The Parable of the Down Syndrome Child

The Parable of the Down Syndrome Child November 28, 2016

I would like to present a modern-day parable of sorts.

Unlike most parables, this one is based on a scientific paper, and unlike most parables, I will draw explicit parallels with my intended target at the end.

Background

In my final year of my degree I attended a lecture on ‘Plasticity, Constraint, Expertise and Talent’, and the lecturer made mention of a paper that made my ears prick up. Some months later, after the course, I was speaking to that lecturer and asked if he remembered the paper, and could give me the citation. Unfortunately, whilst he recalled making the reference, he couldn’t recall the specifics, but suggested that Professor Karmiloff-Smith might. Annette Karmiloff-Smith[i] is just one of the faculty members that explains why Birkbeck’s psychology department is so highly thought of[ii] (then again, so is Fred Dick[iii], the lecturer I mentioned). Annette responded a mere 15 minutes later that whilst she couldn’t recall the specifics (she was replying on mobile, and was on the move), that the author was Carolyn Mervis, and to check her website. Again, no luck. However, an email to Professor Mervis, which she responded to within 90 minutes, directed me to the article, and indeed the book in which the article, ‘Early Lexical Development: Theory and Application’, appeared. The book, ‘The Psychobiology of Down Syndrome’ (1988) is by my right elbow as I write.

Having extolled the virtues of asking researchers about their work, on with the parable.

A parable about childhood education

Imagine that you are the parent of a child with Down Syndrome. You love your child, as parents do, and you are aware of the additional difficulties that having Down Syndrome will likely create for your child. You resolve to do your best to mitigate these difficulties

How would this manifest?

Well, for starters, you know that Down Syndrome children tend to have learning difficulties, and that this manifests notably in vocabulary (e.g. Martin et al., 2009[iv]). As such, doing your best to help your child to learn their vocabulary is something that you feel you can do. For some this might be motivated out of embarrassment for their child not having the same abilities as neurotypical (and, let’s be honest, chromosome-typical) children. Further, it may be motivated by the knowledge, that some of those neurotypical children, along with their neurotypical parents, may judge and/or bully your child, and so you want to minimize the possibility of this by giving your child a leg-up on language and related abilities.

Fair enough.

AveryLambert

An interlude on the science of childhood object categorisation

However, there is a problem. Children go through some fairly typical stages as they build associations between objects and the categories to which those objects belong. We’ve all heard the one about the kid that learns that four-legged furry things are called (dogs – or cats, depending upon your household and the amount of exposure to the quadruped du jour), and then labeling the other common household pet the same way, i.e. calling a cat a dog, or a dog a cat. This is over-extension of a category. It is normal. All kids do it. And not just with household pets.

Object categories, once obtained at a conceptual level, go through periods of over- and under-extension. That is to say, children sometimes apply names to things when they shouldn’t (category over-extension), and sometimes they fail to apply the name when they should (category under-extension). This can be illustrated through what are called adult-basic, child-basic, and child-basic-only categories. Adult-basic categories are the simple categories that children can apply to things, and these are the same as child-basic categories, for example adults and children tend to agree that footballs and whiffle balls are balls. The child-basic-only category ‘ball’ may also include Xmas ornaments, a spherical candle, and multi-sided beads.

What would you anticipate that the reaction of the parent of a neurotypical child would be to a child going through this completely normal process with the categories “ball”, “car”, and “kitty”? (These categories are used in many studies as they consistently appear early in both neurotypical and Down Syndrome vocabularies: Gillham, 1979[v]; Nelson, 1973[vi].)

Now, what would you anticipate that the reaction of the parent of a Down Syndrome child would be to them going through this completely normal process?

(Feel free to skip to ‘Briefly summarizing the science’ if lexical development in normally developing and Downs Syndrome children is of no interest.)

Early Lexical Development: Theory and Application

This longitudinal study was of three boys and three girls with Down Syndrome, aged around 18 months at the start, and around 40 months at the end. The normally developing children were also from middle class families, and from the same two small mid-western American cities, they were gender- and birth order-matched children. The normally developing children were about 9 months younger, to allow for the approximate mental age as it relates to language acquisition, to be comparable with the Down Syndrome children.

Here’s an excerpt from Mervis (1988[vii]):

The most relevant analysis involved whether or not mothers labeled at least one of the child-basic-only objects with its child-basic name during the play period on the day that the child first demonstrated comprehension of that name. The mothers of the normally developing children used this type of labeling in 67% of test cases. In contrast, the mothers of the children with Down Syndrome did so in 31% of the test cases. Thus, in most cases for the children with Down Syndrome and in several cases of the normally developing children, maternal labeling patterns provided no indication of the existence of a child-basic category that was not identical to the adult-basic category that was labeled by the same name.

This is incompatible with the way in which children develop their categories, especially in the case of children with Down Syndrome:

The persistence of children with Down Syndrome despite conflicting input is well illustrated by one child on the day she first comprehended “kitty”. When I asked Suzanne (a pseudonym) if there was a kitty, she handed me a stuffed tiger. Her mother immediately told her that it was not a kitty and asked me to repeat the trial. I did so, with the same result. This time, Suzanne’s mother told her loudly and firmly that the object was not a kitty, and again asked me to repeat the trial. By now, Suzanne was upset enough to have tears in her eyes, but she still handed me the tiger. Suzanne clearly considered it to be a kitty. In sum, the combined results from the maternal language analyses and the child comprehension analyses provided strong support for the claim that the children’s initial categories are based on the form-function principle, rather than on linguistic input.

In that summary what Mervis is pointing out is that children have informal theories about things, generally predicated on the child’s assessment of the correlation between a whole object’s form/function and it’s belonging to a particular category. The insertion of Adult-basic names for objects into the conversation between parent and child as a correction has little-to-no impact. Some objects and categories must pass through child-basic only categories first.

So the issue then becomes how effective parents are at introducing correct labels to begin with (and later, as with the case of Suzanne and her mother, above, how parents go about correcting error):

For the normally developing children, new labels generally were learned for child-basic-only members from all three child-basic categories. In 74% of cases, the mother had provided an appropriate illustration during the play session immediately prior to the child’s comprehension of the adult-basic label. In almost all cases of illustration, the mother also provided a verbal description of the relevant attributes. Furthermore, examination of the transcripts from prior sessions, beginning when the child demonstrated referential comprehension, indicated that illustrations were rare. For the normally developing children, the first case of comprehension following an illustration occurred four months before the first case without illustration. The mean age at comprehension following an illustration was more than three months less than the mean age at comprehension without an illustration.

Mothers (as was the case in these studies) followed two different patterns for correction for the labeling of objects. The first is to encourage adjustment to the adult-basic label based on the child’s perceived knowledge of that label. The second is to encourage adjustment based on how similar the incorrectly named object is to the adult-basic label – the more similar the incorrectly labeled object is to the correct label, the more likely the parent is to make the correction. Following is an example of the first:

The probability that mothers would disagree with their child’s use of a child-basic name for a child-basic-only object might also be expected to vary as a function of the child’s knowledge of the adult-basic name. The proportion of disagreements should be very low prior to the child’s comprehension of the adult-basic name. Increases in proportion of disagreement should occur following comprehension of the adult basic name and then again following its production […]

The data from the longitudinal study are consistent with this pattern only for the mothers of the normally developing children. These mothers disagreed with their children’s label slightly less than 10% of the time prior to the child’s comprehension of the relevant adult-basic label. The proportion of disagreement increased significantly following comprehension of this label, and then increased again (although not significantly) following its production. Once again, these differences could not be attributed to increases in disagreement over time, independent of child knowledge of the relevant labels. The mothers of the children with Down Syndrome disagreed with their child 25% of the time prior to comprehension of the relevant adult-basic label. The proportion increased, but not significantly, following first comprehension. Overall, the mothers of the children with Down Syndrome disagreed with their labels 35% of the time. In contrast despite their children’s greater knowledge of the adult basic labels, the mothers of the normally developing children disagreed only 16% of the time.

The second strategy I mentioned, basing correction on how similar the object is to the named category (possibly taking into account other correctly labeled objects nearby), was engaged in by all mothers of normally developing children, and by no mothers of Down Syndrome children!

In addition, “Of the ‘What’s That?’ questions that were addressed to the children with Down Syndrome, 54% were asked in reference to an object for which the child could produce an appropriate label; the corresponding figure for the normally developing children was 69%.” As such, parents of children with Down Syndrome ask their children ‘What’s that?’ when the child doesn’t have the vocabulary to answer the question about half the time. Parents of normally developing children do so about one-third of the time.

Briefly summarizing the science

Parents of Down Syndrome children use childlike names less than half as often as parents of typically developing children, and tend to disagree with their child’s child-like naming more than twice as often. All children persist in giving child-like names and persist in over- and under-extension of categories as part of learning adult-basic names and categories. Down Syndrome Children persist in this for longer, for obvious reasons. Some parents of Down Syndrome children attempt to over-extend their child by asking ‘what’s this?’ of objects that the child has given no indication of having the lexical ability to label, and they do so significantly more often than parents of normally developing children.

Back to the parable

Above I asked you to put yourself in the shoes of a parent of a child with Down Syndrome. I suggested that your desire to nurture and protect your child might manifest as “…doing your best to help your child to learn their vocabulary…” Did this strike you as about right?

We’ve just seen that parents of Down Syndrome children do seem to do this, but they don’t use child-appropriate names as often (unless they happen to also be adult-appropriate), they correct their children away from child-appropriate names before they’re necessarily ready to make that move, and they use the ‘what’s this?’ testing strategy in a way that more frequently leads to failure, and presumably frustration.

You have a child with mild to moderate intellectual disability. This manifests in slower learning, so whilst seeking to extend your child’s learning is natural and understandable, a moment’s thought would indicate that it is exactly the wrong thing to do. The child is not willfully disobedient.

To illustrate the point, read the following sentence (taken from Mervis) with the idea of a normally developing child in mind:

“…an adult produced the sentence, “That’s an elephant, isn’t it?” and the child then called elephants “intit” for several weeks, despite numerous attempts by adults to correct him.”

There’s a good chance that you smiled. That’s a child-appropriate misunderstanding of language – they’ve taken the final word, the position in a sentence that children tend to place the most emphasis on (called ‘the recency effect’ in memory research), and assumed that was the name of the novel (or indicated) item in the environment.

Now read that same sentence taking on the mantel of a parent who knows that their child has some level of intellectual disability, the extent of which may not yet be known, and see if you find yourself smiling. Understand that the parent, by now, is used to other parents, and their children, staring at their child a bit longer than is appropriate. Understand that they are now used to curious parents looking into the stroller and being momentarily taken aback before regaining appropriate composure and making the right social noises. And understand that they are now accustomed to other people who are a little less decorous than that.

Of course you would try and accelerate your child’s learning, but what your child needs is more space to learn words and categories, not less space, and more pressure (even when that pressure is applied with love).

This is a parable, how?

What’s the lesson here? What’s my actual target that this is supposed to be an allegory of? (As if you didn’t know.)

First, let me say that I have tried to paint an empathetic picture of a parent (or parents) trying to do what’s best for their child based on their understanding of the world, and the things that they believe about their child.

My intended target is, of course, the American Conservative parent that I have illustrated over the last three posts. These are the people who consistently vote Republican – especially recently – not because they believe in the GOP, but because they have an explicit policy of ‘never-Democrat.’ They want to feel like they have power, so they are therefore implicitly ‘never-Independent.’ These people are, due to some combination of Fundamentalist Christian beliefs (mostly Evangelical Protestant, but also Catholic), poor educational attainment, low socio-economic status, and deeply conservative political ideology, raising children in a highly punitive environment, with an over-reliance on corporal punishment, an under-reliance on education, except for that based in the idiosyncratic understanding of scriptural learning they gain from their particular local church. And these people are approximately 25% of the American population.

I don’t for a moment believe that these are bad people, I believe they are people who have suffered from the worst possible combination of poor education and low socio-economic status. They turn to their religion for solace, and their political leaders for the opportunity to be raised up. But their religion is instrumental in their ongoing problems with education and self-understanding, and their politics puts them at the mercy of ideologues who think of them merely as a means to personal power, rather than as a constituency to be raised up.

So, how are the choices about parental education style made by two-thirds of the mothers of Down Syndrome children in the study in anyway comparable to the choices made by a majority of conservative fundamentalist parents?

(Recall that not all Evangelicals are poor and ill-educated, some are very wealthy, and highly educated, but their choices as parents are, nevertheless, coloured by their decision to become white Evangelicals. These people are less the target of this parable than the ill-educated, low-SES, white Evangelicals.)

Understanding words vs. understanding moral concepts

Object categorization and basic language development is something that humans go through. It is at once, highly complex, and yet, when we are talking about concrete objects, and the nouns for them, like “ball”, “car”, and “kitty”, something most children have under control by the time they get to kindergarten, let alone school. By comparison, ideas about morality are very much more complex, it relies on a language that is mostly conceptual in nature, as it often doesn’t have a direct physical referent. When it does have a physical referent, it is generally to do with specific behaviours, and often with regard to part of a person.

I said that children rely on “correlation between a whole object’s form/function and it’s belonging to a particular category.” So even if the category is a simple binary, e.g. good/bad, right/wrong, the child is not given to extracting parts and features of objects, let alone actions, and labeling those. So whatever the children under three were receiving corporal punishment for, in a previous post of mine[viii], it was almost certainly for something that they were not in a position to comprehend as wrong. It brings to mind the idea of children being punished for playing with their genitals because adults superimpose sexual content on to the behaviour that children simply can’t and won’t have in mind. Indeed, a hysterical reaction to such natural curiosity about one’s own body says a whole lot more about the adult than it does the child.

What such hysteria usually says is that the adult has bought into the idea that humans are sinful, naturally bad, inherently evil, etc., etc., And if you look for proof of people being naturally bad, you can certainly find it. Indeed, you will encourage it – self-fulfilling prophecy, and all that. Equally, if you look for the positive, the naturally and inherently good, you’ll find and encourage that, too.

Born into sin/having a sinful nature vs. Down Syndrome

Sin is not real, at best it is the equivalent of child-only basic category for some behaviours that might be seen as inappropriate (ironic, huh?). Indeed whilst I can accept ‘sin’ as a word for a thing, albeit a word I would only use illustratively, what that thing is not, is applicable to small children. The only visible marker for sin is that you are human, and if you subscribe to the belief that we are all sinners, well, that’s all you need. Down Syndrome, by contrast, is real. It comes with some level of measurable intellectual disability, and it has visible markers that most people recognise.

As such, the parents of a child with Down Syndrome need only take a deep breath and resist the urge to over-correct (yes, I know that’s a very big “only”). Conservative parents have a much simpler task: accept that children are children, do not super-impose adult concerns onto them before they are cognitively capable of dealing with them, and look out for when they are cognitively capable of dealing with them. Of course, just as that is a very big “only” for the parents of a Down Syndrome child, that task is not at all “simple” for an ill-educated parent with a lifetime of religious and political “education” (indoctrination) to fall back on.

The Child of Conservative parents vs. The Down Syndrome Child

No. I am not equating being raised conservative to having Down Syndrome and the concomitant intellectual disability, any comments even flirting with something so absurd will be ignored (by me, at least). I am illustrating the problems of the complexity of moral education that a deeply indoctrinated conservative Evangelical parent with a neurotypical child will face, with the comparative simplicity of word and category education that the parent of a Down Syndrome child, who actually has some level of intellectual disability, will face.

Parents of Down Syndrome children (to whom I hope I have caused no offence) have some understanding of what Down Syndrome is, what it entails, and so on. I noted above that a great deal of the pressure that a parent with a Down Syndrome child feels comes down to beliefs about how their child will be treated by society at large, how they might be judged as parents, and how best to mitigate these things. Understandably parents try to give their children the best start they can, but the strategies adopted amongst two-thirds of the mothers in the study were (presumably) well-meaning, but counter-productive.

Equally, Conservative fundamentalist parents try to give their children the best start in life. The strategies adopted, based as they are on incorrect beliefs about what it is to be human (sinful in nature and, as per my prior posts, ultimately culpable with no room for blaming the environment) need to be addressed. Similar to the parents of Down Syndrome Children, Conservative fundamentalist parents have concerns as to what their family, neighbors, and congregation (and possibly even God) will think about each and every thing their child does. So much for “judge not.”

Just as the parents of Down Syndrome children should cater to their individual child’s particular needs, and as such learning should be paced to the child’s abilities, so too should the conservative parent. This does not preclude teaching one’s child manners, how to behave at church, and so on, but it does mean that expecting a small child to sit through a long sermon in a stuffy church is probably inappropriate. If the child starts acting up, remember that attempting to foist adult behaviours on to a child (the very thing that you punish the child for in other circumstances), must be done judiciously. Introducing a child to appropriate adult behaviours can only be done when they understand the difference between the child-only-basic category and the adult-basic category.

The twist in the tale

Of course, if you pay attention to your child’s individuality, introduce them to appropriate behaviours as and when they are ready for them, and care just a little bit less about what nosy family and neighbours think, and care about nurturing the child’s individuality just a little bit more, then you’re raising you child the way most liberals, leftists, and many centrists (i.e. Democrats) do… and that would never do! (See Lakoff’s (2002)[ix] Nurturing Parent/Strict Father archetypes) ‘Never-Democrat’ is a paradigm case of long-standing and deep-seated identity politics, yet it is undeniably both conservative and Republican, and predominantly Southern and Mid-Western States, and it ultimately damages many of the children raised in this way.

NOTES

[i] http://eprints.bbk.ac.uk/view/people/Karmiloff-Smith=3AAnnette=3A=3A.html

[ii] http://www.bbk.ac.uk/news/birkbeck-psychology-research-ranked-5th-best-in-the-world

[iii] http://eprints.bbk.ac.uk/view/people/Dick=3AFrederic=3A=3A.html

[iv] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860304/

[v] Gillham, B. (1979). The First Words Language Programme. London: George Allen Unwin.

[vi] Nelson, K. (1973). Structure and strategy in learning to talk. Monographs of the Society for Research in Child Development, 38(1-2, serial no. 149)

[vii] Mervis, C. (1988). Early lexical development: theory and application. In L. Nadel (Ed.), The psychobiology of Down Syndrome (pp. 101-145). Cambridge, MA: MIT Press.

[viii] http://www.patheos.com/blogs/tippling/2016/10/13/duval-on-moral-epistemology-pt-3-2-conservatives-and-corporal-punishment/

[ix] Lakoff, G. (2002). Moral Politics: How Liberals and Conservatives Think (2nd Ed.). London:  University of Chicago Press.

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