When is a Behavioural Change Normal? When Should I Seek Help?

What is a Mental Health Disorder? A mental health disorder is a syndrome or a behavioural, emotional, or psychological pattern that reflects a psychological, biological, or developmental dysfunction. It is associated with distress, disability, or an increased risk of adverse consequences for both the affected individual and their environment. It should not be a culturally sanctioned or expected response to a particular event.

Main Mental Health Disorders The most common mental health disorders include anxiety, depression, grief, post-traumatic stress disorder, obsessive symptoms, behavioural maladjustments, psychosis, and regression syndrome in individuals with Down syndrome.

When Should a Person with Down Syndrome Be Assessed? Professional help should be sought when there are persistent changes in the individual’s behaviour and emotional state. These changes should be distinct from their previous state, persist over time, be dysfunctional, and cause distress to both the individual and their family. Often, caregivers are the first to notice these signs, which may manifest differently compared to individuals without intellectual disabilities.

Mental Health Assessment The assessment process begins with an interview and evaluation of the individual, ideally conducted alone. Subsequently, a discussion with family members or caregivers takes place, always with the individual’s consent. Information on developmental history and specific background is gathered, and if necessary, a physical examination is conducted to rule out organic causes. Finally, treatment options, which may include medication or other therapeutic alternatives, are discussed, and follow-up is established to monitor the patient’s progress.

Description of Disorders

Depression Depression is a syndrome characterised by persistent sadness, accompanied by other symptoms that may vary depending on the individual’s cognitive abilities. Common symptoms include the loss of daily living skills, memory deterioration, slowing of activities, and lack of motivation. Attention difficulties, cognitive alterations, changes in appetite and sleep, social withdrawal, soliloquies, delusional ideas, passivity, and frequent episodes of crying may also be present.

Anxiety Anxiety becomes problematic when its intensity or duration is disproportionate to the actual danger or when it occurs without a recognisable threat. It can lead to a high level of physiological activation, disrupting an individual’s functioning. Symptoms include excessive sweating, palpitations, and digestive issues such as diarrhoea or nausea.

Grief The grieving process in individuals with Down syndrome has particular characteristics. Their response is often delayed, and their perception of time differs, making it more difficult to comprehend the process of loss. In some cases, the lack of participation in farewell rituals, such as funerals, can delay grief processing.

Post-Traumatic Stress Disorder (PTSD) Individuals with Down syndrome are more vulnerable to re-experiencing past trauma. They may have difficulty understanding temporality and rely on visual memory to process events. Additionally, they may struggle to communicate their fears and distress.

Psychosis Psychotic symptoms can vary significantly depending on the individual and their cognitive level. Not all isolated symptoms indicate a psychotic disorder, but it is crucial to assess their impact on daily functioning.

Obsessive Symptoms and Compulsions Individuals with obsessive symptoms experience recurrent thoughts, impulses, or images that cause significant anxiety or distress. These thoughts are often difficult to communicate. To relieve this distress, individuals may develop compulsions, which include repetitive behaviours such as excessive handwashing, meticulously arranging objects, or mentally repeating words.

Regression Syndrome in Individuals with Down Syndrome This syndrome is characterised by an unexpected and severe regression in cognitive and adaptive functioning. It manifests as a rapid loss of previously acquired skills and an increase in maladaptive behaviours. It typically appears between the ages of 14 and 17, though it can occur between 10 and 30 years.

Triggering factors may include environmental stressors or significant routine changes. Diagnosis considers the onset of psychiatric or neurological symptoms within 12 weeks in a previously healthy individual, alongside mental state alterations, emotional dysregulation, insomnia, language deterioration, movement disorders, and psychiatric symptoms such as anxiety, hallucinations, delusional ideas, or agitation.

It is essential to rule out other causes before confirming the diagnosis.

Conclusion Mental health care for individuals with Down syndrome requires a specialised approach, involving detailed assessments and continuous follow-up. Early identification of behavioural and emotional changes is key to providing the best possible quality of life for individuals and their families.