1. Wandering/Running Off
   • The most important thing is the safety of the child. This would include good locks and door alarms at home and a plan written into the IEP at school regarding what each person’s role would be in the event of the child leaving the classroom or playground. Visual supports such as a STOP sign on the door and/or siblings asking permission to go out the door can be a reminder to the child or adult with Down syndrome to ask permission before leaving the house.
2. Stubborn/Oppositional Behavior
   • A description of the child or adult’s behavior during a typical day at home or school can sometimes help to identify an event that may have triggered non-compliant behavior. At times, oppositional behavior may be an individual’s way of communicating frustration or a lack of understanding due to their communication/language problems. Children with Down syndrome are often very good at distracting parents or teachers when they are challenged with a difficult task.
3. Attention Problems
   • Individuals with Down syndrome can have ADHD but they should be evaluated for attention span and impulsivity based on developmental age and not strictly chronological age. The use of parent and teacher rating scales such as the Vanderbilt and the Connors Parent and Teacher Rating Scales can be helpful in diagnosis. Anxiety disorders, language processing problems and hearing loss can also present as problems with attention.
4. Obsessive/Compulsive Behaviors
   • These can sometimes be very simple; for example, a child may always want the same chair. However, obsessive/compulsive behavior can also be more subtly repetitive, manifesting through habits like dangling beads or belts when not engaged directly in an activity. This type of behavior is seen more commonly in younger children with Down syndrome is no different than those in typical children at the same mental age, the frequency and intensity of the behavior is often greater. Increased levels of restlessness and worry may lead the child or adult to behave in a very rigid manner.
5. Autism Spectrum Disorder
   • Autism is seen in approximately 5%-7% of individuals with Down syndrome. The diagnosis is usually made at a later age (6-8 years of age) than in the general population. Regression of language skills, if present, also occurs later (3-4 years of age). Potential intervention strategies are the same as for any child with autism. It is important for signs of autism to be identified as early as possible so the child can receive the most appropriate therapeutic and educational services.

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