Assessment of mental health problems in people with Down syndrome: key considerations

Abstract

Accessible summary• People with Down syndrome can have problems with the way they think, feel, and act. • Those who help people understand these difficulties need to have information about the factors that can contribute to such problems. • This knowledge is important so difficulties can be found early, and help given. SummaryThe dual disability literature is marked by a lack of reviews with respect to assessment of specific aetiological groups. The current review summarises the wide body of literature relevant to the assessment of psychiatric and behavioural problems in people with Down syndrome. Adequate assessment within this population requires knowledge, not only of epidemiological findings with respect to psychiatric and behavioural problems, but also an understanding of other important areas including psychometrics, neurocognitive functioning, dementia and other medical issues. These areas are reviewed, and directions for future research are proposed.

Down Syndrome and Dementia: Guide to Identification, Screening, and Management

“…17 Fortunately, adults with DS are at lower risk for psychosis compared with those with other intellectual disabilities. 18 Use of private speech, or "self-talk," has at times been interpreted as psychosis but is not and should be viewed as adaptive communication for adults with DS. 19 Adults with DS may also have primary anxiety and depression but may be unable to self-report their symptoms.…”

“…19 Adults with DS may also have primary anxiety and depression but may be unable to self-report their symptoms. 18 Caregiver input is essential in gathering comprehensive data on baseline behavior for comparison with noted changes. 17 Behavioral and personality changes may in fact precede a deterioration of memory as frontal lobe function may be first to be affected in DS patients with dementia.…”

Will General Practitioners be adequately prepared to meet the complexities of enhanced dementia screening for people with learning disabilities and Down syndrome: key considerations

“…Information provided will need to be individually assessed and take into account the person's level of learning disability, associated needs and the need for psychological and emotional support. Indeed, for people with learning disabilities who are particularly prone to depression and anxiety, with higher prevalence rates than in the general population (Spendelow ), the screening information could have a significant effect upon their mental health and well‐being. No one can predict how someone is likely to react, but few people would dispute that being at risk of developing dementia is deeply distressing (Alzheimer's society's ) and has the potential to cause distress and lower morale (Cairns et al .…”

“…Early signs of dementia may therefore not be as noticeable or can be overshadowed by the person's comorbidities. Screening discussions therefore require a degree of sufficient specialist knowledge in regard to common differential diagnosis, behavioural phenotypes and comorbid health needs associated with certain syndromes (Spendelow ). Background knowledge of typical behavioural traits commonly associated with Down syndrome, Prader‐Willi, Cornelia de Lange syndrome, fragile X and many other genetic syndromes is essential to inform the screening process.…”

“…). In addition, the practitioner will need to be aware of the obsessional behaviours, thyroid dysfunction, cardiac problems and sensory impairments commonly associated with Down syndrome (Spendelow ). Unfortunately, this is not always the case, as GP training in learning disabilities has been optional to those who have wished to specialise in higher training, and very little, if any has been incorporated within undergraduate training (Aspray et al .…”