, Winter 2009. Down Syndrome Victoria Members Journal 7
have performed a number of tests including psychologicaltests, medical evaluations, radiological examinations andbehavioural testing.An important ﬁnding is that children with autism and Downsyndrome also tend to fall into two groups. One group hassymptoms from early infancy and toddlerhood and anothergroup has regression with loss of language and social skills.However the second group regresses at a much later agethan seen in children with autism alone.A recent small study, done in Cincinnati, compared childrenwith regression in autism alone to those with regression inchildren with a dual diagnosis. This supported previousreports that children with both autism and Down syndromehad a later onset of regression at between 3-8 years of agecompared to the regression seen in children with autismalone (18 months-2 years)
Symptoms and behaviours of autism in children with Down syndrome.
Parents often notice that their child with Down syndromeis developing differently from other children with Downsyndrome of the same developmental age. There is someevidence that those children who have additional healthproblems, such as post cardiac surgery brain injury, epilepsy(infantile spasms) and hypothyroidism, are at greater risk of developing autism. A family history of autism may alsoincrease the risk for a child who has Down syndrome.A study from Sweden of children with Down syndrome andautism showed considerable delay in the diagnosis of autism.Average age of diagnosis was 14.4 years (standard deviation7.6 years, range of 4-33 years)
. From the work of the groupat Kennedy Krieger Institute, we know that children withDown syndrome and autism have a lack of social interestin peers and social withdrawal, very odd bizarre stereotypesand anxiety. Other symptoms such as a fascination for lightsand spinning things like fans or wheels, a need for extremeroutine and repetitive behaviours such as ﬁnger twirling,hand ﬂapping and repetitive play are also present.As well as these, there can be extreme sensitivity toparticular sounds, places, smells, leading to distress andanxiety often manifest as a temper tantrum or meltdown.Children may not respond to their name being called andthey may show little interest in playing with toys. Thoughthey may develop language, the functional use of language,such as to greet someone or to communicate with anotherin a two way conversation is limited. They may lose language(regression) or never develop any words.
Other features which may indicate autism
for sameness and predictability.
eye poking .
lining them up in strict order.
their ears or having a tantrum when a baby cries or acertain advertisement comes on the television) sensitivityto seams or labels on clothing, difﬁculty with sensory play,such as with Playdoh, sand, paint and water.
of certain foods. Food texture, temperature and tastemay be factors.
How to get a diagnosis
It is recognised that a multidisciplinary team approach ismost helpful when considering a diagnosis of autism in a child,adolescent or adult. In Victoria there are autism assessmentteams in the each of the Child and Adolescent Mental HealthServices (CAMHS). Other teams providing a multidisciplinaryassessment are based in paediatric units in public hospitalsthroughout the state. There is also a number of privatepractitioners who work in the area of autism and they toocan offer assessment. Some of these practitioners haveexpertise in making a diagnosis in adults.A detailed medical, psychological and speech and languageassessment is needed. Even in non-verbal children, anassessment of their communication system or style is vitalto help understand their needs. Similarly, a cognitive testingcan highlight particular learning difﬁculties or strengths.
Why make the dual diagnosis?
A diagnosis is important so that the appropriate educationalprogram and support can be offered to allow children toachieve the best possible outcomes. Children with Downsyndrome and autism may learn differently from childrenwith Down syndrome alone. It is also useful for parents tounderstand and manage unusual or aggressive behaviours andlearn how to prevent them. These behaviours can sometimesbe viewed as the child being naughty or attention seeking andinstead they are due to anxiety and social difﬁculties.A number of cognitive, behavioural and pharmaceuticaltreatments are beneﬁcial for some of the symptoms of autism. These can help the young person be less stressed andanxious and more available to learn and interact with others.
How to get help with the diagnosis of autism
Autism Victoria is a useful resource to help parents withidentifying appropriate support and help for their child.Autism Victoria24 Drummond St,Carlton VIC 3053(03) 9657 1600www.autismvictoria.org.au
9156 Voice WINTER 2009 FIN.indd 716/6/09 10:11:30 AM