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Rebecca E. Sheehy, Ph.D., Wendy B. Doret, Ph.D., Roberta Rosenblum, M.S., P.D.,Sam Nussbaum, C.S.W.
Association for Children with Down Syndrome
4 Fern Place, Plainview, NY, 11803
Phone 516-933-4700
Vitamin Therapy in Down Syndrome: The Effects of Vitamin Therapy on the Number of Parent-Reported Illnesses in a Group of Children with Down Syndrome
Introduction
In recent times, a great deal of emphasis has been placed on the importance of adequate vitamin intake to overall health and the prevention of disease. This emphasis has led many people to view large doses of vitamins as a treatment for disease rather than as a preventive measure against disease. This emphasis, and preliminary research linking vitamin supplementation to improvements in intelligence scores in non-handicapped school children (Benton and Roberts, 1988) and mentally retarded children (Harrell, Capp, Davis, Peerless & Ravitz, 1981) have led many parents to administer large doses of vitamins to their children with Down Syndrome hoping to maximize their intellectual potential. Additional research into the effectiveness of this "vitamin therapy" has failed to replicate these preliminary results either in school children (Yudkin, 1991) or children with Down Syndrome (Pruess, Fewell & Bennett, 1989). In conjunction with reports of increased intellectual ability are indications that the vitamin supplementation increased the overall health of the children (Yudkin, 1991). If vitamin therapy can improve the overall health of children with Down Syndrome, we might expect some indirect intellectual benefit. Specifically, children that spend less time ill during a school year might be better able to attend to educational tasks and be more likely to participate in activities.
Subjects
Subjects were all students at the Association for Children with Down Syndrome in Bellmore, NY. A total of 14 children with Down Syndrome ranging in age from 12 months to 5.5 years participated in the study. 8 children were already being administered vitamin supplements by their parents (vitamin group). The remaining 6 children in the study were not receiving any vitamin supplements (control group).
Methods
In order to investigate the question of whether vitamin therapy can increase the overall health of children with Down Syndrome, a questionnaire was developed and distributed to parents by the school nurse. Parents were asked to report the child’s current height and weight as well as the number, duration and nature of illness(es) for a given month. The completed questionnaires were collected by the school nurse on the last day of each month from 10/31/97 until 9/31/98. For purposes of scoring, one week or less of reported illness was counted as an individual illness. If a child was ill longer than one consecutive week, each additional week was scored as a separate illness. This procedure was followed in order to differentiate between children that had a single short-duration illness and children that had a single long-duration or chronic illness. The number of illnesses reported in each month was tallied, and a mean across months was calculated to yield an illness score.
Results
For the vitamin group, the illness score was .71, and for the control group, the illness score was .91. Mean body weight of children in the vitamin group was 31.36 lbs, and mean body weight of children in the control group was 28.40 lbs. These results are presented in Figures 1 and 2 respectively. An independent samples t test was conducted to test the hypothesis that the mean illness scores and mean body weight scores differed between the vitamin group and the control group. Although inspection of figures 1 and 2 suggested that there was a trend for the vitamin group to have fewer illness and a higher body weight than the control group, the statistical analyses of the data did not support this observation. Neither the mean illness scores nor the mean body weight scores of the vitamin group and the control group were significantly different from each other (illness scores: t8..34=.49 p=.6; mean body weight t8.73=-.80 p=.446).
Discussion
The lack of significant results in the current study would seem to indicate that vitamin therapy did not significantly affect the overall health of the children. This result is consistent with observations in the research literature that vitamin supplementation only improves health to the extent that it compensates for a diet that may be deficient in certain vitamins and minerals (Yudkin, 1991). In other words, the same improvements previously observed in school children given vitamin supplements might also be realized by providing the children with a well-balanced diet. In addition, reports in the medical literature of specific vitamin deficiencies in individuals with Down Syndrome have not been substantiated by subsequent research, and in fact serum levels and absorption rate of these vitamins has been found to be normal (Del Arco, Riancho, Luzuriaga, Gonzales-Macias & Flores, 1992; Pueschel, Hillemeir, Caldwell, Senft, Mevs & Pezzullo, 1990).
The results of this study, although consistent with the literature should, however be viewed with caution. The lack of double-blind procedures in the administration of the vitamin supplements, as well the variability in the types of supplementation the children were receiving may have introduced a bias into the sample. In addition, the interpretation that the two groups were not equivalent at the start of the study can not be ruled out in the absence of a pre-treatment measure. It is therefore possible that the children who received vitamin therapy tended to be sicker than the control group before the study, and the measured equality between the groups may in fact be illustrating a net improvement in the vitamin group. It is also important to note that parents often estimated (rather than measured) the weight of their children and reported it inconsistently and possibly inaccurately. This state of affairs may have contributed to the lack of significant effects for this measure.
The results of this study, although suggestive, should in fact be considered inconclusive. The question addressed in this study is an important one, as the administration of large doses of vitamins might have unforseen effects on a developing child, and may even be toxic in some cases (Rudman and Williams, 1983). It is important to determine if the possible benefits of vitamin therapy outweigh the risks of giving possibly toxic doses of vitamins to children with Down Syndrome. The pattern of results do suggest, however that the possible costs of vitamin therapy do not seem to be balanced by any measurable benefit. Until there is definitive evidence that vitamin therapy is beneficial, this alternative therapy should be approached with caution.
References
Benton, D., & Roberts, G. (1988). Effect of Vitamin and Mineral Supplementation in Intelligence of a Sample of School-children. Lancet, 1, 144
Del Arco, D., Riancho, J. A., Luzuriaga, C., Gonzales-Macias, J., & Florez, J. (1992). Vitamin D Status in Children with Down Syndrome. Journal of Intellectual Ability Research, 36, 251-257.
Harrell, R. F., Capp, R. H., Davis, D. R., Peerless, J., & Ravitz, L. R. (1981). Can Nutritional Supplements Help Mentally Retarded Children? An Exploratory Study. Proceedings of the National Academy of Sciences, 78(1), 574-578.
Preuss, J. B., Fewell, R. R., & Bennett, F. C. (1989). Vitamin Therapy and Children with Down Syndrome: a Review of Research. Exceptional Children, 55(4), 336-341.
Pueschel, S. M., Hillemeier, C., Caldwell, M., Senft, K., Mevs, C., & Pezzullo, J. C. (1990). Vitamin A Gastrointestinal Absorption in Persons with Down Syndrome. Journal of Mental Deficiency Research, 34, 269-275.
Rudman, D., & Williams, P. (1983). Megadose Vitamins: Use and Misuse. New England Journal of Medicine, 309(8), 488-489.
Yudkin, J. (1991). Intelligence of Children and Vitamin-Mineral Supplements: The DRF Study. Discussion, Conclusion and Consequences. Journal of Personality and Individual Differences, 12(4), 363-365.