We have seen people with Down syndrome with a variety of phobias. Concern about heights is one we see more commonly. For this fear in particular, we often ask if it is indeed a phobia or if it is caused by something else.
Our sense is that many people with Down syndrome have a difference in depth perception. Having watched thousands of people get up on the exam table, it is clear that many people with Down syndrome find moving to different levels challenging. Even moving from one surface to another, such as from tile to carpet, can be disconcerting to some.
How much “fear of heights” is a phobia versus a difference in depth perception may be difficult to ascertain.
What can be done?
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Consider a good eye exam to assess vision. Monocular vision (seeing with one eye) limits depth perception. Is there a problem that can be addressed to improve binocular vision?
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Consider other therapies. Our sense is that much of the depth perception challenge in people with Down syndrome is “in the brain, not in the eyes.” By that we mean the eyes may be functioning adequately but the ability of the brain to interpret the signals may be affected. We are not aware of a treatment for this. However, could a person get occupational or physical therapy to improve the situation? Some other available therapy? We do not have an answer, but it is worth consideration.
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Try using in-the-moment calming strategies. These may include taking deep breaths or squeezing a stress ball. It may be helpful to hold the individual's hand or arm and use reassuring phrases such as "I'm right here with you" or "Let's count our steps as we go" (in the case of going up or down stairs).
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Consider desensitization. Desensitization is a treatment for phobias. Desensitization is a means of gradually reducing a person’s fear by incrementally helping him/her tolerate being around things he/she fears. In the case of the fear of heights, the person would be gradually brought to higher places. Some relaxation techniques can be used while the person is exposed to the high places. However, if the problem is really a depth perception issue that is driving the fear, will the person respond, or will we only make them more fearful? Unfortunately, we are not aware of a good answer for that question either.
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Consider using visuals. One thing that might give some benefit is the use of pictures to prepare the person for the upcoming exposure to heights. Many people with Down syndrome benefit from having knowledge of what is to come rather than being exposed unexpectedly. However, whether it will be enough to overcome the fear can only be determined by trying.
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What about medication? If it is truly a phobia, medications for anxiety will often only have limited (if any) benefit. Unfortunately, many medications for anxiety may make someone feel slightly unsteady on his/her feet and may actually make the situation worse because it may increase the sense of ill-ease associated with high places.
Other strategies can be found in our Tips for Going Up and Down Stairs Safely article.