Maladaptive behaviour in children and adolescents with Down's syndrome.
Teens with Down syndrome trade outward acting-out for inward withdrawal, and that quiet shift is the behavior to watch.
01Research in Context
What this study did
The team tracked the kids with Down syndrome. Ages ran from 3 to 18 years.
Parents filled out the same behavior checklist twice, about four years apart. No teaching was done.
What they found
Fighting, yelling, and hitting dropped as the kids got older.
Quiet withdrawal, worry, and sadness rose fast after age 14. By late teens, one in three showed clear internalizing signs.
How this fits with other research
Glenn et al. (2007) show the same routines that help little kids with DS turn harmful after mental age 5. The teen rise in withdrawal may be the later phase of that shift.
Sasson et al. (2022) split DS teens into three ASD-symptom groups. The most withdrawn teens sat in the high-symptom cluster, hinting that the climb in internalizing signs is not just "teen moodiness" but tied to social-cognitive traits.
Boettcher et al. (2024) found the same link in other genetic disorders: more withdrawal now predicts more anxiety later. Together these papers warn that social withdrawal is a red flag, not a phase to wait out.
Why it matters
If you serve teens with Down syndrome, add a quick withdrawal check to every six-month review. A simple five-question parent screener is enough. When scores rise, start social-skills groups, teach coping statements, and loop in the psychiatrist early. Catching the shift at 14 gives you four years to teach replacement skills before adult day-program placement.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add one withdrawal question ("Is the student pulling away from peers?") to your next parent check-in and graph the yes/no answer each month.
02At a glance
03Original abstract
BACKGROUND: Although children with Down's syndrome (DS) are at lower risk for psychopathology than others with intellectual disability, they do show more problems than typically developing children. However, age-related trends in these problems remain unclear. METHODS: The present authors examined age-related changes in the maladaptive behaviours of 211 children and adolescents with DS aged between 4 and 19 years (mean = 9.74 years). Most participants (n = 180) were recruited from families residing in the greater Los Angeles area, California, USA, while a minority (n = 31) were patients from a clinic specializing in the psychiatric management of people with DS. The participants were divided into four age groups: (1) 4-6 years, (2) 7-9 years, (3) 10-13 years and (4) 14-19 years. RESULTS: Externalizing behaviours were lower across both the community and clinic samples, while internalizing behaviours were significantly higher in older adolescents aged between 14 and 19 years. Increases were found in withdrawal, seen in 63% of community-based adolescents, and 75% of clinic adolescents. CONCLUSIONS: Older adolescents with DS may show decreased externalizing symptoms and subtle increases in withdrawal. Possible relationships are discussed between these shifts and increased risks of later-onset depression and Alzheimer's disease in adults with DS.
Journal of intellectual disability research : JIDR, 2002 · doi:10.1046/j.1365-2788.2002.00431.x