairment: vision, hearing

4 Motor impairments: disruptions to the accuracy, coordination, strength and consistency of movement

5 Sensory processing difficulties: sensory avoidance and sensory seeking

6 Anatomical differences: smaller stature, smaller oral cavity, short stubby fingers, difference in the emergence of teeth

Sensory processing

Often exhibit difficulties in taking in, integrating and making use of sensory information.

Impacts on: behaviour that is otherwise puzzling, emotion- unable to settle down, arousal level- lacking get up and go/a bit hyper, performing skilled activities.

If a child has DS/autism may be more likely to have severe sensory difficulties.

A good sensory diet has just the right amount of input to maintain a functional level of arousal.

1 Routines

2 Environmental accommodations and supports

3 Sensory snacks to meet sensory seeking needs

4 supported leisure activities tailored to sensory preferences

Learning style

Strong social motivation

Defects in attention/executive functioning

Stronger visual processing and weakness with auditory processing

Learning through doing

Learning through getting it right NOT trial and error

Learning through visual and kinaesthetic channels

Tailored to individual ability to focus and maintain focus

Learning in a different way


Targeting new learning in the zone of proximal development (Vygotsky).  The next step s/he is able to achieve with support. Task is not too easy and not too hard, broken down in smaller steps, more structured opportunities for practice.


Motivated by extrinsic factors not task mastery: motivating materials, preferred activities, rewarding routines/praise.

Rather than achieved/not achieved assess level of support needed and consistency of performance.

1 never/does not attempt

2 occasionally/with great difficulty

3 inconsistent/with some difficulty

4 most times/with effort

5 always with ease

Specific speech language and communication needs

Not just a pattern of typical development more slowly.  Impairments are not just secondary to LD and hearing impairments.

What is difficult?

1 Understanding language

2 Producing/using speech

3 Putting words together in sentences

Typically language expression lags behind language comprehension and non verbal cognition.  Robust approaches are needed to address phonology and syntax.


Use shorter length of sentences

Omit grammatical words more frequently

Have difficulties learning the sound structure of words

Difficulties producing intelligible speech

Limited capacity for remembering and repeating back things they have just heard, hence the need for signing, language through reading, auditory memory training, phonological awareness training.  Early hearing loss (through glue ear)has significant impact on speech and language.


Concerns about behaviour can fade away when the pupil feels he belongs and is valued and is engaged in activities that are relevant and meaningful to him.

1 Security: routines

2 Demands: just the right challenge

3 Motivation: extrinsic rewards

4 Communication challenges

5 Use functional behaviour analysis and behaviour management plans.

A behaviour management plan seeks to replace the undesirable behaviour with a positive behaviour.

Undesirable behaviours are about the individual making sure his/her needs are met.

Step 1

Define a specific problem from a general problem

Step 2

Carry out functional behaviour analysis

A: Antecedents

B: Behaviour

C: Consequence

All behaviours occur for a reason and fulfils a purpose for the child.

1 Demand avoidance

2 Self stimulation

3 Attention seeking

4 Material gain

5 Stress reduction


1 Define the behaviour

2 Do an ABC

3 Identify what maintains the behaviour

4 Brainstorm: ways of changing the routine around the behaviour

5 Plan: outline the strategy

6 Monitor: did the behaviour reduce

Planning individual learning profiles

Use the class timetable as a starting point

First: identify times when the child can be part of the class without additional support-allocate TAs to planning, preparing, recording

Next: identify times when child can take part in same activities as class with additional support

Then: identify remaining time when individualised differentiated activities can be carried out.

Use TAs to foster independence and co-operation with group

Minimise withdrawal

Schedule time when the teacher works directly with child.

Class teachers should be involved in training, work with the pupil, plan, monitor, liaise.

All learning should be lead by qualified teachers not delegated to TAs.

Transition is important: pass on information to new class.

Individual programmes must be planned in advance and divided in to:

1 “on the hoof” pupils work alongside classmates, adults support and observe as needed.

2 Pre-planned differentiated class activities: team identify activities and resources beforehand.

3 Different activities: pupil supported to follow individualised programmes addressing key skills areas.

May 2020