However this is not the whole story and there is increasing research on the development of the brain and its impact on both verbal and non verbal communication.
Children with 22q will often have immature social skills and will have difficulties understanding social situations as they have problems interpreting the non verbal cues which are a very important part of communication and social interaction.
When very young this does not present much of a problem as at the young baby and toddler stage all children have little understanding of social niceties you just have to see how a young baby or toddler will take a toy from other child. Even before they can speak babies will gradually start to pick up on the non verbal communication such as facial expressions and gestures as well as verbal communications such as the tone of a parents voice or the noises made by peers.
In pre-school years as other children's social skills start to develop these differences become more pronounced. In Sarah's case she started at pre-school when she was about two and appeared to enjoy the experience. However watching her play was quite interesting as she would appear to play alongside rather than playing with other children. Sarah would find it very difficult to initiate play and she always needed the help of an adult to interact with other children. In a large group she would hang about on the periphery trying to join in but not being able to do so.
Sarah is a very sociable girl, enjoys company and wants to be accepted as part of a group but she still has problems initiating play and has limited play skills, which means that her play is often repetitive. This problem is compounded by the fact that her development is around 18 months to two years behind other children of the same age and the differences between Sarah and her peers are becoming more marked. Like many other children with 22q Sarah is more comfortable with older children (who can lead play) or younger children who are more attuned to her play skills. We are now finding that she plays better with the younger siblings of classmates.
On several occasions Sarah has said that she has no one to play with at break time and we have tried to address this by ensuring that she is able to fill part of the time with lunchtime clubs. Periodically the school has run social skills sessions for a number of children which Sarah really enjoys. The school has also introduced a buddy system where every day one or more classmates are asked to ensure that they include Sarah in their games. Unsurprisingly other children can quickly lose interest in her because of her immaturity and tendency to be repetitive.
Often she will prefer the company of adults who she knows well rather than spend time with other children.
There are a number of common characteristic seen in people with 22q including
- Social immaturity,
- Have a tendency to think very rigidly, needing to stick to the rules and avoiding spontaneity. A good example was when Sarah wanted me to search for something online and got quite annoyed when I didn't go through exactly the same steps as she uses at school even though we got to the same result.
- Easily led and will follow the crowd because they want to be friends
- Obsessive behaviours and autistic type behaviours e.g. at the moment she is obsessed with knowing what other people are doing at a particular time of day.
- Difficulty in picking up social cues, working out when to join in with a conversation or when to listen.
- Low self esteem or lack of confidence.
- Inappropriate behaviour
Alongside education, social skills is the main area which gives us concern as we do not want her to become unsociable and withdrawn.
We have try to give Sarah the opportunity for as much social interaction as possible. At the weekend she attends a drama group which is something she really enjoys and is a good way to boost her confidence. She also goes to a Brownies group and has recently joined a special needs Cub Scouts pack.
In the last few months we have seen an increase in confidence, she has asked to go into a shop on her own to buy sweets or a drink and during the last school holiday on two occasions she found a new friend to play with without outside assistance. The best example of her increasing confidence was recently when walking our dog we were talking to another owner when completely unprompted Sarah said to the lady "What is your dog called?" Hopefully this progress will continue but we recognise that this area will present many challenges for us over the coming years.
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