Associations among co-occurring medical conditions and
cognition, language, and behavior in Down syndrome
Emily K. Schworer, Ameena Ahmed, Lori Hogenkamp, Shelby Miller, Anna J. Esbensen
Introduction
● Gastrointestinal issues (GI), hearing loss,
vision impairment, thyroid problems, and
congenital heart defects (CHD) are more
prevalent in Down syndrome (DS) compared
to the general population.
● There is a need to better understand
associated outcomes for these medical
conditions given their high prevalence in DS
and limited literature on associated outcomes.
● Understanding the interconnectedness of
co-occurring medical conditions with
outcomes will assist medical providers in
addressing cognitive and behavioral
challenges in DS.
● The objective is to evaluate the relationship
between specific medical conditions (i.e., GI
issues, hearing loss, vision impairment,
thyroid problems, and CHD) and cognition,
language, maladaptive behavior, executive
functioning, and social behavior in children
and adolescents with DS.
Hypotheses
Hypotheses were formed based on existing
literature:
● Children with DS who have GI issues will have
more difficulty with executive function and more
maladaptive behaviors.
● Children with DS who have hearing loss will
have lower language abilities and executive
function, and more maladaptive behaviors.
● Children with DS who have vision problems
will have lower cognitive and language skills.
● Children with DS who have thyroid problems
will have more maladaptive behaviors and
lower cognitive ability.
● Children with DS who have CHD will have
lower language abilities, executive function,
and cognitive ability, and more maladaptive
behaviors.
Multiple domains had no hypotheses and
associations between medical conditions and
behaviors were explored.
Methods Discussion & Implications
● Participants & Procedures: Participants were 73 children with DS ages 6 to 17 (M chronological age ● The association between GI concerns and
= 12.67, SD = 3.16). All participants were administered a set of neuropsychological assessments outcomes of interest were pervasive across
including measures of intelligence and language and their caregiver completed all questionnaires. multiple measures and indicate a persistent
● Measures: The study included the following measures, Demographic and Medical History relationship between GI concerns and child
Questionnaire, to assess co-occurring medical conditions, Stanford-Binet Intelligence Scales, 5th functioning.
Edition (SB5; Roid, 2003) to assess cognition, Expressive Vocabulary Test, 3rd Edition (EVT-3;
● Children with GI concerns may be experiencing
Williams, 2018) and Peabody Picture Vocabulary Test, 5th Edition (PPVT-5; Dunn, 2019) to assess
symptoms that cause them to act out, be
language, Child Behavior Checklist (CBCL; Achenbach, 2001) to assess maladaptive behavior,
aggressive, seem withdrawn, experience a
Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2; Gioia et al., 2015) to
assess executive function, and Social Responsiveness Scale, Second Edition (SRS-2; Constantino & worse mood, or demonstrate difficulties with
Gruber, 2012) to assess social behavior. executive functioning or socially relating to other
children.
● Providers of children with DS presenting with
challenges with behavior, executive functioning,
Results or social skills are encouraged to screen for
undiagnosed GI concerns.
● Despite a considerably small group of children
● Table 1 reports the co-occurring medical conditions for participants in the current study. not being treated for thyroid problems (n = 3),
there may be differences with executive function
if this medical condition goes unaddressed.
● Most medical concerns and cognitive and
behavioral measures investigated were not
significantly associated. One interpretation is
that those medical conditions do not affect child
functioning, however, there may be other
varying reasons for this result unique to each
● Children with GI concerns had more internalizing/externalizing behaviors, greater executive medical condition.
functioning difficulties, and more social difficulties than children without GI concerns (p < .05).
Conclusion
This study contributes to our understanding of the
interrelation of co-occurring medical conditions
with cognitive and behavior characteristics in
children and adolescents with DS. Behavioral
interventionists are encouraged to consider
medical contributors to behavioral presentation.
The findings of this study have implications for
devising interdisciplinary, multi-level, and patient-
and family-centered approaches to care.
Acknowledgement
● Children with DS and untreated thyroid problems had higher challenges with cognitive This poster was prepared with support from the Eunice Kennedy Shriver
regulation compared to children with DS and treated or no thyroid problems. National Institute of Child Health and Human Development of the
National Institutes of Health (PI Esbensen: R01 HD093754) and CCHMC
● Differences were not observed with cognitive, language, maladaptive behaviors, executive LEND program (Maternal and Child Health Bureau T73MC00032). This
research would not have been possible without the contributions of the
functioning, and social behavior on hearing difficulties, vision difficulties, or CHD. participating families and the community support.