All children with Down Syndrome experience some form of
learning difficulty as the brain develops differently in those with the genetic
condition, making the learning process less efficient. However the severity
varies from child to child and cannot be predicted 5. This results in children
with the condition reaching milestones later than others who do not have the
Although every child is different, most children with Downs
Syndrome have many characteristic strengths, including social interaction. With
encouragement they are often able to develop these skills alongside their peers
in an age-appropriate manner. Most children think visually and digest
information best when it is presented by pictures or gestures. Due to this,
many children with Down Syndrome begin communicating using signing 3. Another
strength associated with children affected by the condition is their reading
ability, as it builds upon their visual learning skills. 2
Children with the Down Syndrome also have some
characteristic weaknesses, including verbal communication, and many children
experience significant delay in learning to talk 3. Hearing problems contribute
significantly to this, as they often lead to difficulty in picking up other
people’s speech. This can have negative effects on the child’s learning 7. A
delay in verbal communication also arises from difficulty controlling the
tongue, lips and facial muscles as well as poor short term (working) memory.
Vision problems can also lead to a slower development of the child’s visual learning.
Before the age of 5 months, the child should react to
sounds, however they may not respond to the same sound every time. This can be
due to congested middle ear fluid 7 or the child may not have the ability to
turn their head towards the source of the sound. During this time period it is
important that the child is talked to and read books on a daily basis to
encourage the development of speech 4.
As the child reaches 6 months old,
you should start to expect them to recognise and explore where sounds are
coming from, especially if they are sudden. They should be able to recognise short
instructions, such as “no”, although they may not completely understand the
command yet. As the child approaches 10 months, they should begin to babble or
talk to themselves 2. This is an important skill as it indicates their abilities
to vocalise in later life. Failure to babble may result in further oral
stimulation being required to assist with the development of the movements
needed for speech production 4.
At around 16 months, the child should understand around 50
words but will still not be able to speak. They should however be interested in
making and repeating simple noises, such as animal sounds. To further develop
their speech the child must learn to organise the sounds of speech 8. The
child should enjoy listening to simple stories and recognise objects in
pictures within the book. Now the child should be able to stand and walk short
distances, and should have developed the necessary oro-motor skills to chew
solid foods and drink through a straw 2. Feeling should now be expressed
openly on the child’s face and they should now display the ability to make
simple choices such as choosing a favourite toy 4.
By 25 months the child should be sociable and want to
interact with others , and they should be able to retrieve objects when shown
how to through demonstration. There should be signs of obvious comprehension of
language and they should be able to understand a variety of word, including
nouns and verbs, however many children will not be able to produce spoken words
due to poor oral motor skills 4.
By 30 months the child’s comprehension should have continued
to grow and they should now be able to follow a simple command. They should
begin to communicate verbally and should be able to say their own name or call
for “mummy” and “daddy”. However their oral motor skills will not have
progressed enough for them to speak clearly and be completely understood by
As the child approaches 35 months, they should begin to
pronounce some words more clearly and try to communicate verbally a lot more.
They may begin to try to form sentences, however they may not be intelligible.
The child should now be able to listen to stories that are up to 20 minutes
long and they should be able to understand around 250 words. Many children are
very inquisitive at this age and often ask “why?”. Some children with less
progressive oral motor skills still find it difficult to use the tip of their
tongues and struggle to pronounce consonants 4.
From 36 to 40 months, the child should begin to hold short
conversations and can produce up to 150 words, however some are still not
pronounced correctly. Many children can recognise colours and can use pronouns
in their sentences. Sometimes the gender is still confuses and he is used
instead of she or vice versa 4.
By 60 months most children can easily pronounce many words
and retell short stories. Similar environments and symbols can often be
recognised. Most letters of the alphabet are known and around 20 written words
can be recognised 4.
Around 70 months the child begins to produce longer
sentences of 4 words and around 10,000 words can be comprehended. Over 400
words can be spoken clearly and many children can now read short sections
within stories 4.
People with Down Syndrome go through puberty at the same time
and in the same order as other individuals of their age group, however they are
often less emotionally mature, meaning it can be a difficult time for them 1.
It is important that the child understands the changes which are occurring and
they should be given information about the topic in a way they can easily understand
For girls, breast development begins around the age of 8 to
13, followed by the first period at 12 years old (slightly before the age of
those in the general population). Girls usually have a growth spurt at the
beginning of puberty however their height only increases slightly throughout
the rest of puberty 9.
It is advisable to plan ahead how to help the child with
their first period, most people with the condition who are more independent may
cope well, however other may need additional help 9.
Research suggests that around 70% of women with Down
Syndrome are fertile and in many cases women with the condition have given
birth and both mother and baby have been healthy. However, there is an increased
chance of miscarriage and there is a 50% chance that the child will also have
Down Syndrome. Children born to a mother with the condition are also more
likely to premature or stillborn, so the pregnancy will need to be closely
monitored. Problems may also arise if the mother has a heart defect as there
will be considerable strain on the heart during childbirth 9.
In boys, puberty normally begins from the ages of 9 to 14
with the growth of testicles. It is important if puberty starts outside this
age range that medical advice is sought, as thyroid problems are more common in
people with Down Syndrome and can affect the timing of puberty. Boys will
usually experience a growth spurt during puberty, and changes in the skin, body
odour and mood will also occur 9.
Although men with Down Syndrome have lower fertility than
the general population, there have been people with the condition who conceive.
Therefore it is important that contraception is used unless the couple are
planning a pregnancy 9.
Each person with Down Syndrome is effected by the condition
to varying degree, so some children attend mainstream school whereas others
attend a school that caters for their more specific needs. This is the same
when people with the condition become older, some are able to live fairly
independent lives and have jobs, whereas others need more assistance in the
form of sheltered housing with care assistants 10.
There are lots of employment options for those with the
condition and people are often helped through supported employment. This is
when people with a disability can be given extra support to help them in the
work place 11. There are many different types of work which may be suited to different
people, including paid work, supported apprenticeships and volunteering. All of
these activities help to encourage independence, develop social skills and gain
People with Down Syndrome have a life expectancy of around
50-60 years, however as they age, more problems are likely to develop in those
with the condition, for example hyperthyroidism, diabetes and arthritis. This may
mean that more assistance is required as the person grows older 1.
Depression is also a common occurrence in older people. Often
people with Down Syndrome rely heavily on their parents and family for physical
and emotional support. When there is a bereavement in the family it can be a very
difficult time and they may need additional support to get through this period
Onset seizures are common, starting around the age of 40 in
males and 50 in females. These seizures have be shown to be associated with the
development of Alzheimer’s disease in
later life 13. Older people are more likely to develop dementia in general,
with an 80% risk of people with Down Syndrome developing the condition at the
age of 65 14.