ADHD and Down Syndrome

Other Medical Symptoms That May Seem Like ADHD

Thyroid Issues

About 30 percent of people with Down syndrome have thyroid disease at some point in life. Most have hypothyroidism, or underactive thyroid gland; a few have disease that results in overactive thyroid gland (Graves' disease). An underactive thyroid gland can, among other things, make a child very tired and apathetic.

Too much thyroid activity can cause agitation and restlessness. Therefore, both conditions can look like poor attention and behavior.

Because thyroid disease is so prevalent in this population, and because it is difficult for doctors to detect just by examining your child, an annual blood test for thyroid hormone is recommended by the Down Syndrome Health Care Guidelines.

Sleep Issues

Sleep disorders are extremely common in Down syndrome. These disorders are a group of conditions with many different causes but one thing in common: They all interfere with getting a good night's sleep. As a parent, you know that tired children can behave very differently from tired adults: They can become restless, whiny, and difficult to calm. And people of all ages have difficulty focusing and learning new information when they are sleep-deprived.

Sleep apnea, or short periods of not breathing during sleep, is especially common. People with Down syndrome have small, often "floppy" airways, which can become completely or partially blocked during sleep by large tonsils and adenoids, or by the floppy walls of the airway collapsing as air is exhaled. Regardless of the cause of obstruction, the sleeper must awaken briefly to resume breathing. Some patients with sleep apnea awaken hundreds of times every night.

Symptoms associated with but not specific to sleep apnea include snoring, lots of thrashing while asleep, excessive daytime sleepiness, mouth breathing, and unusual sleep positions such as sleeping in a seated or hunched-forward position.

Children suspected of having a sleep disorder should undergo a sleep-study evaluation at an accredited sleep center.

What types of communication difficulties can look like ADHD?

People with Down syndrome can have many barriers to effective communication. The receptive language skills of children with Down syndrome (how well they understand what is being said) are often much stronger than their expressive language skills (how well they can say it). Parents often comment, "He knows what he wants to tell us, he just can't seem to put the words together, or we can't make out what he is saying." Classroom participation is thus more difficult as well. The child may express his frustration by acting out or by inattention.

What types of educational problems can look like ADHD?

Children with Down syndrome have a wide range of learning styles. Your child's educational team may need to try more than one method of presenting material before finding the one that works best for your child. If material is presented in a way that is not compatible with a child's learning style (for example, oral lectures for a student who needs visual aids and prompts), that child may appear bored, fidgety, and hyperactive.

The level of the material might also be a problem. If a child is presented with concepts that are too difficult for his cognitive level, his attention might drift. A child who is bored with overly easy material might also tune out. In either case, a child who is not engaged with the material could act out.

What types of emotional issues can look like ADHD?

Because of the communication problems discussed above, people with Down syndrome may have difficulty talking about things that make them sad or angry. Major life changes such as loss or separation may spur inappropriate behavior at school or work.

What are the next steps?

If you are concerned about decreased attention span, impulsive behavior, and excessive fidgeting or other non-directed motor activity in your child, consult your pediatrician, a developmental and behavioral pediatrician, or a child psychiatrist.

Originally featured on National Down Syndrome Society (NDSS.org) and reprinted with permission. Copyright © 2012 Meredith Corporation.