When a child has a dual diagnosis of Down syndrome and autism spectrum disorder, therapy and education approaches must be specially tailored to their needs and the way they learn. At Therapy & Wellness Connection, our speech therapists, occupational therapists, physical therapists, and ABA therapists are committed to ensuring that every child is properly diagnosed and receives therapy that is going to help them thrive and reach their full potential.

In the past, it was presumed that autism was fairly rare in people with Down syndrome. We now know that’s not the case. Per the Down Syndrome Resource Foundation, it’s estimated autism is about 10-25 percent more common among people with Down syndrome as it is for the typical population. However, diagnosis of autism typically comes much later in kids with Down syndrome than it does for other kids. According to DSRF, the mean age of an autism diagnosis for a child with Down syndrome was about 14.4 years. It’s been well-established  that the sooner kids receive early intervention treatment for autism, the better their long-term prognoses on several fronts.

There are several reasons for the delay in autism diagnosis for kids with Down syndrome. For one thing, while Down syndrome is almost instantly recognizable (and verifiable with a blood test), autism spectrum disorder is not. It is subjective, based upon observed social communication and behavior patterns.

A delayed diagnosis does put these kids at a disadvantage developmentally, academically, and socially – even compared to kids who only have one of the two disabilities. For example, there is a faulty assumption that all people with Down syndrome are “outgoing” or “charming.” But when a child with Down syndrome also has autism, they may struggle to relate socially, failing to live up to the unrealistic expectations of social strengths. (However, there is some evidence that kids this dual diagnosis may have stronger social skills than those solely diagnosed with autism.)

Parents of children with Down syndrome who are also on the spectrum may at first think they’ve done something wrong, particularly when they notice their child is making fewer strides or exhibiting more behavioral problems compared to other kids with Down syndrome.

Our ABA, occupational, physical, and ABA therapists work with lots of kids who have dual diagnoses of Down syndrome and autism. We can help parents recognize the signs and help them navigate the process to obtain ADOS testing and a diagnosis, which can help open the door to additional services.

Diagnosing Autism in a Child with Down Syndrome

It’s generally accepted that a child with autism will present some combination of the following:

• Pervasive deficits in social interaction and social communication, not accounted for by general developmental delays.
• Repetitive, restricted behavior patterns, activities or interests.
• Hypo- or hyper-reactivity to sensory input.
• Symptoms present in early childhood.
• Combined symptoms limit everyday function.

We often hear parents of kids with a dual diagnosis of Down syndrome and autism say they recognized something was different early on, but they couldn’t tell exactly what. This is understandable because many of the characteristics of autism are also routinely observed in kids with Down syndrome – especially the social communication component. Lots of children with Down syndrome have difficulty with expressive language, speech sound production and voice, as well as underlying cognitive deficits. That makes a dual diagnosis tricky!

If you suspect your child might have autism, it’s important to talk to the members of your professional support team, including your pediatrician, speech therapist, ABA therapist, physical therapist, occupational therapist, child psychologist, teachers, etc. Get their input and guidance. Ultimately, an autism diagnosis will be made by a physician or psychiatrist, but having feedback from the other professionals who know your child well can be valuable when presenting your concerns.

Treatment for Kids With a Dual Diagnosis

Many of our pediatric patients at Therapy & Wellness Connection have comorbidities (more than one condition). Those diagnoses can provide access and a road map, but ultimately, our therapies and education services are tailored to the individual child. Kids with both of these conditions often benefit from multiple, early intervention therapies, including speech, occupational, ABA, feeding/swallowing and physical therapy.

If your child has been diagnosed with both autism and Down syndrome or are concerned your child with Down syndrome might be on the spectrum, we can help.

Therapy & Wellness Connection – your connection to a life without limitations – provides ABA therapy, speech therapy, occupational therapy, and physical therapy to children in Cleveland, Brecksville-Broadview Heights, Akron and surrounding communities. We also offer summer camp, day programs, homeschooling, alternative schooling, virtual therapy and education, vocational counseling and more. Call us at (330) 748-4807 or send us an email.

Additional Resources:

Down Syndrome and Autism Spectrum Disorder Dual Diagnosis: Important Considerations for Speech-Language Pathologists, Dec. 14, 2020, American Journal of Speech-Language Pathology