Down syndrome Case 1

Down syndrome Case 1

Background History

Jane is 21 years old and has Down 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 behavior. She was regularly physically aggressive towards her parents and often tearful. Jane was unable to explain her behavior and her relationship with her family was rapidly deteriorating as her behavior 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 behavior 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 standardized and non standardized 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 hypothesized that the low mood and challenging behavior 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

Create a plan for your weekly sessions with Jane. Design the plan so that all areas of difficulty identified in the previous assessment is dealt with. In what ways will you provide support for Jane and her family during these sessions?

What are some community support organizations that you can refer to? In what capacity can they help?