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For people with Down syndrome, family members, caregivers and professionals.

Behavior Change

October 2013 | Brian Chicoine, MD - Medical Director, Adult Down Syndrome Center

Any and all behavior change should be viewed as a possible communication tool.

In the office, via email, at conferences, and most anywhere we talk about Down syndrome, someone will ask about a change in behavior. When I teach medical students and residents, I always tell them that if they are going to sleep through the rest of my presentation, this is the one slide they should review. 

“There is an interaction between physical and mental health. Any and all behavior change should be viewed as a possible communication tool.” 

When there is a behavioral change, it is imperative to look at possible contributing factors. Could there be a physical health problem? A social issue? A psychological stress? A problem in any and all of these areas can contribute to behavioral change.

We have seen hypothyroidism present as depression, celiac disease present with agitated behavior, sleep apnea present as psychoses, and atlanto-axial instability present as a disinterest in school work. The list is endless. We must take a look at physical issues when there is a change in behavior. 

Likewise, social issues can create behavioral change. Years ago, we were asked to see a man with DS who was “whacking people.” The request was for an anti-psychotic medication. In evaluating the situation, we asked the patient what the problem was and he reported his roommate was discretely stealing his things. Our patient wasn’t so discrete when he retaliated. We certainly didn’t condone his aggressive behavior but the treatment was a social solution rather than a medication.

Might the person be trying to share grief, depression, a sense of fear due to a parent’s health problems, or some other psychological stress? 

Might it be a combination of all three, like the man we evaluated years ago who wasn’t doing his job as well? He was about to lose his job. Our evaluation uncovered hypothyroidism (underactive thyroid) and depression. Hypothyroidism can cause depression. Although he had improvement with treating the hypothyroidism, his symptoms didn’t resolve. He also required an anti-depressant.  Then, despite him feeling well, the social situation needed attention. His employer was reluctant to let him return. A meeting was held, the employer’s concerns were addressed, and the man with DS successfully returned to work. 

When investigating a behavioral change, it may take some digging but looking at all aspects of the individual is much more likely to result in understanding the problem and being successful in the treatment. 

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Please note: The information on this site is for educational purposes only and is not intended to serve as a substitute for a medical, psychiatric, mental health, or behavioral evaluation, diagnosis, or treatment plan by a qualified professional. We recommend you review the educational material with your health providers regarding the specifics of your health care needs.