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Comparing the differences between down syndrome and autism

Capone USA Introduction During the past 10 years, I have evaluated hundreds of children with Down's syndrome, each one with their own strengths and weaknesses, and certainly their own personality.

I do not think I've met a parent who does not care deeply for their child at the clinic; their love and dedication is obvious. But some of the families stand out in my mind. Sometimes parents bring their child with Down's syndrome to the clinic - not always for the first time - and they are deeply distraught about a change in their child's behavior or development. Sometimes they describe situations and isolated concerns that worry them such as their child has stopped learning new signs or using speech.

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He is happy playing by himself, seeming to need no one else to make the odd game he is playing shaking a toy, lining things up fun. When they call to him, he does not look at them.

  • There are some medical conditions in which ASD is more common such as Fragile-X syndrome, other chromosome anomalies, seizure disorder, and prenatal or perinatal viral infections;
  • This developmental regression may be followed by excessive irritability, anxiety, and the onset of repetitive behaviors.

Maybe he is not hearing well? He will only eat three or four foods. The suggestion of a new food, or even an old favorite, brings about a tantrum like no other. He is constantly staring at the lights and ceiling fans.

Not just while they pass by, but obsessively. Getting him to stop staring at the lights is sometimes difficult and may result in a scene.

  • But some of the families stand out in my mind;
  • There is not enough information available to know at this time;
  • There is general agreement that;
  • They may feel an additional label is not necessary or accurate.

He requires a certain order to things. Moving a chair to another spot in the room upsets him until it is returned to it's usual spot. Some families do their own research and mention that they think their child may have autistic spectrum disorder ASD along with Down's syndrome. Others have no idea what may be happening.

They do know it is not good and they want answers now. This article is for families in situations like this and other, similar ones. If your child has been dually-diagnosed with Down's syndrome and autistic spectrum disorder DS-ASD or if you believe your child may have ASD, you will learn a little more about what that means, what we are learning through data collection, and insights to the evaluation process.

In fact, until recently, it was commonly believed that the two conditions could not exist together.

Down's Syndrome and Autistic Spectrum Disorder

Parents were told their child had Down's syndrome with a severe to profound cognitive impairment without further investigation or intervention into a diagnostic cause.

Because this philosophy is relatively new to medical and educational professionals, there is little known about children and adults with DS-ASD medically or educationally. We have collected and analyzed data from clinical medical evaluations, psychological and behavioral testing, and MRI scans of the brain.

Signs and symptoms As parents, it is common, if not expected, for you to worry at times about your child's development. It is also common to hear only part of the criteria for a particular label. This is especially true when it comes to DS-ASD because there is little information available on the topic.

This can be especially troublesome if your child suddenly picks up a new habit you associate with ASD such as incessantly shaking toys.

The children we have seen at Kennedy Krieger Institute who have DS-ASD present symptoms in several different ways, which we have separated into two general groups: Group One Children in this first group appear to display "atypical" behaviors early. During infancy or toddler years you may see: Repetitive motor behaviors fingers in mouth, hand flapping Fascination with and staring at lights, ceiling fans, or fingers Extreme food refusal Receptive language problems poor understanding and use of gestures possibly giving the appearance that the child does not hear Spoken language may be highly repetitive or absent.

Along with these behaviors, other medical conditions may also be present including seizures, dysfunctional swallow, nystagmus a constant movement of the eyesor severe hypotonia low muscle tone with a delay in motor skills.

If your child with Down's syndrome is young, you may see only one or a few of the behaviors listed above. This does not mean your child will necessarily progress to have autistic spectrum disorder. It does mean that they should be monitored closely and may benefit from receiving different intervention services such as sensory integration and teaching strategies such as visual communication strategies or discrete trial teaching to promote learning.

Group Two A second group of children are usually older This group of children experience a dramatic loss or plateauing in their acquisition and use of language and social-attending skills. This developmental regression may be followed by excessive irritability, anxiety, and the onset of repetitive behaviors. This situation is most often reported by parents to occur following an otherwise "typical" course of early development for a child with Down's syndrome.

According to parents, this regression most often occurs between ages three to seven years. The medical concerns and strategies for these two groups may be different. There is not enough information available to know at this time. However, regardless of how or when ASD is first discovered, children with DS-ASD have similar educational and behavioral needs once they are identified. Some will have speech, some will not. Some will rely heavily on routine and order, and others will be more easy-going.

Combined with the wide range of abilities seen in Down's syndrome alone, it can feel mystifying. It is easier if you comparing the differences between down syndrome and autism an understanding of ASD disorders separate from Down's syndrome.

Autism, autistic-like condition, autistic-spectrum disorder ASDand pervasive developmental disorder PDD are terms that mean the same thing, more or less. They all refer to a neurobehavioral syndrome diagnosed by the appearance of specific symptoms and developmental delays early in life.

These symptoms result from an underlying disorder of the brain, which may have multiple causes, including Down's syndrome. At this time, there is some disagreement in the medical community regarding the specific evaluations necessary to identify the syndrome or the degree to which certain "core-features" must be present to establish the diagnosis of ASD in a child with Down's syndrome.

Unfortunately, the lack of specific diagnostic tests creates considerable confusion for professionals, parents, and others trying to understand the child and develop an optimal medical care and effective educational program.

Comparing the differences between down syndrome and autism is general agreement that: Autism is a spectrum disorder: Many of the symptoms overlap with other conditions such as obsessive-compulsive disorder OCD or attention deficit hyperactivity disorder ADHD. ASD is a developmental diagnosis. Expression of the syndrome varies with a child's age and developmental level. Autism is a life-long condition. The most commonly described areas of concern for children with ASD include: Communication using and understanding spoken words or signs Social skills relating to people and social circumstances Repetitive body movements or behavior patterns.

Of course there is inconsistency in any of these areas in all children, especially during early childhood. Children who have ASD may or may not exhibit all of these characteristics at any one time nor will they consistently demonstrate their abilities across similar circumstances. Sometimes ASD is overlooked or considered inappropriate for a child with Down's syndrome due to cognitive impairment.

For instance, if a child has a high degree of hyperactivity and impulsivity only the diagnosis of ADHD may be considered. Children with many repetitive behaviors may only be regarded as having stereotypy movement disorder SMDwhich is common in individuals with severe cognitive impairments.

Most parents agree that severe behavior problems are usually not easily fixed. Finding solutions for behavioral concerns is one reason families seek help from physicians and behavior specialists. Compared to other groups of children with cognitive impairment, those with Down's syndrome, as a group, are less likely to have behavioral or psychiatric disorders.

  • Some families do their own research and mention that they think their child may have autistic spectrum disorder ASD along with Down's syndrome;
  • The most commonly described areas of concern for children with ASD include;
  • Some of the more common include;
  • Parents were told their child had Down's syndrome with a severe to profound cognitive impairment without further investigation or intervention into a diagnostic cause;
  • As this context undergoes several transformations, families of children with disabilities may need more support, due to the greater parental involvement required.

When they do, it is sometimes referred to as having a "dual-diagnosis. If you think your child may have ASD disorder, share this before or during your evaluation. Don't wait to see what might happen. Incidence Estimating the prevalence or occurrence of ASD disorder among children and adults with Down's syndrome is difficult.

This is partly due to disagreement about diagnostic criteria and incomplete documentation of cases over the years. This is substantially higher than is seen in the general population. Apparently, the occurrence of trisomy 21, lowers the threshold for the emergence of ASD in some children. This may be due to other genetic or other biological influences on brain development.

A review of the literature on this subject since 1979, reveals 36 reports of DS-ASD 24 children and 12 adults. Of the 31 cases that include gender, an astonishing 28 individuals were males.

The male-to-female ratio is much higher than the ratio seen for autism in the general population. Additionally, in reports that include cognitive level, most children tested were in the severe range of cognitive impairment. Generally, the cause of ASD is poorly understood, whether or not it is associated with Down's syndrome. There are some medical conditions in which ASD is more common such as Fragile-X syndrome, other chromosome anomalies, seizure disorder, and prenatal or perinatal viral infections.

Down's syndrome should be included in this list of conditions. Characterizing and recording these differences in brain development through detailed evaluation of both groups of children will provide a better understanding of the situation and possible treatments for children with DS-ASD.

A detailed analysis of the brain performed at autopsy or with magnetic resonance imaging MRI in children with autism shows involvement of several different regions of the brain: The preliminary results support the notion that the cerebellum and corpus callosum is different in appearance in these children compared to those with Down's syndrome alone.

We are presently evaluating other areas of the brain, including the limbic system and all major cortical subregions, to look for additional markers that will distinguish children with DS-ASD from their peers with Down's syndrome alone.

An analysis of neurochemistry in children with ASD alone has consistently identified involvement of at least two systems. However, our clinical experience in using medications that modulate dopamine, serotonin or both systems has been favorable in some children with DS-ASD.

  1. Data analysis was performed by the mean and standard deviation. A total of 60 mothers of children with disability ranging from 7 months to 6 years of age participated and were divided into three groups.
  2. Others have no idea what may be happening.
  3. According to parents, this regression most often occurs between ages three to seven years.
  4. Compared to other groups of children with cognitive impairment, those with Down's syndrome, as a group, are less likely to have behavioral or psychiatric disorders.
  5. In addition to the medical assessment, you will be asked to help complete a checklist to determine whether or not your child has ASD.

Obtaining an Evaluation If you suspect that your child with Down's syndrome has some of the characteristics of ASD or any other condition qualifying as a dual-diagnosis, it is important for him to be seen by someone with sufficient experience evaluating children with cognitive impairment--ideally Down's syndrome in particular.

Some of the same symptoms which occur in DS-ASD are also seen in stereotypy movement disorder, major depression, post-traumatic stress disorder, acute adjustment reactions, obsessive-compulsive disorder, anxiety disorder, or when children are exposed to extremely stressful and chaotic events or environments.

Sometimes when children with Down's syndrome are experiencing medical problems that are hidden--such as earache, headache, toothache, sinusitis, gastritis, ulcer, pelvic pain, glaucoma, and so on—the situation results in behaviors that may appear "autistic-like" such as self-injury, irritability, or aggressive behaviors.

A comprehensive medical history and physical examination is mandatory to rule out other reasons for the behavior. When cooperation is elusive, sedation or anesthesia may be required.

Down's Syndrome and Autistic Spectrum Disorder

If so, use this "anesthesia time" effectively by scheduling as many specialty examinations as is feasible at one session. In addition to the medical assessment, you will be asked to help complete a checklist to determine whether or not your child has ASD. Each of these is completed either in an interview with parents or done by parents before coming to the appointment.

They are then scored and considered along with clinical observation to determine if your child has ASD. Some of the more common include: