INTELLECTUAL DISABILITY (MENTAL RETARDATION)

Most patients presenting in clinical settings with an Autism Spectrum Disorder, such as Aspergers
syndrome or autism, have other comorbid disorders. Mental retardation is a possible comorbid
disorder at the more severe end of the autism spectrum.

Mental retardation is a term for a pattern of persistently slow learning of basic motor and language
skills ("milestones") during childhood, and a significantly below-normal global intellectual capacity as
an adult. One common criterion for diagnosis of mental retardation is a tested intelligence quotient
(IQ) of 70 or below.

People with mental retardation may be described as having developmental disabilities, global
developmental delay, or learning difficulties.

ALTERNATIVE TERMS
The term "Mental retardation" has acquired pejorative and shameful connotations over the last few
decades and is now used almost exclusively in technical or scientific contexts where exactness is
necessary. The term 'intellectual disability' is increasingly common, and used on this website where
possible.

In North America the broad term developmental delay has become an increasingly preferred
synonym by many parents and direct support professionals. Elsewhere, however, developmental
delay is generally used to imply that appropriate intervention will improve or completely eliminate
the condition, allowing for "catching up." Importantly, this term carries the emotionally powerful
idea that the individual's current difficulties are likely to be temporary.

Developmental disability is preferred by most physicians, but can also refer to any other physical or
psychiatric delay, such as delayed puberty.

Both the phrases 'intellectual disability' and 'learning disability' are increasingly being used as a
synonym for people with significantly below-average IQ. These terms are sometimes used as a
means of separating general intellectual limitations from specific, limited deficits as well as
indicating that it is not an emotional or psychological disability. Intellectual disability is also used to
describe the outcome of traumatic brain injury or lead poisoning or dementing conditions such as
Alzheimer's disease. It is not specific to congenital conditions like Down syndrome.

The American Association on Mental Retardation continues to use the term mental retardation. In
June 2006 its members voted to change the name of the organization to the "American Association
on Intellectual and Developmental Disabilities," rejecting the options to become the AAID or AADD.
Part of the rationale for the double name was that many of the members worked with people with
autism and Asperger's syndrome, also known as pervasive developmental disorders, not all of whom
were also mentally retarded.


In the UK, "mental handicap" had become the common medical term, replacing "mental
subnormality" in Scotland and "mental deficiency" in England and Wales, until Stephen Dorrell,
Secretary of State for Health in England and Wales from 1995-7, changed the National Health
Service's designation to "learning disability." The new term is not yet widely understood, and is often
taken to refer to problems affecting schoolwork (the American usage): which are known in the UK as
"learning difficulties." British social workers may use "learning difficulty" to refer to both people with
MR and those with conditions such as dyslexia.

SIGNS
There are many signs. For example, children with developmental disabilities may learn to sit up, to
crawl, or to walk later than other children, or they may learn to talk later. Both adults and children
with intellectual disabilities may also:
have trouble speaking
find it hard to remember things
have trouble understanding social rules
have trouble discerning cause and effect
have trouble solving problems
have trouble thinking logically.

In early childhood mild disability (IQ 6070) may not be obvious, and may not be diagnosed until
they begin school. Even when poor academic performance is recognized, it may take expert
assessment to distinguish mild mental disability from learning disability or behavior problems. As
they become adults, many people can live independently and may be considered by others in their
community as "slow" rather than retarded.

Moderate disability (IQ 5060) is nearly always obvious within the first years of life. These people
will encounter difficulty in school, at home, and in the community. In many cases they will need to
join special, usually separate, classes in school, but they can still progress to become functioning
members of society. As adults they may live with their parents, in a supportive group home, or even
semi-independently with significant supportive services to help them, for example, manage their
finances.

Among people with intellectual disabilities, only about one in eight will score below 50 on IQ tests. A
person with a more severe disability will need more intensive support and supervision his or her
entire life.

The limitations of cognitive function will cause a child to learn and develop more slowly than a
typical child. Children may take longer to learn to speak, walk, and take care of their personal needs
such as dressing or eating. Learning will take them longer, require more repetition, and there may be
some things they cannot learn. The extent of the limits of learning is a function of the severity of the
disability.

Nevertheless, virtually every child is able to learn, develop, and grow to some extent.

DIAGNOSIS
According to the DSM-IV, there are three criteria before a person is considered to have a
developmental disability: an IQ below 70, significant limitations in two or more areas of adaptive
behavior (i.e., ability to function at age level in an ordinary environment), and evidence that the
limitations became apparent in childhood. It is formally diagnosed by professional assessment of
intelligence and adaptive behavior.

IQ tests were created as an attempt to measure a person's abilities in several areas, including
language, numeracy and problem-solving. The average score is 100. People with a score below 75
will often, but not always, have difficulties with daily living skills. Since factors other than mental
ability (depression, anxiety, lack of adequate effort, etc.) can yield low IQ scores, it is important for
the evaluator to rule them out prior to concluding that measured IQ is "significantly below average".

The following ranges, based on the Wechsler Adult Intelligence Scale (WAIS), are in standard use
today:
Class IQ
Profound mental retardation Below 20
Severe mental retardation 2034
Moderate mental retardation 3549
Mild mental retardation 5069
Borderline mental retardation 7079

Significant limitations in two or more areas of adaptive behavior
Adaptive behavior, or adaptive functioning, refers to the skills needed to live independently (or at
the minimally acceptable level for age). To assess adaptive behavior, professionals compare the
functional abilities of a child to those of other children of similar age. To measure adaptive behavior,
professionals use structured interviews, with which they systematically elicit information about the
person's functioning in the community from someone who knows them well. There are many
adaptive behavior scales, and accurate assessment of the quality of someone's adaptive behavior
requires clinical judgment as well. Certain skills are important to adaptive behavior, such as:
daily living skills, such as getting dressed, using the bathroom, and feeding oneself
communication skills, such as understanding what is said and being able to answer
social skills with peers, family members, spouses, adults, and others.

Evidence that the limitations became apparent in childhood
This third condition is used to distinguish it from dementing conditions such as Alzheimer's disease
or is due to traumatic injuries that damaged the brain.

CAUSES
Down syndrome, fetal alcohol syndrome and Fragile X syndrome are the three most common inborn
causes. However, doctors have found many other causes. The most common are:

Genetic conditions. Sometimes disability is caused by abnormal genes inherited from parents, errors
when genes combine, or other reasons. Examples of genetic conditions include Down
syndrome,Fragile X syndrome, and phenylketonuria (PKU).

Problems during pregnancy. Mental disability can result when the fetus does not develop inside the
mother properly. For example, there may be a problem with the way the fetus's cells divide as it
grows. A woman who drinks alcohol (see fetal alcohol syndrome) or gets an infection like rubella
during pregnancy may also have a baby with mental disability.

Problems at birth. If a baby has problems during labor and birth, such as not getting enough oxygen,
he or she may have developmental disability due to brain damage.

Health problems. Diseases like whooping cough, measles, or meningitis can cause mental disability.
It can also be caused by not getting enough medical care, or by being exposed to poisons like lead or
mercury.

Iodine deficiency, affecting approximately 2 billion people worldwide, is the leading preventable
cause of mental disability in areas of the developing world where iodine deficiency is endemic.
Iodine deficiency also causes goiter, an enlargement of the thyroid gland. More common than full
fledged cretinism, as retardation caused by severe iodine deficiency is called, is mild impairment of
intelligence. Certain areas of the world due to natural deficiency and governmental inaction are
severely affected. India is the most outstanding, with 500 million suffering from deficiency, 54
million from goiter, and 2 million from cretinism. Among other nations affected by iodine deficiency,
China and Kazakhstan have begun taking action, while Russia has not.

Malnutrition is a common cause of reduced intelligence in parts of the world affected by famine
such as Ethiopia.

The use of forceps during birth can lead to intellectual disability in an otherwise normal child. They
can fracture the skull and cause brain damage.

Institutionalization at a young age can cause intellectual disability in normal children.

Sensory deprivation in the form of severe environmental restrictions (such as being locked in a
basement), prolonged isolation, or severe atypical parent-child interactions.

Psycho-social disadvantage. Contributing factors are lack of reading material, use of language not
common in that community, poor diet, poor health practices, and poor housing.

TREATMENT AND ASSISTANCE
By most definitions it is more accurately considered a disability rather than a disease. It can be
distinguished in many ways from mental illness, such as schizophrenia or depression. Currently,
there is no "cure" for an established disability, though with appropriate support and teaching, most
individuals can learn to do many things.

There are usually a variety of agencies in the most countries that provide assistance for people with
developmental disabilities. They will usually include state-run, for-profit, and non-profit, privately
run agencies. Within one agency there could be departments that include fully staffed residential
homes, day habilitation programs that approximate schools, workshops wherein people with
disabilities can obtain jobs, programs that assist people with developmental disabilities in obtaining
jobs in the community, programs that provide support for people with developmental disabilities
who have their own apartments, programs that assist them with raising their children, and many
more.

Although there is no specific medication for intellectual disability, many people with developmental
disabilities have further medical complications and may take several medications. Beyond that there
are specific programs that people with developmental disabilities can take part in wherein they learn
basic life skills. These "goals" may take a much longer amount of time for them to accomplish, but
the ultimate goal is independence. This may be anything from independence in tooth brushing to an
independent residence. People with developmental disabilities learn throughout their lives and can
obtain many new skills even late in life with the help of their families, caregivers, clinicians and the
people who coordinate the efforts of all of these people.


Click here for the full range of Asperger's and autism fact sheets at www.autism-help.org
This autism fact sheet is licensed under the GNU Free Documentation. It is derivative of a Mental
retardation article at http://en.wikipedia.org








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Home Education Medical Information List DS and Autism
Down syndrome and Autism Spectrum Disorder | Print |
E-mail

The term, dual-diagnosis, refers to a person with a developmental disability, such as Down syndrome
(DS) and a psychiatric disorder, such as an autistic spectrum disorder (ASD) also known as autism. In
recent decades, there has been wider recognition that persons with DS can also have a co-existing
psychiatric disorder.
It is currently believed that the majority of children with DS do not have a coexisting psychiatric or
behavioral disorder. However, each case is different.
Parents can learn more in the following articles, which include signs and symptoms:
Articles from the Krieger Institute:
More than Down Syndrome: A Parents View
A Look at What We Know
Dual Diagnoses: the Importance of Diagnosis and Treatment
Language and Communication: The Key is Effectiveness
Changing Behavior & Teaching New Skills
A Family's Experience with Multiply Disabled Child
Additional Web Resources:
Milestones - Resources located in Cleveland, Ohio
Disability Solutions - Special Edition Down Syndrome Autism Spectrum Disorder
Diagnosis of Autism in Children With Down Syndrome
Down's Syndrome Children with Autistic Features
Ohio's Parent Guide to Autism - pdf
Ask the Experts
________________________________________
Diagnosis of Autism in Children With Down Syndrome
Glenn Vatter
3124 Henneberry Road
Jamesville, NY 13078-9640
(315) 677-3844
Reprinted with the permission of the author
1998 Glenn Vatter. All rights reserved
Article on-line
Diagnosis of Autism in Children With Down Syndrome
Synopsis
As many as ten percent of persons with Down syndrome may also suffer from autism. Exact data is
difficult to obtain. Many cases go undiagnosed, or are diagnosed at a later age. Many diagnosticians
are unawares that the two conditions may exist or are reluctant to apply the second diagnosis.
Autism diagnosis is much more complicated than Down syndrome; there is no blood test, genetic
marker, facial features, or other characteristics that apply to all autistic persons. The diagnosis is
subjective, depending on meeting observations of certain behaviors. Diagnosis and treatment of
autism is much more critical than for Down syndrome. Without early detection and intervention the
life of a person with autism may be much more limited than that of a person with Down syndrome
and often results in autistic children living in a residential school rather than at home because of
inability of the parents and the school system to cope with the child's behaviors.
Symptoms of autism in Down syndrome
The key area affected developmentally in a child with Down syndrome is the cognitive area, the
development of thinking, reasoning, and understanding. Delays are expected in this area. Another
area of development is the social and emotional development. These areas develop more normally
in a child with Down syndrome but not in a child with autism. Coleman and Rogers (1992) give the
following account of the expected social and emotional development in a child with Down
syndrome.
Most babies with Down syndrome show the least delay in social and emotional development,
smiling when talked to at 2 months (range 1.5-4 months), smiling spontaneously at 3 months (range
2-6 months, and recognizing parents at 3.5 months (range 3-6 months); each of these milestones
show only a 1-month delay on average. Although some studies suggest that the intensity of affective
responses such as smiling and laughing may be slightly less than that shown by ordinary babies,
parents respond warmly to the onset of smiling and eye contact. The Down syndrome babies begin
to enjoy pat-a-cake and peek-a-boo games at about 11 months (range 9-16 months), which is about
3 months later than ordinary babies. Studies in the second year of life show the babies to be skilled
in social communication even using social skills to attempt to distract an adult from a task the baby
does not want to attempt. The babies are warm, cuddly, and normally responsive to physical
contact, unlike babies with some other types of disabilities such as autism.
This normal emotional responsiveness continues into adult life, and as studies of teenagers have
shown, it develops into proper empathy, making the person with Down syndrome a sensitive and
socially aware person to live with.
So the key areas to watch for in a child with Down syndrome suspected of having a complicating
behavior disorder such as autism is in the social and emotional areas. Some professionals will argue
that social and emotional development can be expected to be affected by delays in cognitive
development and it is not evidence of a separate disorder. This is where the subjective nature of
autism diagnosis comes in. It's a matter of degree.
Some key behaviors that may point to the possibility of autism in a child with Down syndrome are:
1. Extreme Autistic Aloneness - The child does not relate to people normally and seems to
prefer to be left alone. The child seems to consider other persons as objects, not people. He will not
join in group play with other children. Unlike children with Down syndrome, who are very lovable
and huggable, the autistic child does not want to be held.
2. Anxiously obsessive desire for the preservation of sameness - Any differences in daily
routines can cause a large upset.
3. Lack of eye contact - Autistic persons typically do not make eye contact but will look away or
"right through" other people.
4. Shows repetitive, "Stereotypical" movement, like sitting for long periods of time with an
object in his hand and just waving it back and forth looking at it.
A checklist of autistic behaviors is presented in Figure 1. Some of these characteristics are normal, up
to a point, in a child with Down syndrome. This complicates the diagnosis of autism in those
children. In the next section, the DSM-IV criteria for diagnosing autism is presented with annotations
as to whether each behavior is more prevalent in autism than in Down syndrome.
Individuals with autism usually exhibit at least half of the traits listed below. These sympthoms can
range from mild to severe and vary in intesity from symptom to symptom. In addition, the behavior
usually occurs across many different situations and is consistently inappropriate for their age.
Difficulty in mixing with other children
Insistence on sameness; resists changes in routine
Inappropriate laughing and giggling
No real fear of dangers
Little or no eye contact
Sustained odd play
Apparent insensitivity to pain
Echolalia (repeating words or phrases in place of normal language)
Prefers to be alone; aloof manner
May not want cuddling or act cuddly
Spins objects
Not responsive to verbal cues; acts as deaf
Inappropriate attachment to objects
Difficulty in expressing needs; uses gestures or pointing instead of words
Noticeable physical overactivity or extreme underactivity
Tantrums - displays extreme distress for no apparent reason
Unresponsive to normal teaching methods
Uneven gross/fine motor skills. (May not want to kick ball but can stack blocks.)

Adapted from the original by Professor Rendle-Short, Brisbane Children's Hospital, University of
Queensland, Australia.
Figure 1. Checklist of autistic behaviors
Autism and PDD - Definitions
The official term for autism, as defined by the American Psychiatric Association in their DSM-IV, is
Pervasive Developmental Disorders(PDD). The Pervasive Developmental Disorders is a class of five
diagnosable disorders including Autistic Disorder, Rett's Disorder, Childhood Disintegrative Disorder,
Aspergers's Disorder, and Pervasive Developmental Disorder Not otherwise Specified. Sometimes
the term autism is used to describe the Autistic Disorder and sometimes it is used to describe all five
PDD's. There are also other related diseases that together are called the autistic spectrum disorders.
For purposes of this article I assume autism to include all five PDD's.
Diagnosis of Autism in Down Syndrome - DSM-IV Checklist
Autism is diagnosed by evaluating the behavior of the patient. There are sixteen descriptive
symptoms to look at. If an appropriate combination of eight are displayed, a diagnosis of autism is
reached. These symptoms are grouped into four general areas; Severely Impaired Social Interactions,
Severely Impaired Communications and Imagination, Extremely Limited Interests and Activities, and
First Observed in Infancy or Early Childhood. In some cases, as in Down syndrome, mental
retardation may mask the autism and a diagnosis may come later or not at all.
The diagnostic criteria for Autism as given by the American Psychiatric Association is contained in
their Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. (DSM-IV) The diagnosis is
quite complex and is recognized only when done by a qualified professional.
Diagnosing autism in a Down syndrome person is a bit trickier than in a non-Down syndrome person.
Some of the criteria for autism is normally present in Down's persons and in itself does not mean
that autism is present. Following is DSM-IV for the Autistic Disorder with bullets after each criteria to
indicate if that criteria is normally found in Down syndrome or if it is more indicative of autism.
Diagnosis for the other four PDD's is similar to that for the Autistic Disorder, generally with certain
items deleted. When diagnosing autism in a Down's person, the diagnostician must examine each
criteria in terms of whether it is a normal trait for the person with Down syndrome and, if it is a
normal trait, is it more severe than normally found in a Down's person.
a. A total of six (or more) items from (1), (2), and (3), with at least two from (1) and one each
from (2) and (3).
1. Qualitative impairment in social interaction, as manifested by at least two of the following:
a. Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze,
facial expression, body postures, and gestures to regulate social interaction.
Not normally seen in Down syndrome, more indicative of autism.
b. Failure to develop peer relationships appropriate to developmental level.
Not normally seen in Down syndrome, more indicative of autism.
c. A lack of spontaneous seeking to share enjoyment, interests, or achievements with other
people (e.g., by lack of showing, bringing, or pointing out objects of interest).
Somewhat true in Down syndrome but much more pronounced in autism.
d. Lack of social or emotional reciprocity.
Somewhat true in Down syndrome but much more pronounced in autism.
2. Qualitative impairments in communication as manifested by at least one of the following:
a. Delay in, or total lack of, the development of spoken language (not accompanied by an
attempt to compensate through alternative modes of communication such as gesture or mime).
Not normally seen in Down syndrome.
b. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a
conversation with others.
Normally seen in Down syndrome, although not to the extent seen in autism.
c. Stereotyped and repetitive use of language or idiosyncratic language.
Seen somewhat in Down syndrome but not to the extent seen in autism.
d. Lack of varied, spontaneous make-believe play or social initiative play appropriate to
developmental level.
Not normally seen in Down syndrome.
3. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as
manifested by at least one of the following:
a. Encompassing preoccupation with one or more stereotyped and restricted patterns of
interest that is abnormal in either in intensity or focus.
Not normally seen in Down syndrome.
b. Apparently inflexible adherence to specific, nonfunctional routines or rituals.
Not normally seen in Down syndrome.
c. Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting or
complex whole body movements).
Not normally seen in Down syndrome.
d. Persistent preoccupation with parts of objects.
Not normally seen in Down syndrome.
b. Delays or abnormal functioning in at least one of the following areas, with onset prior to age
3 years: (1) Social interaction, (2) Language as used in social communication, or (3) Symbolic or
imaginative play.
Children with Down syndrome will normally display some deficits in these traits depending
on the severity of mental retardation. Since this is not entirely unexpected, it is usually ignored in
the records and not so noted. Therefore when autism is diagnosed at a later age and the records or
memory is searched for this evidence it is either not found in the official records of the child or it is
forgotten about because it was not deemed all that unusual at the time. The diagnostician may then
discard the possible diagnosis of autism because the appearance is given (falsely) that these traits
were not present prior to 36 months of age. Because of this quirk in the diagnosis, there probably
are many persons with Down syndrome with autism but it is not so diagnosed.
c. The disturbance is not better counted for by Rett's Disorder or Childhood Disintegrative
Disorder.
Issues in diagnosing autism in persons with Down syndrome
There are a number of reasons why there are not very many reported cases of autism in persons
with Down syndrome.
One issue in the diagnostic criteria is the requirement for onset before age three. In the case of
Down syndrome, the parents of a young child with Down syndrome and the professionals attending
them are concerned with the Down syndrome itself with its possible complications of cardiac
problems, leukemia, and other problems. Delays in development are expected. Given the expected
delays in development, it simply does not occur to parents or professionals that autism may be
present. The parents have probably never heard of autism and are completely unawares of
symptoms. The same can be true for some of the professionals dealing with child with Down
syndrome. Only the most astute of diagnosticians is likely to recognize autism in a child with Down
syndrome before age three. Only when the child becomes older, or if the parent persists, may it
become clear that autism is present. But some diagnosticians will apply the three year rule and
decline the autism diagnosis later on because the records do not show the presence of the
symptoms before age three. The issue of early onset, then, becomes a major obstacle to the
diagnosis.
Another issue is that persons with Down syndrome come with a few of the DSM-IV criteria already
there as a part of the Down syndrome. When looking for eight of sixteen specified criteria the
diagnostician may be tempted to excuse those symptoms characteristic of Down syndrome and not
garner enough symptoms to give the autism diagnosis.
Also, some professionals may consider only the Kanner autism, where there is little or no mental
retardation, to be the true autism and decline a diagnosis in the Down syndrome case where there is
usually some mental retardation. Others may decline the diagnosis because autism causes are
usually cloudy or unknown in an individual case, and given the mental retardation in Down
syndrome, may say that since there is a known cause, they decline the diagnosis.
Some diagnosticians may not wish to burden the family with an additional label, i.e. autism. This
denies the family the opportunity to join autism support groups and to seek out autism
interventions. While the autism and Down syndrome treatment protocols overlap and have many
similar characteristics, the autism treatments are much more intense. And treatment for autism is
more critical in averting lifetime consequences .
Most of the above issues are addressed in the textual portion of DSM-IV, in favor of giving the
autism diagnosis when the behaviors are present. There is nothing in either the textual matter or in
the diagnostic criteria which suggests any aversion to diagnosing autism in a person with Down
syndrome and/or mental retardation. The textual matter specifically states that many autistic
persons are also mentally retarded. It also states that if there is a loss of data from early years or the
data is unclear as to whether the symptoms were present before age three, that the autism
diagnosis should be given.
I am in contact with a number of parents with children having the dual diagnosis of Down syndrome
and autism. All have reported extreme difficulty in obtaining the dual diagnosis. They could not
understand the failure of their children to develop socially and emotionally, with deficits beyond
that normally found in a child with Down syndrome. They had to shop around and practically beg the
professionals to tell them what was wrong with their child. These are not cases of hypochondriac
parents trying to pile up diagnoses but rather concerned parents who want to know what is wrong
with their child.
Studies
Studies of autism in Down syndrome are quite limited. Ghaziuddin (1992) found two children who
fulfilled DSMIII-R criteria for autism from an estimated total of forty with Down syndrome. Wing and
Gould (1979) diagnosed four children from a group of thirty child with Down syndrome as having
autism or were within the spectrum of the autistic group. Turk (1992) reported 9% of his series of
children with Down syndrome met the full criteria for autism. Lund (1988) diagnosed five adults with
autism from a group of forty four with Down syndrome. Bregman (1988) and Wakabayashi (1979)
also described children with the dual diagnosis. Howlin, et al. (1995) described four boys with Down
syndrome who were diagnosed with autism at ages eight to eleven. The authors report that,
although there is no epidemiological study of the prevalence of autistic spectrum disorders in a large
population of children with Down syndrome, the evidence currently available suggests that it is in
the order of 10%. Also in the article, the authors reported that M. Ghazziuddin had personally
communicated that he found autism in10% of his subjects with Down syndrome. Dr. Ghazziddin also
communicated personally to me that 10% would be a reasonable number. Ghaziuddin (1997)
describes three persons with Down syndrome and autism. Gillberg, et al. (1986) found 5% of
subjects with autism in 20 persons with Down syndrome.
A number of studies of very large Down syndrome populations were conducted which resulted in
very low rates of autism. Gath and Gumley (1986) found 1% of subjects with autism in 193 persons
with Down syndrome. Myers and Pueschel (1991) found 1% of subjects with autism in 497 persons
with Down syndrome. Collacut, et al. (1992) found 2.2% of subjects with autism in 371 persons with
Down syndrome. The lower autism rates in these studies may be deceptive. The key issue in these
studies was to determine susceptibility of persons with Down syndrome to psychiatric disorders. The
studies were done by researchers looking for occurrences of psychiatric disorders in mentally
retarded children and adults. They were not specifically looking for autism. Diagnoses of Depression,
Psychoses, Personality Disorders, Conduct Disorders, Schizophrenia, Emotional Disorders, autism,
and many others were made. Some were done using 1980 versions of DSM III or ICD-9. One study
was done by examining old records and making a retroactive diagnosis based on observations made
years before by people laboring under older concepts, such as when autism was routinely diagnosed
as schizophrenia. Two authors admitted that the persons diagnosed with psychoses might also have
been grouped as having autism. One author assigned the diagnosis of psychoses in several cases of
autistic-like behavior because the behavior wasn't reported before the age of 30 months. I went
through these studies and reassigned those cases where the author suggested autism could have
been assigned instead of other disorders and recalculated the autism rates . They came out as high
as 16%.
As mentioned earlier, diagnosis of autism is rather subjective to begin with, and gets even murkier in
persons with Down syndrome and other known forms of mental retardation. Finding clear and valid
statistical data is very difficult due to the vagaries of autism diagnosis. Establishment of a clear
scientific statistic is not the point. The point is that the two disorders do indeed co-concur, and in
significant numbers. Since the stakes are much higher in autism as mentioned earlier, it is critical
that autism be recognized when it is present in children with Down syndrome so that appropriate
treatment protocols can be pursued and the parents can look outside the Down syndrome
community.
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