Why do children with Down syndrome exhibit difficult behaviors?

Difficult behaviors in children with Down syndrome typically stem from three main causes: limited communication abilities (children cannot always express their needs verbally and use behaviors to communicate), fatigue and hypotonia (which makes physical effort more costly and leads to cognitive fatigue), and difficulties with rules and transitions (abstract rules are hard to understand and unexpected changes create stress).

What are the signs of fatigue in children with Down syndrome?

Signs of fatigue in children with Down syndrome include eye rubbing, restlessness, and withdrawal. Remember that a tired child equals an irritable child, and cognitive fatigue builds up quickly due to hypotonia making physical effort more costly.

How should I structure the environment to prevent difficult behaviors?

To structure the environment effectively: create clearly identified areas for different activities (play, rest, meals), reduce distractions and excessive stimulation, adapt furniture to the child's size, organize equipment in a visible and accessible way, and put away items that aren't needed.

What role do routines and visual aids play in managing behavior?

Routines and visual aids are crucial for prevention. Establish predictable routines for every moment of the day, use pictograms and visual schedules, allow the child to tick off completed stages, and display sequences visually. This helps children understand expectations and reduces anxiety from unexpected changes.

Guide Pratique - Gestion des Comportements Difficiles Trisomie 21

📋 Practical Guide

Q: What should I ask myself when encountering difficult behavior?

When facing difficult behavior, ask yourself: 'What is he trying to tell me?' Remember that difficult behavior is never free - it's always a response to an unmet need, communication difficulty, or over-stimulation. Look for the cause before intervening in the behavior.

Q: How should I use this practical guide for managing difficult behaviors?

This document serves as your daily reminder. Keep it handy, post it in your workspace, and consult it whenever you encounter difficult behavior. It contains the essentials of what you've learned during training and provides quick reference for understanding, preventing, and managing challenging situations.

Management of Difficult Behaviors in Children with Down Syndrome

🎯 How to use this guide

This document is your daily reminder. Keep it handy, post it in your workspace and consult it whenever you encounter a difficult behavior. It contains the essentials of what you've learned during training.

🧠 1. Understand: Why these behaviors?

💬 Limited communication

Children cannot always express their needs verbally
Difficult behaviours are attempts to communicate
Question to ask yourself: "What is he trying to tell me?"

😴 F atigue and hypotonia

Hypotonia makes physical effort more costly
Cognitive fatigue builds up quickly
A tired child = an irritable child
Signs: eye rubbing, restlessness, withdrawal

🔄 Difficulties with rules and transitions

Abstract rules are hard to understand
Transitions generate anxiety
Children need predictability
The unexpected is a source of stress

💡 To remember

Difficult behavior is never free. It's always a response to an unmet need, communication difficulty or over-stimulation. Look for the cause before intervening in the behavior.

🛡️ 2. Prevent : Act before the crisis hits

🏠 S tructuring the environment

Create clearly identified areas (play, rest, meals)
Reduce distractions and excessive stimulation
Adapting furniture to the child's size
Organize equipment in a visible and accessible way
Put away what you don't need

📅 Routines and visual aids

Establish predictable routines for every moment of the day
Use pictograms and visual schedules
Allow the child to tick off the stages completed
Display sequences at the child's eye level
Maintain consistency: same order, same reference points

⏰ Anticipating transitions

Gradual warnings: "in 5 minutes", "in 2 minutes".
Use visual timers (Time Timer, hourglass)
Create transition rituals (saying goodbye, tidying up)
Offer limited choices to give control
Show visually what comes next

✅ The golden rule of prevention

Structure + Routine + Anticipation = Safety
The more a child knows what's going to happen, the less anxious he'll be, and the less difficult his behavior will be.

🎯 3. Intervene: Manage the crisis

🚨 EMERGENCY PROTOCOL

When challenging behaviour shows up

STAY CALM

Take a deep breath

SECURE

Keep hazards out

SHORT INSTRUCTION

"Stop, Sit, Breathe

DESESCALADE

Calm-down techniques

🧘 Your posture: the key to everything

Your calm is contagious, and so is your stress.
Lower your tone of voice
Slow down your movements
Ultra-short instructions: 2-3 words maximum
Don't negotiate during a crisis
Don't repeat the same thing 10 times

❌ TO AVOID

- Raising the tone
- Long speeches
- Negotiating during the crisis
- Repeat over and over
- Showing annoyance
- Physical force

✅ TO DO

- Stay calm
- Short instructions
- Show rather than tell
- Validating emotion
- Redirecting attention
- Helping you to calm down

🛠️ De-escalation techniques

Positive distraction: "Oh look, what's over there?"
Guided breathing: "Blowing out the candles together".
Withdrawal area: Quiet corner with cushions (not a punishment!)
Gentle physical contact: Hand on shoulder, cuddle if accepted
Sensory tools: Anti-stress ball, fidget, weighted blanket

📢 Phrases to be used during the crisis

"Stop."

"Look at me."

"Breathe with me."

"I can see you're angry."

"We're going to the quiet corner."

"Show me what you want."

"I'm here."

⚠️ Specific situations

Refusal: Simply reformulate + propose a choice + give time
Agitation: Secure + discharge activity + calm time
Screaming: Validate emotion + do not overreact + redirect to an alternative

🌱 4. After the crisis: Rebuilding and moving forward

💬 S imple, reassuring debriefing

Wait a few minutes until the child has calmed down
Verbalize with simple words: "You were angry. You yelled. Now it's over."
Reassurance: "I'm here. I love you. Everything's okay."
Quickly restore normalcy
Don't dwell on the past or lecture

⭐ Positive reinforcement: your superpower

Systematically reward adapted behavior
Specific congratulations: "You've put your toys away, that's great!"
Create a visual reward system (stickers, pom-poms)
Put 10 times more energy into the positive than the negative
Creating a virtuous circle: good behavior → recognition → pride → repetition

📊 O bserve and adapt continuously

Keep a behavior log (when, context, triggers)
Identify recurring patterns
Adjust routines and environment according to observations
Collaborate with professionals (speech therapist, psychologist, educator)
Celebrate every small step forward

🎉 Recognizing progress

Have the screams diminished? Are seizures shorter? Does the child sometimes use gestures to communicate? It's a victory! Every little step counts and deserves to be celebrated.

✅ My Daily Checklist

Check every day to prevent difficult behavior

Is the environment structured and uncluttered?

Are visual routines displayed and accessible?

Have I prepared the day's transitions?

Are rest periods planned to avoid fatigue?

Are my instructions clear, short and visual?

Have I provided choices to give the child control?

Am I ready to value positive behavior today?

Is my quiet corner accessible and welcoming?

💬 Key phrases to remember

"Behind every behavior, there's a message".

"Your calm is contagious

"Predictability = Safety

"Value the positive 10x more".

📝 My Personal Notes

Use this space to note :

The specific triggers you observe
Techniques that work best with this child
Your questions to professionals
Observed progress