Mental health and behaviour in people with Down syndrome

People with Down syndrome require the same factors to achieve and maintain good mental health as the rest of the population, including respectful relationships, inclusion and participation, a sense of being valued, opportunities to exercise choice and independence, and having future plans to look forward to.

When diminished, these factors can contribute to the risk of psychiatric disorders or the incidence of challenging behaviour. An annual comprehensive health assessment is recommended, including assessment of behaviour and risk of psychiatric disorders, and may require multidisciplinary referral. Promoting mental health wellbeing and identifying and treating psychiatric disorders are essential to optimising quality of life in people with Down syndrome.

People with Down syndrome have an increased risk of psychiatric disorders at certain life stages; for instance:

• depression and anxiety disorders are more common in adolescence and early adulthood, when social barriers and difficulties become more apparent—see Psychiatric disorders in people with developmental disability
• obsessive compulsive and phobic disorders are more common than in the general population at any age
• young people with Down syndrome can experience a regressive condition associated with catatonia, also described as ‘Down syndrome disintegrative disorder’, ‘new-onset autistic regression’ and ‘regression, dementia, and insomnia’; it can present with negativism, loss of independence, speech impairment and slowed movement—also exclude medical or other causes of functional decline
• Alzheimer disease can occur at an earlier age than the general population (average age of diagnosis is 50 years)—include assessment of function in annual screening from age 30, see also Functional decline in adults with Down syndrome.

There is an increased incidence of autism spectrum disorder (ASD) and attention deficit disorder (ADD) in people with Down syndrome.

Psychiatric disorders and poor mental health undermine both function and wellbeing. Some people with Down syndrome may express their frustration, sadness, distress or psychiatric disorder through a change in their behaviour; see What is challenging behaviour?. Routines and repetition are important for most people with Down syndrome; this has been referred to as a tendency to follow familiar ‘grooves’ of thought and action, and may be considered part of a common behavioural phenotype in people with Down syndrome. Maladaptive grooves (eg unhealthy eating, sedentary lifestyle, defiance, reluctance to try new activities) may need behavioural support and replacement strategies—refer to an occupational therapist, psychologist or behavioural specialist.