Behavior and Adaptive Functioning in Adolescents With Down Syndrome: Specifying Targets for Intervention

Abstract

Background Research suggests that adolescents with Down syndrome experience increased behavior problems as compared to age matched peers; however, few studies have examined how these problems relate to adaptive functioning. The primary aim of this study was to characterize behavior in a sample of adolescents with Down syndrome using two widely-used caregiver reports: the Behavioral Assessment System for Children, 2nd Edition (BASC-2) and Child Behavioral Checklist (CBCL). The clinical utility of the BASC-2 as a measure of behavior and adaptive functioning in adolescents with Down syndrome was also examined. Methods Fifty-two adolescents with Down syndrome between the ages of 12 and 18 (24 males) completed the Peabody Picture Vocabulary Test, 4th Edition (PPVT-IV) as an estimate of cognitive ability. Caregivers completed the BASC-2 and the CBCL for each participant. Results A significant proportion of the sample was reported to demonstrate behavior problems, particularly related to attention and social participation. The profile of adaptive function was variable, with caregivers most frequently rating impairment in skills related to activities of daily living and functional communication. Caregiver ratings did not differ by gender and were not related to age or estimated cognitive ability. Caregiver ratings of attention problems on the BASC-2 accounted for a significant proportion of variance in Activities of Daily Living (Adj R2 = 0.30), Leadership (Adj R2 = 0.30) Functional Communication (Adj R2 = 0.28, Adaptability (Adj R2 = 0.29), and Social Skills (Adj R2 = 0.17). Higher frequencies of symptoms related to social withdrawal added incremental predictive validity for Functional Communication, Leadership, and Social Skills. Convergent validity between the CBCL and BASC-2 was poor when compared with expectations based on the normative sample. Conclusion Our results confirm and extend previous findings by describing relationships between specific behavior problems and targeted areas of adaptive function. Findings are novel in that they provide information about the clinical utility of the BASC-2 as a measure of behavior and adaptive skills in adolescents with Down syndrome. The improved specification of behavior and adaptive functioning will facilitate the design of targeted intervention, thus improving functional outcomes and overall quality of life for individuals with Down syndrome and their families.

Memory profiles in Down syndrome across development: a review of memory abilities through the lifespan

“…Furthermore, because STM and WM processes require interaction between cortical regions and the hippocampus ([ 77 – 80 ]), behavioral data suggest impairment in connectivity among neural regions in DS. Past research has shown unique patterns of neural activity in children with DS and, in particular, under-connectivity between distant neural regions in those with DS compared to TD controls [ 6 , 138 ].…”

“…Furthermore, although research has consistently documented adaptive function deficits in individuals with DS [ 5 , 6 , 144 ], research examining the relation between memory and adaptive function remains very limited. The two studies examining this relationship found that LTM performance is predictive of adaptive function in teens with DS, after accounting for age [ 9 , 25 ].…”

“…The syndrome results in a gradually declining IQ during childhood (i.e., cognitive gains do not keep pace with chronological age) [ 3 ]. Beginning at an early age, individuals with DS have impairments in adaptive functioning [ 4 – 6 ] and specific cognitive domains such as expressive language, and executive function that are in excess of overall cognitive impairments (for reviews, see [ 7 – 9 ]).…”

Specificity: A Phenotypic Comparison of Communication-Relevant Domains Between Youth With Down Syndrome and Fragile X Syndrome

“…The existing literature has been mixed with regard to these latter domains. Although several studies have pointed to sex-differences in pragmatics, behavior, and communication skills (Lund, 1988 ; Berglund et al, 2001 ; Määttä et al, 2006 ; Van Gameren-Oosterom et al, 2011 ; de Sola et al, 2015 ; Lee et al, 2017 ), studies focused on the adolescent period specifically have generally shown no sex differences with regard to pragmatics (Martin et al, 2017 ) or behavior (Jacola et al, 2014 ). Taken together, these results suggest that sex differences in DS may vary as a function of chronological age and developmental level and, perhaps, the context of assessment.…”

“…As individuals get older, those externalizing behaviors tend to decline, whereas increased internalizing symptoms (e.g., social withdrawal, depression, anxiety, secretive behavior) are more likely to occur (Grieco et al, 2015 ). Finally, within DS, there is some, albeit inconsistent evidence, of sex differences with regard to behavioral difficulties; indeed, some studies have suggested increased behavior problems in males (Van Gameren-Oosterom et al, 2011 , 2013 ), whereas others have reported increased problems in females (Dykens et al, 2002 ), and still others have found no differences (Jacola et al, 2014 ).…”