DOWN'S SYNDROME - ADULT
Jane is 21 years old and has Downs Syndrome. She lives with her mother, father, older brother and pet dog. Her father works full time and her mother remains at home to support Jane. Jane and her family recently moved to the area from the north of the country where she had previously engaged in many groups and hobbies. Her hobbies were dancing, drama and art. She also had a volunteering job at a local nursing home where she handed out the tea and coffee. Since moving house, Jane has no hobbies and spends all day with her mother watching television and DVD’s. Jane has good verbal communication and is independently mobile.
Reason For Referral
Jane was referred for occupational therapy by her GP having demonstrated regular difficulties with low mood and aggressive behaviour. She was regularly physically aggressive towards her parents and often tearful. Jane was unable to explain her behaviour and her relationship with her family was rapidly deteriorating as her behaviour worsened.
Occupational Therapy Assessment
Jane received a full physical health check by her GP which showed no apparent physical cause for her symptoms. Jane was receiving support from a nurse who was monitoring her medication and ensuring that she received regular health checks such as dentist and optician appointments. Since physical causes of Jane’s behaviour had been ruled out, occupational therapy embarked on a goal to identify the cause of her difficulties and to support her and her family in reducing them.
Jane was assessed by occupational therapy using a variety of standardised and non standardised tools. These included formal assessments such as the Model of Human Occupation Screening Tool (MOHOST) and the Assessment of Motor and Processing Skills (AMPS). These assessments were augmented with informal interviews with Jane’s family, an environmental assessment, observation of functional tasks and completion of an interests check list.
This assessment identified that:-
- Jane had difficulties with the sequencing of tasks, identifying which order to carry out tasks in;
- She also had difficulty with standing for long periods of time;
- Jane lacked motivation to complete domestic and self care tasks;
- An environmental assessment and observation identified a significant level of auditory (noise) and visual stimulus when Jane was expected to carry out a task - for example, the television would be on in the lounge, the microwave and radio on in the kitchen in addition to which her dog was a very vocal creature and regularly contributed to the noise levels;
- Jane’s difficulties resulted in her parents completing a lot of her activities of daily living as they believed that she was unable to do so. She was also fully supported with her personal care;
- Jane appeared to lack meaningful occupation in her day and it was hypothesised that the low mood and challenging behaviour were a result of this lack of occupation. She was likely to be feeling bored and frustrated and her self esteem was deteriorating.
Occupational Therapy Treatment Plan
Jane and her family received an occupational therapy programme consisting of 12 weekly sessions of between 1 and 1.5 hours' duration.
The sessions focused on:-
- Using visual sequences for personal care and simple meal preparation which enabled Jane to wash and dress with minimal support. She was also able to make her own breakfast and drinks;
- Enabling Jane to carry out more complex tasks in the kitchen by supplying her with a perching stool;
- Placing visual indicators on the washing machine settings enabling Jane to do her own laundry;
- Supporting the family to understand Jane’s difficulties with distractions and reducing auditory stimuli in the home;
- Supporting the family to help Jane be as independent as possible by only completing the specific part of the task that she struggled with rather than completing the whole task eg opening a tight jar lid rather than making the whole sandwich;
- Giving Jane her own chores in the home such as the family laundry and dusting which she was praised for doing. Jane also helped her mother make the evening meal at least twice a week;
- Supporting Jane to look into accessing appropriate volunteering opportunities in the area.
Jane was also referred to social services with a view to having a personal assistant who could support her in accessing the community without her family. She was also supported to engage with the local gym and drama group.
As a result of the occupational therapy input and collaborative working with other agencies:-
- Jane’s challenging behaviour reduced significantly;
- Her mood improved as she began to engage more and access her local community regularly;
- There was a noticeable reduction in the amount of times she was seen crying;
- Her relationship with her family improved dramatically - Jane is now able to help her mother with daily tasks and is praised on a daily basis for this help.
In addition Jane’s mother was able to enrol onto a local college course as she had more free time which improved her own mood and energy levels enabling them to spend quality time together when they were both free.
Jane achieved all the goals that were set in the original assessment. She gave verbal feedback that she enjoyed working with the occupational therapist and was sad that she was not going to see them anymore.