What is Down Syndrome?
By Siegfried M. Pueschel, M.D., Ph.D., M.P.H. Dr. Pueschel, Director, Child Development Center, Rhode Island Hospital, Providence, Rhode Island was awarded The Arc's l990 Distinguished Research Award.
This article was originally published by The Arc of the United States, www.TheArc.org.
People with Down syndrome are first and foremost human beings who have recognizable physical characteristics and limited intellectual endowment which are due to the presence of an extra chromosome 21.
The estimated incidence of Down syndrome is between 1 in 1,000 to 1 in 1,100 live births. Each year approximately 3,000 to 5,000 children are born with this chromosome disorder. It is believed there are about 250,000 families in the United States who are affected by Down syndrome. [Note: In Rhode Island, approximately 15 babies per year are born with Down syndrome - DSSRI].
This statement by the Down Syndrome Society of Rhode Island clarifies the meaning of and emphasizes the importance of language when referring to individuals with Down syndrome. The words that people use can help all individuals to lead more complete and enriching lives. Words can also create barriers and reinforce stereotypes. The primary goal of this statement is to ensure that correct language is used when talking, or writing, about individuals with Down syndrome.
- The correct name of this diagnosis is Down syndrome. There is no apostrophe (Down). The "s" in syndrome is not capitalized (syndrome).
- An individual with Down syndrome is an individual first, and foremost. The emphasis should be on the person, not the disability. Down syndrome is just one of many words that can be used to describe a person. A child with Down syndrome, an adult with Down syndrome, or a person with Down syndrome is a more appropriate way to discuss a person with this condition.
- Words can create barriers; try to recognize that a child is "a child with Down syndrome" or that an adult "is an adult with Down syndrome." Children with Down syndrome grow into adults with Down syndrome; they do not remain "eternal children."
- Ask yourself if using the words, "poor," "pitiful," or "unfortunate" when referring to an individual with Down syndrome is in her/his best interest.
- Each person has her/his own unique strengths, capabilities, and talents. Try not to use the cliches that are so common when describing an individual with Down syndrome. To assume all people have the same characteristics or abilities is degrading. Also, it reinforces the stereotype that "all kids with Down syndrome are the same."
- Most important, look at the person as an individual, your child, your family member, your student, your friend. Proudly acknowledge their individuality and their accomplishments.
What is the cause of Down syndrome?
Although many theories have been developed, it is not known what actually causes Down syndrome. Some professionals believe that hormonal abnormalities, X-rays, viral infections, immunologic problems, or genetic predisposition may be the cause of the improper cell division resulting in Down syndrome.
It has been known for some time that the risk of having a child with Down syndrome increases with advancing age of the mother, i.e., the older the mother, the greater the possibility that she may have a child with Down syndrome. However, most babies with Down syndrome (more than 85%) are born to mothers younger than 35 years. Some investigators reported that older fathers may also be at an increased risk of having a child with Down syndrome.
It is well known that the extra chromosome in trisomy 21 could either originate in the mother or the father. Most often, however, the extra chromosome is coming from the mother.
What kind of information can be provided through genetic counseling?
Parents who have a child with Down syndrome have an increased risk of having another child with Down syndrome in future pregnancies. It is estimated that the risk of having another child with Down syndrome is about one in 100 in trisomy 21 and mosaicism. If, however, the child has translocation Down syndrome and if one of the parents is a translocation carrier, then the risk of recurrence increases markedly. The actual risk depends on the type of translocation and whether the translocation is carried by the father or the mother.
What health concerns are often observed in people with Down syndrome?
The child with Down syndrome is in need of the same kind of medical care as any other child. The pediatrician or family physician should provide general health maintenance, immunizations, attend to medical emergencies, and offer support and counseling to the family. There are, however, situations when children with Down syndrome need special attention:
1. 60 - 80%of children with Down syndrome have hearing deficits. Therefore, audiologic assessments at an early age and follow-up hearing tests are indicated. If there is a significant hearing loss, the child should be seen by an ear, nose and throat specialist.
2. 40 - 45% of children with Down syndrome have congenital heart disease. Many of these children will have to undergo cardiac surgery and often will need long-term care by a pediatric cardiologist.
3. Intestinal abnormalities also occur more often in children with Down syndrome. For example, a blockage of the food pipe (esophagus), small bowel (duodenum), and at the anus are not uncommon in infants with Down syndrome. These may need to be surgically corrected at once in order to have a normally functioning intestinal tract.
4. Children with Down syndrome often have more eye problems than other children who do not have this chromosome disorder. For example, 3% of infants with Down syndrome have cataracts. They need to be removed surgically. Other eye problems such as cms-eye (strabismus), near-sightedness, far-sightedness and other eye conditions are frequently observed in children with Down syndrome.
5. Another concern relates to nutritional aspects. Some children with Down syndrome, in particular those with severe heart disease often fail to thrive in infancy. On the other hand, obesity is often noted during adolescence and early adulthood. These conditions can be prevented by providing appropriate nutritional counseling and anticipatory dietary guidance.
6. Thyroid dysfunctions are more common in children with Down syndrome than in normal children. Between 15 and 20%of children with Down syndrome have hypothyroidism. It is important to identify individuals with Down syndrome who have thyroid disorders since hypothyroidism may compromise normal central nervous system functioning
7. Skeletal problems have also been noted at a higher frequency in children with Down syndrome, including kneecap subluxation (incomplete or partial dislocation), hip dislocation, and atlantoaxial instability. The latter condition occurs when the first two neck bones are not well aligned because of the presence of loose ligaments. Approximately 15% of people with Down syndrome have atlantoaxial instability. Most of these individuals, however, do not have any symptoms, and only 1-2% of individuals with Down syndrome have a serious neck problem that requires surgical intervention.
8. Other important medical aspects in Down syndrome, including immunologic concerns, leukemia, Alzheimer disease, seizure disorders, sleep apnea and skin disorders, may require the attention of specialists in their respective fields.
Can Down syndrome be medically treated?
Although many medications and therapies have been touted as treatment for people with Down syndrome, there is no effective medical treatment available at the present time. However, recent advances in molecular biology make it feasible now to examine the genetic basis for Down syndrome. Once we identify the genes on chromosome 21 (many already have been discovered) and once we find the mechanism of how these genes interfere with normal developmental sequences, and if one could counteract these specific actions, a rational approach to medical therapy could emerge.
What educational services and vocational opportunities are available for people with Down syndrome?
Today early intervention programs, preschool nurseries, and integrated special education strategies have demonstrated that youngsters with Down syndrome can participate in many learning experiences which can positively influence their overall functioning. Research has shown that early intervention, environmental enrichment, and assistance to the families will result in progress that is usually not achieved by those infants who have not had such educational and stimulating experiences.
Children with Down syndrome, like all children, can benefit from sensory stimulation, specific exercises involving gross and fine motor activities, and instruction in cognitive development. Also, preschool nurseries play an important role in the young child's life since exploring the environment beyond the home enables the child to participate in a broader world.
Later, the school can give the child a foundation for life through the development of academic skills and physical as well as social abilities. Experiences provided in school assist the child in obtaining a feeling of self-respect and enjoyment. School should provide an opportunity for the child to engage in sharing relationships with others and help to prepare the child to become a productive citizen. Contrary to some views, all children can learn, and they will benefit from placement in a normalized setting with support as needed.
During adolescence, youngsters with Down syndrome should be exposed to pre-vocational training in order to learn good work habits and to engage in proper relationships with co-workers. Appropriate vocational counseling and job training will result in meaningful employment, and this, in turn, should lead to a feeling of self-worth and of making a contribution to society.
What attitude should society have?
It is important that society develop attitudes that will permit people with Down syndrome to participate in community life and to be accepted. They should be offered a status that observes their rights and privileges as citizens, and in a real sense preserves their human dignity. When accorded their rights and treated with dignity, people with Down syndrome will, in turn, provide society with a most valuable humanizing influence.
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