Comorbidity of Down Syndrome and Autism by J. Pary MD

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Among persons with Down Syndrome, about 10% may have autism according to Howlin,

Wing and Gould.1 These authors describe four boys (one was 8-years-old, one 9

years-old, and two 11-years-old). All four boys had significant abnormalities in

the core criteria of autism:(a)impaired social interactions;(b)impaired

communication and © stereotyped routines. They had impaired social interaction

as evidenced by: lack of awareness of others' feelings, inability to seek

comfort, impaired imitation, lack of social play, and poor peer relationships.

They also had poor eye contact nonverbal communication) and impaired

imagination. Three of four showed stereotyped speech. All four children showed

the following stereotyped routines: motor stereotypies, preoccupation with parts

of objects, distress over trivial changes,insistence on routines and

preoccupation with a narrow interest.

Two of the four disliked physical contact. All four either were aggressive to

peers or would push away other children. All four flapped their arms and three

of the four rocked back and forth. Their special interests ranged from fitting

things in boxes, specific videos, spinning things, flickering candles and

switches. They were attached to such objects as leaves and sticks, a pink hair

brush and a piece of hose-pipe. All four had fixed daily patterns and/or fixed

places for objects.

One of the more striking points emphasized by the authors is that autism is

diagnosed later in persons with Down syndrome than in the general population.

Typically, autism is diagnosed before school age. In Down syndrome, the

diagnosis is made much later. The authors stress that the parents the four boys

had concerns about their sons' development. The parents of these children had

difficulties getting professionals to consider autism as the reason why their

sons were falling further behind in school. For example, the school reports did

not indicate any concerns about social development. Nor did reports suggest that

they were different from their peers.

The authors note the obvious effects of autism on the children's need for

specialized teaching that is highly structured for the child's particular skills

and deficits. They also emphasize once a diagnosis of autism is made, it can be

a relief for the parents. They can be referred to parental support groups for

children with autism.

Diagnosing autism in persons with Down syndrome is akin to the problem of the

mental retardation overshadowing a diagnosis of mental ilness. This article

suggests that the occurence of autism and Down syndrome is under-recognized.

Perhaps, future studies will be able to determine whether ten percent of

individuals with Down syndrome are at risk for autism.

J. Pary, M.D.

Associate Professor of Psychiatry

Southern Illinois University, School of Medicine

P.O. Box 19230

751 Rutledge Street

Springfield, IL 62794-9230

The Habilitative Mental Healthcare Newsletter

Jan/Feb 1997, Vol. 16, No. 1.

© 1997 Pysch-Media, Inc.