Mental Health problems in children with Down syndrome

Overview

In general, people with learning difficulties are more at risk of behavioural, emotional or psychiatric problems as compared to the non-intellectually disabled. People with Down syndrome are reported to have a lower incidence of behavioural problems than others with intellectual disability but still at greater risk than the non-disabled population.

Children
Current estimates are that 18-38% of children with Down syndrome will develop neurobehavioral or psychiatric co-morbidity at some point.
The symptoms displayed by children with Down syndrome vary depending on degree of language and communication impairment, intellectual disability and age.
Mental health difficulties encompass a wide range of disorders including:
• anxiety
• obsessive compulsive behaviours
• chronic sleep difficulties
• attention deficit disorder
• autistic spectrum disorder
• depression
• regression with decline in cognitive and social skills.

It is important, in all children whose behaviour changes, to rule out organic causes e.g. thyroid dysfunction, constipation, obstructive sleep apnoea, chronic inflammatory processes as well as non-organic precipitants such as significant life events.

Adults
As with children, recognition of mental health issues in adults with Down syndrome is complicated by the degree of intellectual disability and speech deficit.
Common mental health issues include:
• Anxiety: This is a common concern, with some individuals experiencing anxiety disorders that can manifest as excessive worry, irritability, and difficulty concentrating.
• Depression: Individuals with Down syndrome are vulnerable to depressive disorders, which can be difficult to identify due to atypical symptoms and easily confused with dementia or physical problems such as hypothyroidism. Diagnosis is further complicated by the difficulties in interpreting special investigations such as MRI scans.
• Obsessive-Compulsive Disorder (OCD): OCD is more prevalent in this population compared to the general population.
• Psychosis: Hallucinations and other symptoms of psychosis can occur.
• Dementia: Due to a higher incidence of early-onset Alzheimer’s disease, some adults with Down syndrome may develop dementia.
• Neuro-diversity: Autism Spectrum Disorder (ASD), Attention-Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder and tics
Adults with Down syndrome appear to be protected from some psychiatric disorders such as personality disorder, anxiety, and schizophrenia.

Factors and triggers
Several factors can contribute to the development of mental health issues in both adults and children, including:
• Environmental stress: Individuals with Down syndrome are often sensitive to changes in their environment, such as moving, losing a loved one, or shifting daily routines.
• Physical health problems: Underlying medical issues can cause or worsen mental health symptoms. It is critical to first rule out conditions like thyroid dysfunction, sleep apnoea, or pain.
• Communication barriers: The inability to express thoughts and emotions verbally can be a source of frustration, anxiety, and behavioural change.