Down Syndrome Abstract
of the Month:
Nov 2007
Typical or pathological? Routinized and compulsive-like behaviors in children and young people with Down syndrome.
Glenn S, Cunningham C.
Intellect Dev Disabil. 2007 Aug;45(4):246-56.
Faculty of Health and Applied Social Sciences, John Moores University, Liverpool, UK.
Abstract:
Routinized and compulsive-like behaviors (RCBs) are common in typically developing children and in children and adults with Down syndrome, but what functions do they serve? Parents completed questionnaires for RCBs, behavior problems, and adaptive behaviors. Children who had Down syndrome had significantly higher levels of RCBs than did the typically developing children at all MAs; RCBs were positively associated with adaptive behaviors for younger MA and CA groups, but not older MA children and all adults with Down syndrome. For children with Down syndrome and MAs over 5 years and all adults, RCBs were associated with behavior problems. We concluded that RCBs support developmental progress for all children with MAs less than 5 years, but may have different functions for older individuals.
My comments:
The authors describe routinized and compulsive behaviors as actions that have to be carried out in a particular way (things have to be "just right") or "insistence on sameness" and repetition. As mentioned in the abstract, these behaviors are expected in certain stages of normal development. But do they occur later in development in children and young adults with DS, and if so, are they useful or maladaptive behaviors at that point?In the first part of the study, the authors concluded that children with DS did not have any more of the routinized or compulsive behaviors than children without DS, but the behaviors of children with DS appeared to be more intense. (The authors did not give any examples of intensity, so I presume this refers to how demanding the child is that the behaviors be carried out or how upset the child gets if the behavior is interrupted.) The authors also found that if the child with DS' mental age was assessed at over 5 years of age, the parents were more likely to refer to the behavior as being a "problem behavior."
In the second part of the study, the authors looked at behaviors over time and found no evidence of a decline in compulsive behaviors after reaching the mental age of 5 years. (The mean mental age of the group of subjects with DS was just over 6 years of age, which limits the ability to project the results into a young adult group.)
"Just right" behaviors are adaptive in small children who feel a need to exert a measure of control over their environment. In older children, these behaviors may actually be a compensatory mechanism to prevent the person from being overwhelmed by complex external stimulation. So they remain, in essence, attempts to control the environment. So in young children with DS, these routinized behaviors are normal and adaptive. In children and young adults with a mental age greater than 5 years, these behaviors become maladaptive only when they interfere with everyday life.
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