ADHD and Down Syndrome

Recognize whether a child with Down syndrome also has attention deficit hyperactivity disorder.
National Down Syndrome Society

Attention deficit hyperactivity disorder, or ADHD, is a commonly diagnosed childhood problem. ADHD is characterized by consistent demonstration of the following traits: decreased attention span, impulsive behavior, and excessive fidgeting or other non-directed motor activity. All children, including children with Down syndrome, display these traits from time to time. But the child with Down syndrome may exhibit these traits more often than other children his age.

How common is ADHD in children with Down syndrome?

The frequency of ADHD in children with Down syndrome is not known with certainty. However, ADHD-like symptoms are more common in young children with Down syndrome compared with children from the general population. Compounding symptoms -- such as stereotypy (repetitiveness), anxiety, or extreme irritability -- in the presence of ADHD-like symptoms may indicate another disorder such as autism, bipolar disorder, or obsessive-compulsive disorder.

Uncomplicated ADHD is common in younger children with Down syndrome. However, many school age children with ADHD frequently have other behavioral conditions, including oppositional defiant disorder, disruptive behavior disorder, or obsessive-compulsive traits.

Does that mean that your child has ADHD?

It may, but more often it means that a medical problem needs to be addressed, or that your child's educational program or communication method needs some adjustment. In children with Down syndrome who have difficulty paying attention, ADHD is a diagnosis of exclusion. Other problems must be ruled out first.

What are medical problems that can look like ADHD?

Hearing and Vision Issues

In order for a child to pay attention to classroom material, she has to be able to hear and to see it. Both hearing and visual problems are common in children with Down syndrome. Ear infections are overwhelmingly common and, even if treated, can cause hearing loss for weeks. People with Down syndrome have middle ear structural abnormalities that can cause lifetime mild to moderate hearing loss.

Both near- and far-sightedness are common in individuals with Down syndrome, as well as cataracts and "lazy eye."

How to rule out significant hearing or visual loss as a cause of attention problems

To monitor hearing, an auditory brainstem response test (ABR) or otoacoustic emission (OAE) should be performed early in the child's life (by 3 months of age at the latest) as a baseline. Hearing screens should be performed annually until 3 years of age, and every other year thereafter. Children with abnormal hearing evaluations should be seen by an ear-nose-throat physician (otolaryngologist) to manage treatable causes of hearing loss.

A child with Down syndrome should be evaluated by an eye doctor during the first year of her life, and yearly thereafter. Some children may need more frequent follow-up depending on their visual diagnosis.

Gastrointestinal Issues

People with Down syndrome are at increased risk for an intestinal condition called celiac disease, a condition in which the body cannot process a protein found in wheat and certain other grains. Typical symptoms of celiac disease include loose stools, diarrhea, and poor weight gain, but the condition often presents only with subtle effects on energy and behavior. People with Down syndrome are also predisposed to significant constipation, which when severe can cause abdominal pain, lack of appetite, and restlessness.

Current recommendations for gastrointestinal monitoring include screening for celiac disease between 2 and 3 years of age. This screening should include measurement of IgA antiendomysium antibodies, as well as total IgA. Your child's primary care provider will want to review your child's bowel status with you at each visit as well.

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