The argument for pharmacological intervention is strengthened if the children and adults with Down syndrome is deemed to already have a biological vulnerability (e.g., positive family history, previous episode of depression, concurrent medical illness). Chronic sleep difficulties in children and adultswith Down syndrome need to be evaluated thoroughly by interdisciplinary team in order to rule out any contributory medical conditions. When comparing our sample of adolescents with Down syndrome with a general sample of intellectually disabled adolescents, it can be noticed that adolescents with Down syndrome have less behavioral problems in general. This may include asking your primary care provider, inquiring at work with your employee benefits officer responsible for your medical coverage to give you a list of providers who indicated an interest in evaluating children and adults with developmental disorders. We are presently working on the second edition of our Mental Wellness book and just finished Chapter 2: Assessing the Physical Health/Mental Health Connection. Down Syndrome Association of West MI Section 1, Page 4 Guide for Teens & Young Adults with DS July 2010 chronic illnesses, an annual influenza (flu) shot is recommended as well as a pneumonia vaccine every seven years. Finally, you may consider calling the local department or case coordinator in your district for additional services that may be available in your area. It may be helpful to make a diary of when aggressive behaviour occurs, noting down everything that was going on at that time that could have triggered the behaviour. It covers the fabulous “flop and drop,” bolting, and other common issues experienced in raising people with that extra chromosome. The problems are quite challenging for parents or caregivers to navigate, as the child/adult with Down syndrome with generalized anxiety or obsessive-compulsive profile has a tendency to be stuck, frozen, and require great degree of negative attention that, in turn, is reinforced, and continues in a vicious cycle. There is a need to take a detailed history in all these situations in order to identify the source or environmental triggers contributing to the anxiety in relation to change in immediate home, school or work environment. The use of anticonvulsant medications (as mood stabilizers) need only be considered under careful supervision. Another issue to explore are psycho-social factors. Certain facial and physical features are commonly seen in those with Down syndrome. Although there is increased prevalence of psychiatric disorders in people with intellectual disabilities as a whole (Mantry et al, 2008; Buckles et al, 2013), certain psychiatric illnesses are more common amongst people with Down’s syndrome … Friedlander, R. & Johnson, P.  Kingston, NY: NADD Press. Pulsifer, M. (1999). He is 10 yrs. Enter and space open menus and escape closes them as well. Many families live in areas without a mental health professional skilled in working with children and adults with Down syndrome. Perhaps he is allowed to do whatever he wants at home. Teens with DS have some additional issues. I hope this is helpful and you and your provider can help ease the symptoms. Telephone: 800-221-4602 (Monday-Friday, 9AM ET- 5PM ET) 3. The other symptoms will eventually surface. 8th Floor The tip about getting the school behaviorist involved is a good one. Intermittent explosive disorder involves repeated, sudden episodes of impulsive, aggressive, violent behavior or angry verbal outbursts in which you react grossly out of proportion to the situation. NDSS thanks special guest author Kerim Munir, M.D., MPH, D.Sc., for preparing this piece. Some of the anti-seizure medications do have agitation as a side effect. Parents or caregivers often report that the child/adult’s demeanor had not previously been like that. Children and adults with symptoms of depression often present with extreme social withdrawal, sad (but not labile) affect, and inability to enjoy many activities they used to love. Fax: 646-870-9320 Increased level of restlessness and worry may lead the child or adult to behave in a very rigid manner, even resulting in a state of being “stuck,” as is often reported by caregivers where the child or adult needs to follow familiar routines in these situations. Decreased enthusiasm for usual activities. Consistent positive reinforcement can help your child learn how to behave well. Is there something in the environment contributing to the behavioral change? Children and adults with Down syndrome commonly experience a range of sleep-related difficulties either as primary sleep disorder or associated with mental health problems (e.g., generalized anxiety and mood disturbances). For the most part, those with Down syndrome will tend to suffer from mild to moderate mental retardation. Without seeing [the individual] we, of course, can’t make a diagnosis or specific treatment recommendation but we do have some general advice that can be reviewed and shared with your provider. Change in behavior can be challenging for both a person with Down syndrome and his family. 2. Praise your child every time they behave well and ignore any behaviour you do not expect. I have a 11 year old daughter with down syndrome, that always has been aggressive and attention seeking most of all she is the sweetest thing ever I love her to death, don't know how to help her. Email: [email protected], Headquarters Disrupted sleep commonly co-occurs in both depression and anxiety states and do not necessarily help us to distinguish between them. These are explained in his book Supporting Positive Behavior in Children and Teens With Down Syndrome. The root cause of Down syndrome is related to chromosomal abnormalities. Parents or caregivers need to be forewarned about these adverse effects since it can occur very soon after the initiation of treatment and can be very troubling for them to witness. In a sub-population of children and adults with Down syndrome there is a definite adverse behavioral activation in response to these medications. Many children and adults with Down syndrome have a wonderful disposition: they are fun loving and their interactions generally involve teasing, making jokes, giggly outbursts that often may also lead to intrusive, uninhibited social behaviors. Additional information can be found in our books: Mental Wellness in Adults with Down Syndrome - https://www.woodbinehouse.com/product/mental-wellness-adults-syndrome-guide-emotional-behavioral-strengths-challenges/, The Guide to Good Health for Teens & Adults with Down Syndrome - https://www.woodbinehouse.com/product/guide-good-health-teens-adults-syndrome/, Call today to schedule an appointment or find a doctor at one of our nearly 400 sites of care. The UCEDD programs can also provide advice regarding referral to adult service in the community and help locate mental health providers that have expertise in working with individuals with Down syndrome. February 2017 | Brian Chicoine, MD - Medical Director, Adult Down Syndrome Center. Behavioral change is commonly part of the symptoms of Alzheimer’s disease in people with Down syndrome. The emergence of sexual behavior in the individual with Down syndrome alarms some parents and caretakers who may rightly fear that their child's cognitive deficit makes him or her especially vulnerable: to unwanted pregnancy, sexual exploitation and abuse, and to … This has been going on now for over a year and it continues to get worse. Children with Down syndrome are at an increased risk for engaging in challenging behaviour that may be part of a behavioural phenotype characteristic of Down syndrome. Sadness, fearfulness or anxiety. Are the behaviors disruptive to the family, school or workplace? There is little evidence to support severe psychotic disturbance and aggressive behaviours being common in the Down’s syndrome population. We therefore recommend the following approach for families. Often, these behaviors signal frustration or lack of understanding and can provide important clues about how to best assist the individual's development. Illinois Residents Call to Schedule an Appointment. Your approach will depend on your child’s age, ability, temperament and where the challenging behaviors occur. I, too, have a son with Down Syndrome who has been exhibiting the same kind of behavior in the last 3 weeks! About one out of every thousand births is a Down syndrome birth. There is a great opportunity to use healthy diet as a tool to reinforce positive behaviors. Children and adults with Down syndrome often have significant processing difficulties and present with a very remarkable difficulty in sustaining attention on tasks. Thyroid function tests can be completed by the primary care provider or by a developmental and behavioral pediatrician or even a psychiatrist as part of an initial assessment. These latter medications tend to be limited in efficacy and should be used sparingly and in low doses. Consequence (changing the results) strategies. For people with Down syndrome, family members, caregivers and professionals. Restlessness or sleep … Combination treatment involving both psychosocial and pharmacological components is needed. Oppositional behavioral problems in children with receptive-expressive and cognitive limitations also tend to be associated with increased level of impulsive and hyperactive behaviors and often co-occur with ADHD symptoms. They may be associated with weight loss, poor self care, and inability to be motivated to attend school or go to work placements. Talk to our Chatbot to narrow down your search. Many respond to structure and behavioral interventions with clear-cut reinforcements and rewards. Furthermore, our experience is that our patients have had lots of side effects (seizures, decreased appetite, and agitation, among others). In the classroom setting, behavioral management and one-on-one aide may help to keep the situation in better control and to enable learning. Underlying contribution of constipation or bowel related difficulties need also to be ruled out by the primary care or developmental-behavioral pediatrician with interventions as may be necessary and referral to a nutritionist for counsel. 6. If you have access to the Internet you visit the website for your medical coverage provider and search for professionals in your geographic region who indicated an expertise in developmental disorders. Is the person: unwell, in pain, uncomfortable? Can be found at, Down Syndrome: When to Worry About Mental Health and What to Do About It! with Down’s syndrome, although research has been inconclusive. A most remarkable aspect of depression in children and adults with Down syndrome is its association with environmental noxious triggers. – A Guide for Parents and Care-Givers. They also engage in repetitive, compulsive, as well as ritualistic behaviors that raise the question of obsessive-compulsive disorder. Situational anxiety is often manifest during transitions and anticipation of new situations, e.g., transitions from home to school, transit, meal or bed times, as well as during novel and unfamiliar situations with uncertain expectations in the environment. In children with greater cognitive and receptive-expressive language deficits, especially for younger age groups, the difficulties in attention are often accompanied with impulsive and hyperactive behaviors. Down Syndrome and AutismI wanted to tackle one of the most difficult subjects for most special needs parents - aggressive behaviors. The psychosocial and environmental triggers also lead to a state of generalized anxiety, obsessive compulsive symptoms, and depression and sleep difficulties. If the situation persists and there is no concerted attempt to intervene with psychosocial counseling, treatment with appropriate medications, and behavioral interventions, the mental state may persist and be associated with longer term decline in psychosocial and cognitive functioning. Decline in ability to pay attention. ADHD, OCD, anxiety, and depression are just some mental health issues associated with Down syndrome. If your teen has delayed auditory sequential processing, you may have very childish behavior coupled with very adolescent desires for autonomy. These may include previously unrecognized medical illness or pain or psychosocial stressors, e.g., older sibling moving to college, sudden or chronic illness in a family member, death of a long household pet, absence of a teacher (leave, illness). REPETITIVE BEHAVIOR IN DOWN SYNDROME 3 Repetitive Behavior in Children with Down Syndrome: Functional Analysis and Intervention Repetitive behavior is an umbrella term used to describe behaviors characterized by frequency, repetition, inappropriateness, and invariance (Turner, 1999) including stereotyped and self-injurious behavior. In summary, children/adults with Down syndrome remain exquisitely sensitive to changes in their environment which they often perceive unfavorably. The first step in evaluating … Although the diagnosis of sleep apnea is suspected on the basis of history that often includes evidence for periods of daytime sleepiness, fatigue, it is necessary to conduct further tests to confirm this diagnosis by means of referral for a sleep study at a sleep disorder laboratory often available in major medical centers. All these ordinary events seem extraordinary for children and adults with Down syndrome with a disproportionate psychological impact, as compared to a typical person under similar circumstances. In geographic locations with limited proximity to such services it is always worth remembering that each state in the US has what is known as a University Center of Excellence in Developmental Disabilities (UCEDD) which is part of the Association of University Centers in Developmental Disabilities. Our books also have chapters on behavioral change, assessing for physical causes, treatments, and Alzheimer’s disease. Refusal behaviors need to be interpreted differently in individuals with Trisomy 21 (Down syndrome). 2. Among the reported side effects of stimulants like Adderall are new or increased hostility and aggressive behavior. Sleep related difficulties need to be evaluated by a primary care provider, developmental-behavioral pediatrician or psychiatrist as part of an initial assessment with referral to a sleep disorders clinic or laboratory as needed to rule obstructive sleep apnea – see further discussion below. Aggressive behaviour of Down Syndrome child - Down Syndrome Community - Jul 05, 2015. It may be advisable to first seek a mental health provider who works in a pediatric medical center or who works in close proximity to a pediatric practice. I have been at a loss to explain his sudden aggressive behavior; I've been playing the guessing game: 1. Sorry to hear of the struggles. Look at how the person is feeling when they behave aggressively. The response of children and adults with Down syndrome has not yielded encouraging results. Please remember that the ideal mental health provider skilled in Down syndrome is someone who has knowledge of developmental disorders and who also has had experience in working with children. For children with high-degree impulsivity and disruptive behaviors the use of low dose of clonidine has been helpful, but this medication may also be limited in its efficacy as it may lead to daytime drowsiness in some children. She also is extremely helpful all the time, but … I contacted the person running a study on dementia and Alzheimer’s and they seemed to think he is displaying dementia symptoms. Bear in mind how people with Down’s syndrome learn best so provide lots of visual supports, modelling, developing personal books and films with lots of practice and repetition. Nevertheless, these medical conditions associated in children and adults with Down syndrome need to be ruled out as part of a comprehensive assessment approach. Finally, caveats or steps to consider in addressing any of the above potential medical concerns in the context of treatment of “behavioral problems” include the following: These are the most prominent presentations among children and adults with Down syndrome. Tab will move on to the next part of the site rather than go through menu items. Children and adults with multiple medical problems experience an even higher rate of mental health problems. It can be the presenting symptoms – in other words, there may not be any or minimal changes aside from the behavioral change at the beginning. Consider making a preliminary search in your area for potential providers with experience in working with children and adults with developmental disorders. 1. Many of these programs have been in existence for over 30 years and are located in tertiary care centers with interdisciplinary services that include mental health professionals (child psychiatrists, psychologists, social workers), as well as developmental-behavioral pediatricians. The site navigation utilizes arrow, enter, escape, and space bar key commands. Are people with down syndrome aggressive? Raising a teen isn’t easy under the best of circumstances. Commonly directed at other dogs, this type of aggressive behavior stems from the fact that your pooch is feeling restrained and frustrated by their leash. Assuming that the assessment of dementia/Alzheimer’s disease that you received is correct, we recommend looking at the following: We gave a presentation at our Center a few years ago and there are suggestions for medicine and non-medicine approaches to a person with Down syndrome and Alzheimer’s disease. I am writing to you for advice on how to handle extreme aggressive behavior my 48-year-old son has been displaying. That video can be found at this link: https://youtu.be/1NaXkoS6Bt8. It always helps greatly if you already have a primary care physician who can make referral recommendations or who already has someone in mind who similarly can make an appropriate referral for you. Down syndrome and aggressive behavior - Down Syndrome Community - Jan 21, 2015. Down syndrome is one of the most common genetic birth defects. For this reason, the main emphasis in treatment of ADHD-like symptoms needs to focus on behavioral and therapeutic strategies to enhance adaptive functioning and performance in the home and classroom settings. I think what I would like is to just get an idea on how to handle the temper tantrums and screaming he is doing. Is someone bothering him, has there been a change in residence or job, etc.? Children with Down’s syndrome can be very sensitive to the feelings of others, and if the people around them feel angry or anxious, they may be picking up on these feelings. Learn to watch out for other signs of mood disorders and more. Common behavioral issues in children with Down syndrome include a short attention span, impulsive behavior, slow learning and poor judgment, states the University of Maryland Medical Center 3. Since children and adults with Down syndrome are already at increased risk of weight gain over their lifespan, the increased appetite leading to weight gain associated with atypical neuroleptic medications, can be destabilizing. Likewise, the use of atypical neuroleptic medications ought to be considered only as a last resort, again, with careful monitoring of their potential side effects. For example, temper tantrums are common in 2-to-3-year-olds; for a child with Down syndrome, temper tantrums may begin at 3 or 4. 4. The methodology of applied behaviour analysis has been demonstrated effective with a wide range of challenging behaviours, across various disabilities. Irritability, uncooperativeness or aggression. Keppra may cause psychotic symptoms Depakene (valproate) Klonopin (clonazepam) Keppra (levetiracetam) Like all children, children with Down syndrome are going to present caregivers with challenging behaviors, and they require both clear expectations about “good” behavior and appropriate limit-setting on unacceptable behavior. The other symptoms will eventually surface. “We had a blast connecting with so many other families and advocates. It should be emphasized that the use if clonidine, per se, can be effective only in addressing impulsive, hyperactive and disruptive behavior, and does not necessarily improve primary attention. 1-800-3-ADVOCATE, Aggressive Behavior and Alzheimer's Disease, Adult Down Syndrome Center - Advocate site, https://www.woodbinehouse.com/product/mental-wellness-adults-syndrome-guide-emotional-behavioral-strengths-challenges/, https://www.woodbinehouse.com/product/guide-good-health-teens-adults-syndrome/. Unlike in children with Down syndrome with impulsive, oppositional, and attention deficit profile, the restlessness, fidgeting, and compulsiveness associated with generalized anxiety state has an identifiable onset with a more intermittent course. It is essential to rule out any underlying medical and neurological conditions, and especially to consider the possibility of adverse effect of medications that may lead to secondary mood instability. A young child with Down syndrome that presents with persistent oppositional, impulsive, disruptive, irritable, and aggressive behaviors should be considered under a possible mood disorder. Children and adults with Down syndrome, in particular, are at increased risk for development of obstructive sleep apnea with mild to moderate cessation of breathing during sleep that leads to reduction of oxygen saturation in the blood. Basic Behavioral Principles. Reduced interest in being sociable, conversing or expressing thoughts. There is now wider range of available screening and diagnostic tools for assessment of mental conditions across different developmental age groups in terms of measurement of domains such as non-verbal problem-solving abilities, language and communication and adaptive and behavioral functioning. It's amazing! It is often much more difficult to get an initial appointment and to be able to do so in an acute situation has become increasingly difficult, especially in well known centers. Join us at our 35th Annual Virtual Gala & Auction! Supporting Positive Behavior in Children and Teens with Down Syndrome. 5. This is a common question that many medical as well as mental health providers are asked by concerned parents. (2009). A comprehensive approach is needed in assessment of a child/adult with Down syndrome presenting with mood instability. It is always worth making an initial consultation visit to familiarize the child or adult with the professional and to see if this is a good match for your needs. Clonidine administered at bed time may also help the child to settle down to sleep. This has been going The assessment of mental health concerns in children and adults has improved considerably in recent years. 8 E 41st Street Behavioral change is commonly part of the symptoms of Alzheimer’s disease in people with Down syndrome. The disruptive, oppositional and inattentive child with Down syndrome often does not tend to be unhappy, but rather quite silly, happy, and excited. There is a need to develop a better evidence base with expanded research in mental health aspects of Down syndrome. The increased awareness of the mental health issues bodes very well for the future. 4. Check the full list of possible causes and conditions now! Because emotional/behavioral and physical issues are intertwined, the two need to be treated concurrently. The use of antidepressants or anti-anxiety medications may help and should be reserved for more persistent and serious level of symptoms. Vee P Prasher (UK) and Neha Bansal (UK) Down’s syndrome is the commonest genetic cause of intellectual disabilities (Vicari et al, 2013). Children with Down syndrome may also wander, have attention problems, and show oppositional behavior or compulsive behavior, advises the National Down Syndrome … Top notch! Is the behavior harmful to the child or adult with Down syndrome or to others? 3. In our clinical experience the coexistence of true bipolar disorder and Down syndrome is relatively unknown. In such circumstances assessment of antecedents, behaviors, and consequences (ABCs) and development of a behavioral modification and management plan is essential. When evaluating behavior in a … We are concerned about all the aggressive behavior … Even though they may be delayed in their progression, many achieve meaningful developmental milestones and lead enjoyable and highly enriching lives. We generally don’t recommend this medication or others from that class of medication for those reasons. In an older person with Down syndrome (particularly beyond age 40), assessing for Alzheimer’s disease is important. For this reason, many children with such characteristic behaviors are treated with stimulant medications. Adult Down Syndrome Center 1610 Luther Lane, Park Ridge, IL 60068 847-318-2303 Aggressive Behavior and Alzheimer’s Disease Brian Chicoine, MD Medical Director I received the question below: I am writing to you for advice on how to handle extreme aggressive behavior my 48-year-old son has been displaying. Down syndrome, rather the focus was a particular form of challenging behaviour (e.g., aggression, self-injury) or a particular intervention strategy (e.g., reinforcement) and involved either a sole participant who had Down syndrome or several participants, only one or two of Despite the fact that many individuals with Down syndrome experience significant cognitive delays and other associated physical conditions, they have a very wide range of abilities, and each individual develops at his or her own pace. Levetiracetam is a prime example – it works well as an anti-seizure medication but in some individuals it can really cause agitation. How severe or mild these problems are varies from child to child.
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