Talk:Down syndrome/Archive 13

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Hearing loss in Down syndrome

•Conductive Hearing loss occurs in 38-78% of DS population •Otitis media with effusion is most common cause of HL •Sensorineural Hearing loss and Mixed Hearing Loss occur in 4-20% of DS population •Treating Sensorineural Hearing loss component is necessary •Hearing loss is more severe depending on comorbid conditions such as epilepsy and seizures. •Children with DS have speech and language learning difficulty, with the help of proper amplification devices and otological intervention children can hear and do more insitu learning •Epilepsy and seizure disorders effect the auditory processing in temporal lobe, and increase the severity of HL •Regular wax removal due to narrow ear canals •Tubes before 2y/o

Kreicher, K. L., Weir, F. W., Nguyen, S. A., & Meyer, T. A. (2018). Characteristics and progression of hearing loss in children with Down syndrome. The Journal of pediatrics, 193, 27-33. https://doi.org/10.1016/j.jpeds.2017.09.053

•For those with Severe Sensorineural hearing loss, CI is an option. Cognitive impairment is not a contraindication to implant children with DS but should be considered as a major factor. •SLP and aural rehab to help with speech and language learning Heldahl, M. G., Eksveen, B., & Bunne, M. (2019). Cochlear implants in eight children with Down Syndrome–Auditory performance and challenges in assessment. International journal of pediatric otorhinolaryngology, 126, 109636. https://doi.org/10.1016/j.ijporl.2019.109636 — Preceding unsigned comment added by Caitheaton (talk • contribs) 20:52, 5 April 2020 (UTC)

Better to go with secondary sources rather than primary sources User:Caitheaton. Doc James (talk · contribs · email) 19:31, 10 April 2020 (UTC)

Stigmatising language re: 'mental ability' and weight

I made some edits this morning to some language in the article that appeared to contribute to stigma against people with Down Syndrome. First, I noticed that the article claimed that adults with Down Syndrome had the mental ability of 8- or 9-year-old children. I linked to articles by people with disabilities arguing against the use of ‘mental age’ to describe their disabilities. This implies that adults with Down Syndrome are ‘really’ children. I don’t know if any third-party sources exist that discuss this kind of stigma, but I don’t think it’s fair to categorically discredit the words of people who have been targeted by systemic discrimination.

Moreover, ‘obesity’ and ‘obese’ are increasingly considered derogatory and stigmatising terms that place individual blame on larger-bodied people instead of larger social factors. You may as well say that people with Down Syndrome are ‘retarded’. The weight classifications are based on the Body Mass Index, so I changed the language to reflect that. Re: language about higher-weight patients: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310899/ In addition, focusing on weight as problematic in and of itself may actually contribute to the risk of mortality among larger people: https://journals.sagepub.com/doi/abs/10.1177/0956797615601103. Yes, the current language may be used in medicine, but medicine is not free from bias. ‘Hysteria’ and ‘drapetomania’ used to be considered medical conditions. I think that avoiding stigma is a value that should be upheld.

This isn’t merely a matter of ‘political correctness’; it’s about respecting the experiences and views of the people being described in the article. I don’t think that’s a particularly tall order. — Preceding unsigned comment added by Insolectual (talk • contribs) 17:07, 7 August 2020 (UTC)

For that matter, our standards have it that the lead should summarize the body. The "mental age" business is only mentioned fleetingly in the main text, and IQ is given hardly more attention than that. If we hold to our own standards for encyclopedic writing, that sentence shouldn't be there. Nor is it particularly helpful to the reader: what, in practical terms, does an IQ of 50 mean (and which 8- or 9-year-old child are we talking about exactly)? This is not a good way to summarize the "Neurological" section, taking the least informative bits of it and making them the article's primary message.

The cited source (in Norwegian, which makes verification needlessly difficult) itself points to Rachidi and Lopes (2010), which mentions IQ but has nothing about "mental age", and which describes what "cognitive developmental delays" mean before getting to IQ at all. Emphasizing ideas that the sources do not violates WP:UNDUE. Moreover, as Oxford's Concise Medical Dictionary puts it, mental age is an obsolescent concept, having largely been replaced by a comparison of the functioning of persons of the same age group [1]. At best, it's a redundant number — a function of the IQ being tacitly presented as something else. XOR'easter (talk) 21:04, 7 August 2020 (UTC)

Looking for academic or medical references that actually use "8- or 9-year-old child" in this context, I found only a small number of examples, which turned out to be predatory journals or otherwise unreliable, e.g., following the phrasing of this Wikipedia article so closely it's obvious they copied from it. The statement of cognitive disabilities in terms of effective ages fails WP:MEDRS and WP:UNDUE, plain and simple. XOR'easter (talk) 16:38, 8 August 2020 (UTC)

Change outdated, offensive term

Please change the term "normal" to "typical." (The parents of the affected individual are usually genetically normal.) Thanks.Webberkenny (talk) 18:14, 27 November 2020 (UTC)

Semi-protected edit request on 18 January 2021

103.127.56.236 (talk) 14:44, 18 January 2021 (UTC)sdqqqqqqq

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. EN-Jungwon 16:26, 18 January 2021 (UTC)

One of the main references in this article links to a broken page

The ref is "Malt2013". Could someone with more wiki markup knowledge link to an archived copy of the page? I found the latest working version here: https://web.archive.org/web/20210308020906/https://tidsskriftet.no/2013/02/oversiktsartikkel/helse-og-sykdom-hos-voksne-med-downs-syndrom. — Preceding unsigned comment added by Phil of rel (talk • contribs) 06:05, 10 March 2021 (UTC)

Semi-protected edit request on 29 March 2021

Please remove

A boy with Down syndrome using cordless drill to assemble a book case

and add

A boy with Down syndrome using a cordless drill to assemble a book case

An article is necessary before "cordless", and while it can be omitted if we're creating a certain tone (e.g. "Boy with Down syndrome using cordless drill to assemble book case"), it's necessary when articles are present elsewhere in the sentence. 64.203.186.113 (talk) 17:22, 29 March 2021 (UTC)

 Done Tol | Talk | Contribs (formerly Twassman) 17:48, 29 March 2021 (UTC)

Reorganized and added surgical interventions to management page - hoping to gain access

Health Screening

A number of health organizations have issued recommendations for screening those with Down syndrome for particular diseases. This is recommended to be done systematically.

At birth, all children should get an electrocardiogram and ultrasound of the heart. Surgical repair of heart problems may be required as early as three months of age. Heart valve problems may occur in young adults, and further ultrasound evaluation may be needed in adolescents and in early adulthood. Due to the elevated risk of testicular cancer, some recommend checking the person's testicles yearly.

Cognitive Development

Hearing aids or other amplification devices can be useful for language learning in those with hearing loss. Speech therapy may be useful and is recommended to be started around nine months of age. As those with Down syndrome typically have good hand-eye coordination, learning sign language may be possible. Augmentative and alternative communication methods, such as pointing, body language, objects, or pictures, are often used to help with communication. Behavioral issues and mental illness are typically managed with counseling or medications.

Education programs before reaching school age may be useful. School-age children with Down syndrome may benefit from inclusive education (whereby students of differing abilities are placed in classes with their peers of the same age), provided some adjustments are made to the curriculum. Evidence to support this, however, is not very strong. In the United States, the Individuals with Disabilities Education Act of 1975 requires public schools generally to allow attendance by students with Down syndrome.

Individuals with Down syndrome may learn better visually. Drawing may help with language, speech, and reading skills. Children with Down syndrome still often have difficulty with sentence structure and grammar, as well as developing the ability to speak clearly. Several types of early intervention can help with cognitive development. Efforts to develop motor skills include physical therapy, speech and language therapy, and occupational therapy. Physical therapy focuses specifically on motor development and teaching children to interact with their environment. Speech and language therapy can help prepare for later language. Lastly, occupational therapy can help with skills needed for later independence.

Surgical Interventions

Tympanostomy tubes are often needed and often more than one set during the person's childhood. Tonsillectomy is also often done to help with sleep apnea and throat infections. Surgery, however, does not always address the sleep apnea and a continuous positive airway pressure (CPAP) machine may be useful. Physical therapy and participation in physical education may improve motor skills. Evidence to support this in adults, however, is not very good.

Plastic surgery has been suggested as a method of improving the appearance and thus the acceptance of people with Down syndrome. It has also been proposed as a way to improve speech. Evidence, however, does not support a meaningful difference in either of these outcomes. Plastic surgery on children with Down syndrome is uncommon, and continues to be controversial. The U.S. National Down Syndrome Society views the goal as one of mutual respect and acceptance, not appearance.

Musculoskeletal problems are seen in approximately 20% of individuals with Down syndrome. These problems often arise from ligament laxity and hypotonia.[1] An article in the Journal of the American Academy of Orthopaedic Surgeons explains diagnoses resulting from musculoskeletal problems can be painful if left untreated. Hip instability affects between 2% and 5% of individuals with Down syndrome and can be caused by an atypical acetabulum morphology, ligament laxity, hypermobility or a combination of the three. Patients with hip instability are prone to dislocations. Additionally, rates of arthritis are increasing as the lifespan of individuals with Down syndrome extend; 28% of adults with Down syndrome have hip abnormalities. In young children, a closed reduction and immobilization is often attempted prior to surgical intervention. If this is unsuccessful, surgical intervention is often necessary. The type of surgery depends on the etiology of the hip abnormality. Patients with an atypical acetabulum may require an acetabular osteotomy, whereas patients with a typical acetabulum may require a femoral varus derotation osteotomy. Complications relating to surgical intervention of hip instability are not uncommon. Knee instability, specifically patellofemoral instability is prevalent in 10% to 20% of patients with Down syndrome. Most people with this disorder experience very little pain, however, they may be more susceptible to arthritis in the future. Nonsurgical treatment often includes physical therapy and orthotics. If nonsurgical treatment is unsuccessful, surgical intervention focusing on the patellar tendon and soft tissues may be necessary.[2] In a 2006 study, Ali et al. explains cervical spine instability is also prevalent in patients with Down syndrome. Alantoaxial instability (AAI) is estimated to affect 10%-20% of people with Down syndrome. The main cause of AAI is laxity of the transverse atlantal ligament and is characterized by increased mobility of the C2 vertebra compared to the C1 vertebra. Of those diagnosed with AAI, about 1%-2% are symptomatic. Symptoms include neck discomfort, abnormal gait, alterations in sphincteric control, upper motor neuron lesions, paralysis and in severe cases, death. Surgical intervention is often encouraged in symptomatic patients and often includes spinal fusion. Recommendations for asymptomatic patients include frequent follow up and avoidance of activities that could lead to neck injury.[3]

Gastrointestinal abnormalities are also common among those with Down syndrome. In an editorial published by the Research Institute for Gastroenterology and Liver Diseases, Holmes explains these abnormalities further. Between 6%-7.3% of children with Down syndrome are thought to have gastrointestinal malformations. Symptoms of these malformations include vomiting, diarrhea, constipation or abdominal discomfort. While many of these symptoms are likely to resolve over time, they may result in structural or functional disorders. Structural problems extending from the mouth to anus are thought to occur in similar frequencies to the general public; however, other some particular conditions may be more common. These conditions include: esophageal, duodenal or small intestine atresia or stenosis, annular pancreas which can lead to obstruction of the small intestine, imperforate anus and Hirschsprung disease. If an obstruction occurs prior to birth, a postnatal intervention will likely occur; other bowel obstructions require surgical interventions immediately. An imperforate anus is also likely to require surgical intervention. Other gastrointestinal disorders common in people with Down Syndrome, such as obesity and celiac disease, often do not require surgical intervention and can be managed with alterations in diet.[4]

In a study conducted by Abbag, he explains that congenital heart disease (CHD) can affect up to 61.3% of individuals with Down syndrome. The etiology of CHD is multifactorial; however the most common cause is a atrioventricular septal defect. Abnormalities in the left or right shunt can lead to pulmonary congestion which can causes respiratory distress and increased pneumonia susceptibility. It is recommended that all infants with Down syndrome are referred to a surgeon for screening and surgical intervention if needed.[5]

Non-surgical Interventions

Efforts to prevent respiratory syncytial virus (RSV) infection with human monoclonal antibodies should be considered, especially in those with heart problems. In those who develop dementia there is no evidence for memantine, donepezil, rivastigmine, or galantamine.

Many alternative medical techniques are used in Down syndrome; however, they are poorly supported by evidence. These include: dietary changes, massage, animal therapy, chiropractic and naturopathy, among others. Some proposed treatments may also be harmful.

[1]"Down Syndrome: Musculoskeletal Effects - OrthoInfo - AAOS". www.orthoinfo.org. Retrieved 2021-03-25.
[2]"Down Syndrome in Children: The Role of the Orthopaedic... : JAAOS - Journal of the American Academy of Orthopaedic Surgeons". LWW. Retrieved 2021-03-25.
[3]Ali, Fawzi Elhami; Al-Bustan, Mahmoud A.; Al-Busairi, Waleed A.; Al-Mulla, Fatema A.; Esbaita, Emad Y. (2006-8). "Cervical spine abnormalities associated with Down syndrome". International Orthopaedics. 30 (4): 284–289. doi:10.1007/s00264-005-0070-y. ISSN 0341-2695. PMC 2532127. PMID 16525818. Check date values in: |date= (help)
[4]Holmes, Geoffrey (2014). "Gastrointestinal disorders in Down syndrome". Gastroenterology and Hepatology From Bed to Bench. 7 (1): 6–8. ISSN 2008-2258. PMC 4017552. PMID 25436092.
[5]Abbag, Fuad I. (2006). "Congenital heart diseases and other major anomalies in patients with Down syndrome". Saudi Medical Journal. 27: 219–222.

Earllet9413 (talk) 15:27, 1 April 2021 (UTC)

Semi-protected edit request on 29 September 2021

Please remove the sentence that states inclusive education for people with Down syndrome is not effective and the reference 99, and replace it with “inclusive education, with proper supports, has been shown to be effective for many people with Down Syndrome” and this source https://www.nads.org/wp-content/uploads/2017/06/A_Summary_of_the_evidence_on_inclusive_education.pdf 2600:8805:4D07:B900:E43F:5E60:E93C:C8A0 (talk) 14:36, 29 September 2021 (UTC)

 Not done for now: please establish a consensus for this alteration before using the {{edit semi-protected}} template. It appears that source is significantly less reliable than what is currently in the article. ScottishFinnishRadish (talk) 17:13, 29 September 2021 (UTC)

Semi-protected edit request on 28 December 2021

“Sheltered work” is no longer a contemporary term used in reference to people with disability. In the sidebar, change:

Treatment Educational support, sheltered work environment[6][7]

To:

Treatment Educational support, supported work environment[6][7] 120.22.57.192 (talk) 22:44, 28 December 2021 (UTC)

 Not done: please provide reliable sources that support the change you want to be made. ScottishFinnishRadish (talk) 23:23, 28 December 2021 (UTC)

Remove something from infobox

I really don't think we need to have deaths in the infobox-it's not a disease. I tried doing it but it messed up the whole infobox. DiaamondMiner999 (talk) 22:10, 28 December 2021 (UTC)

 Done. I checked the reference. DS was not a cause of death, having the number in the info box gave the impression of a connection. The citation showed a decrease in the number of deaths between 2005 and 2015, which is a point of interest which could be incorporated into the prognosis paragraph. Here is the link https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388903/ Vahvistus (talk) 23:11, 1 January 2022 (UTC)

Semi-protected edit request on 22 January 2022

Change “ If Down syndrome occurs in one in 500 pregnancies and the test used has a 5% false-positive rate, this means, of 26 women who test positive on screening, only one will have Down syndrome confirmed.[83] If the screening test has a 2% false-positive rate, this means one of eleven who test positive on screening have a fetus with Down syndrome.[83]” to “ If Down syndrome occurs in one in 500 pregnancies and the test used has a 5% false-positive rate, this means of 20 women who test positive on screening, 19 will have Down syndrome confirmed.[83] If the screening test has a 2% false-positive rate, this means 49 of 50 who test positive on screening have a fetus with Down syndrome.[83]”

The math for false positives is the rate positives end up being untrue. The original math interpreted it the opposite way. 204.111.137.25 (talk) 05:49, 22 January 2022 (UTC)

 Not done: The article remains correct. Suppose you have a sample of 50,000 people. ${\frac {1}{500}}\times 50000=100$ people are positive. Of these, $90\%\times 100=90$ people will be detected by the test as true positives. Of the 49,900 people that are negative, $5\%\times 49900=2495$ are false positives. ${\frac {90}{2585}}\approx 3.48\%$, ${\frac {1}{26}}\approx 3.85\%$. Same goes for the second statement. (Edit: I did notice however that the 90% detection rate which was mentioned in the paper was not mentioned in the article, so I added that to the article). ZaidhaanH (talk) 22:31, 22 January 2022 (UTC)

Semi-protected edit request on 22 February 2022

Signs and symptoms - neurological.

Please remove: After reaching 30 years of age, some may lose their ability to speak.[8]

The source states: Alzheimer's disease. Studies have shown that almost all people with Down syndrome have developed neuropathological changes with amyloid plaques and neurofibrillary tangles at the age of 35-40 years (5) . The changes are most pronounced in the frontal lobes and medially in the temporal lobes. It can probably explain changes in orientation, language, speech and social interaction that are frequently seen in people with Down syndrome over 30 years. The first signs of incipient dementia in Down syndrome are often altered behavior, in contrast to the normal population, where reduced short-term memory is the most common onset symptom (44)

Therefore the statement in the article completely misrepresents the information. 2A02:C7F:5D1B:2700:596:89F6:F913:288 (talk) 07:48, 22 February 2022 (UTC)

UK’s Down Syndrome Act 2022

Perhaps the page should mention the UK’s Down Syndrome Act 2022, (BBC, Mon 02 May 2022: 'The Down Syndrome Act means so much to me'), and similar legislation in other jurisdictions. JDAWiseman (talk) 10:11, 2 May 2022 (UTC)

Probability of having a child with DS (Maternal Age)

Probability of having a child with Down syndrome by National Down Syndrome Society (NDSS)

Maternal Age	Incidence of DS
20	0.05% (1 in 2000)
25	0.08% (1 in 1200)
26	0.09% (1 in 1100)
27	0.10% (1 in 1050)
28	0.10% (1 in 1000)
29	0.11% (1 in 950)
30	0.11% (1 in 900)
35	0.29% (1 in 350)
40	1.0% (1 in 100)
44	2.5% (1 in 40)
45	3.3% (1 in 30)
50	12.5% (1 in 8)

Source/Reference: https://www.ndss.org/about-down-syndrome/down-syndrome/

Please, change in 'Epidemiology'. — Preceding unsigned comment added by 93.95.191.17 (talk) 07:59, 31 May 2022 (UTC)

References

Semi-protected edit request on 4 August 2022

Under "Life Expectancy", the source 124 for "A study in 2015 found that the life expectancy of people with Down syndrome varied greatly, depending on their race." is suspect. He also cites a study (on people with Down syndrome in the United States from 1983-1997) that reported median age of death among all deaths of people with Down syndrome in a given year as if they had found the disparities among the actual life expectancy. I could not find the supposed 2015 study, and given the other glaring error in the source I would not necessarily trust it without knowledge of whatever study he refers to. There certainly are discreptancies between races (in the US), one could for example cite:

Early death and causes of death of people with Down syndrome: A systematic review https://onlinelibrary.wiley.com/doi/full/10.1111/jar.12446

This is also cited in the reference that is currently used. But the specific claim about a study that showed great differences in life expectancy currently isn't supported by the citation. In fact, this review (from 2018) does not even include a study from 2015, so I have no idea where that claim is coming from.

(Should this be an edit request or a more general comment? With the current source, this sentence should really just be deleted, and maybe replaced by a more general statement.)Valentinwust (talk) 10:12, 4 August 2022 (UTC)

 Done I've removed the relevant statement as the supporting source was just the claim on the page in a blog-like post that experts supposedly write. Irrespective of if the expert actually wrote it, that doesn't make it authoritative within of itself. I didn't search for the 2015 study myself, so if any editor finds it I have no objections to re-inclusion. —Sirdog (talk) 22:43, 7 August 2022 (UTC)

Advocacy groups

Some groups are listed, some are not. Perhaps a List of ... should be created or a Category? Xx236 (talk) 10:21, 12 December 2022 (UTC)

Semi-protected edit request on 2022-03-03

Current section 1.2 Signs and symptoms, Neurological:
Those with mosaic Down syndrome typically have IQ scores 10–30 points higher.
Requested change:
Those with mosaic Down syndrome typically have IQ scores 10–30 points higher than that.
Advantage: When using a relative adjective like „higher“ one should state its reference point. Without this change, the reader might be let to believe that mosaic Down syndrome comes with an IQ 10-30 points higher than general population, instead of higher than regular Down syndrome.
Disadvantage: None; readability is not impaired by this clarification at all.
--85.212.106.248 (talk) 00:19, 3 March 2022 (UTC)

 Done 晚安 (トークページ) 08:42, 6 March 2022 (UTC)

This isn't any better - I came her to point out the fault in the sentence. What the heck does 'that' refer to? There are three ranges in the preceeding sentence: to what does 'that' refer? And given that they are ranges, do some with mosaic Down syndrome really have an IQ of 99 (top end of high range)? To be clear and consistant in the sentence, the actual range of IQ in mosaic Down syndrome should be given - there's no need to refer back to a different range when you can just say explicitly what the new range is.

MarkinBoston (talk) 14:12, 10 March 2023 (UTC)