The third edition of Maryanne Bruni's comprehensive work on the development of fine motor skills in children with Down syndrome is largely similar in content to the previous editions, but it has been updated to read in a more conversational voice. As in previous editions, Bruni incorporates personal anecdotes from her experience as the mother of a young adult with Down syndrome and her years as an occupational therapist. Her tone is supportive and reassuring, like having a favorite therapist in the room. Bruni does not simply prescribe “what” to do to foster fine motor and adaptive skills but also explains “why,” making this work a valuable resource for motivated parents, teachers, and professionals alike.
Bruni provides a theoretical framework for the development of fine motor skills, which she describes as a “house.” The building blocks are stability, bilateral coordination, and sensation, and the upper levels are dexterity and daily living skills (school tasks, self-help skills, and household tasks/leisure activities). Dedicating a chapter to each component of this house, Bruni discusses how features of Down syndrome can affect foundational skills, discusses how children with Down syndrome learn, and provides numerous skill-building activities. The activities, which are accompanied by photographs, are practical and could be easily incorporated into daily life or a therapeutic program. She presents them by skill progression rather than age and discusses how parents can identify when their child is ready to learn new skills (see especially a new “preprinting developmental chart”). The “Handy Basket” and “Grandma and Grandpa's List” features, collections of household objects and toys for skill development, are a welcome repeat in this edition, as are the handwriting and drawing worksheets in the Appendix. The Appendix also includes an expanded list of resources for materials and various support organizations. A reference list of the research Bruni refers to throughout the book would be useful here as well, and a subsequent edition would benefit from more complete citations, especially for professionals looking to refer to source material.
Bruni's chapter on school tasks is a highlight and includes sample educational goals for fine motor abilities that may be useful for IEP development. The chapter on daily and independent living skills includes extensive discussion on dressing and grooming. Other sections on household, leisure, and community activities seem included for completeness, but because these activities incorporate so many areas of development, such brief mentions can feel inadequate. A list of further reading on these topics helps ameliorate this concern. Bruni also includes information on medical issues in Down syndrome but references the American Academy of Pediatrics Healthcare guidelines published in 1999 rather than the updated guidelines from 2011. She also states that screening cervical spine films should be done for all children, although the latest guidelines recommend films only for symptomatic children, and a thorough history and physical for all.
Bruni ends her book with a chapter on sensory processing in children with Down syndrome. Some of her recommendations, such as visual schedules and consistent routines, would be helpful for behavior management in all children. She is also careful to include medical conditions that should be ruled out before sensory processing disorders are considered, and overall, this chapter seems balanced. A brief discussion of Down syndrome and autism spectrum disorder is also included in this edition, reflecting the increasing awareness that these disorders can cooccur.
Overall, this highly accessible book continues to be a useful resource that families and professionals can read and refer back to time and time again when working with children with Down syndrome on fine motor development.