Individuals with Down Syndrome and Their Families

Early Intervention

The first years of life are a critical period in child development. All young children experience rapid and significant developmental changes during this time. In these early years, the development of basic physical, cognitive, language (speech), social communication and self-monitoring skills is effective, which forms the basis for future progress. Children with Down Syndrome also typically experience delays in certain areas of development, so early intervention is highly recommended. Educaation can be started at any time after birth, but the sooner the better.

Early intervention is a systematic program of therapy/education, exercise and activity designed to address developmental delays that children with Down Syndrome or other disabilities may experience. International agreements and conventions mandate the provision of early intervention services to all eligible children to enhance the development of infants and toddlers and to help families understand and meet their children's needs. The most common early intervention services for babies with Down Syndrome are special education, physical therapy, speech and language therapy, and play/occupational therapy. Early intervention should begin shortly after birth and generally continue until the child is 3 years old.

Development Processes of People with Down Syndrome

Development is a continuous process that begins with conception and progresses gradually in an orderly sequence. In each of the four developmental areas (gross and fine motor skills, language skills, social development, and behavioral adaptation skills) there are specific milestones that serve as prerequisites for subsequent stages. Most children are expected to reach each milestone at a set time, also called the "key age", which can be calculated in weeks, months, or years. Because of the difficulties associated with Down Syndrome, babies will likely experience delays in certain areas of development. When monitoring the development of a child with Down Syndrome, it is more helpful to look at the order of milestones reached rather than the age at which the milestone was reached.
Early intervention and early childhood education at the DOSD Center is aimed at infants/children 0-36 months with Down Syndrome and is built on a strong family-educator or family-therapist collaboration.

Preschool and School Age

Attention deficit hyperactivity disorder (ADHD): covers pre-/post-education skills, communication and social interaction abilities of preschool or school-aged children with Down Syndrome. In addition, ADHD is a condition commonly diagnosed in childhood and adolescence and is characterized by the consistent display of the following features:
All children, including those with Down Syndrome, exhibit these traits from time to time. But children with ADHD display them to a much higher degree than their peers, and they do so in any setting (at home, at school, and at play).

The exact frequency of ADHD in children with Down Syndrome is not known. However, ADHD-like symptoms are more common in young children with Down Syndrome than in normally developing children. Other possible medical conditions, changes in educational programs, and communication needs should be addressed first before a formal diagnosis of ADHD is made.The following may present with ADHD-like symptoms and should be considered:

Hearing and Vision Problems

Children with Down Syndrome are prone to hearing loss and vision problems. Both vision and hearing should be evaluated regularly to rule out conditions that may contribute to attention difficulties, such as ear infections, the need for glasses, and other vision and auditory diagnoses.

Gastrointestinal Problems

People with Down Syndrome have a high risk of celiac disease and constipation. Both diagnoses can cause changes in energy, behavior, and restlessness.

Thyroid Problems

About 30% of people with Down Syndrome have thyroid disease at some point in their lives. Most have hypothyroidism or an underactive thyroid gland. A few have a disease that results in an overactive thyroid gland (graves' disease). An underactive thyroid gland can make a child very tired and apathetic, among other things. Too much thyroid activity can cause agitation and restlessness. So both conditions can seem like poor attention and behavior.

Sleep Disorders

People with Down Syndrome are often diagnosed with various sleep disorders. These disorders are a group of conditions with many different causes, but all result in insufficient sleep. Lack of sleep can also result in restlessness, poor attention, mood swings, inability to focus, and compulsive behavior.


There are many obstacles in front of the effective communication of people with Down Syndrome. In particular, the receptive language skills of children with this difference are often much stronger than their expressive language abilities. A child may express his frustration outwardly or carelessly.


Children with Down Syndrome have a wide variety of learning styles. A child's education team may need to try more than one method of presenting the material before finding what works best for the child. If material is presented in a way that does not suit a child's learning style, that child may appear bored, hyperactive, fidgety or inattentive. 

If you are concerned about decreased attention span, impulsive behavior, excessive fidgeting or other undirected motor activities in your child, it would be appropriate to consult your pediatrician or child psychiatrist. 

The first step in evaluating a child or adult with Down Syndrome presenting with behavioral anxiety is to determine if there are any acute or chronic medical problems related to the described behavior. Below is a list of more common medical issues that may be associated with behavior changes.
The behavioral difficulties seen in children with Down Syndrome are not particularly different from those seen in normally developing children. However, these difficulties may arise later in life and may last longer. For example, tantrums are typically common around the ages of 2 and 3, but for a child with Down's Syndrome they can begin at age 3 to 4.

When assessing behavior in a child or adult with Down Syndrome, it is important to know the individual's receptive and expressive language skill levels. Because many behaviors are associated with frustration in communication. Often times, behavior problems can be resolved by finding ways to help the person with Down Syndrome communicate more effectively.

Behavior changes in adults with Down Syndrome have many potential causes. Some individuals have difficulty transitioning into adulthood as they face the loss of social networks, the separation of older siblings, the death of loved ones, changes in the home, and the challenge of finding meaningful employment. Some individuals also experience vision and/or hearing loss as they age. If these losses are not noticed and treatment is not started, they can cause significant behavioral changes. Hypothyroidism, celiac disease, obstructive sleep apnea, depression, regression, and Alzheimer's disease are other health problems that can cause behavioral changes. Regular check-ups with medical professionals familiar with the healthcare needs of adults with Down Syndrome are the best way to quickly identify or avoid these conditions. 

Regression is a relatively new diagnosis that refers to the loss of previously acquired skills, usually presenting in late childhood or early adulthood. This loss can occur within weeks or months and may include skills such as language, motor skills, self-care, and social interaction. Regression can have several different causes and should be thoroughly investigated by a specialist. If you notice that your loved one is withdrawing from friends and family, talking less, reducing eye contact, engaging in compulsive behaviors, hallucinating or acting aggressively, it is recommended that you make an appointment with your doctor. Remission is different from Alzheimer's disease and in some cases is reversible with treatment.

Friendships and social relationships are important for all children with or without special educational needs. Social inclusion is a critical issue for every student with a disability, regardless of whether the student is studying purely in special education or regular education classrooms. All of the students educated in all these scenarios will eventually live and work in communities where they need to be able to interact with people of their ability level. One of the critical components of social inclusion is that students get to know children with Down Syndrome, and these children see themselves as valuable participants in the classroom and school.

Home-Centered Family Education

Educational activities require the participation of families and siblings in the program, as children with Down Syndrome require continuous and systematic intervention. In home-centered family education, families are provided with the necessary skills to become home educators for their children. Families regularly visit the DOSD Center in systematically planned periods, while educators make regular home visits to guide families in the work to be carried out at home. Studies for families help children generalize the new skills they learn in the institution first to their home and then to other social settings.