Every thorough mental health assessment should include an assessment of physical health to ensure that physical health problems are not affecting mental well-being in any way. This is true whether or not the adult with Down syndrome is suspected of having any kind of mental illness. Discovering physical health problems early in their course may prevent them from causing mental health problems.
We sometimes find that a physical problem is the direct cause of a mental health problem and sometimes it is a contributing factor. However, in either case, as time goes by, the problem often develops other “layers,” and treatment of the physical problem alone is often not adequate. It is necessary to address the problem from all aspects: physical, psychological, and social.
Below is a list of physical health conditions, their possible impact on mental health, and tests or procedures that can be done to assess for the conditions. The list is not comprehensive. In our experience, these conditions have most often contributed to mental health problems in adolescents and adults with Down syndrome. Based on the history, physical, and findings of the tests or procedures, referral to a specialist may also be indicated.
PAIN
Possible impact: Depression, behavior change, aggression, and anxiety
Test or procedure: Interview the adult with Down syndrome and their family/caregiver; thorough physical exam; additional procedures as indicated based on history and physical exam
HEARING IMPAIRMENT
Possible impact: Anxiety, apparent loss of cognitive skills, depression, agitation, aggression
Test or procedure: Hearing test from an audiologist at least every 2 years, or more frequently if indicated by possible change in hearing
VISION IMPAIRMENT
Possible impact: Anxiety, depression, apparent loss of cognitive skills, agitation
Test or procedure: Complete vision exam at least every 2 years or more frequently if indicated by possible change in vision
SEIZURES
Possible impact: Aggression, depression, apparent loss of cognitive skills
Test or procedure: EEG and imaging of the brain (CT scan or MRI)
CERVICAL SUBLUXATION
Possible impact: Loss of skills (particularly decreased ambulation skills, loss of muscle function, incontinence), anxiety, agitation, depression, loss of interest in activities
Test or procedure: Thorough neurological exam (as part of physical exam); lateral cervical spine x-rays in flexion, extension, and neutral; CT scan and/or MRI of cervical spine
URINARY TRACT PROBLEMS*
*Includes urinary tract infections and difficulty/inability to empty the urinary bladder
Possible impact: Development of incontinence, urinary frequency, agitation, anxiety
Test or procedure: Urinalysis (urine test) and possibly urine culture; ultrasound of the bladder and kidney (a pre- and post-void ultrasound or a bladder scan is helpful to assess for problems with emptying the bladder)
ARTHRITIS
Possible impact: Agitation, depression, apparent loss of skills
Test or procedure: Physical exam; x-rays
DIABETES
Possible impact: Apparent loss of skills, urinary incontinence, increased urinary frequency and/or drinking of fluids, agitation, depression
Test or procedure: Blood sugar; consider Hemoglobin A1C (further testing indicated if blood sugar suggests diabetes)
DENTAL CONCERNS
Possible impact: Agitation, poor eating, depression, aggressive behavior
Test or procedure: Thorough dental exam; x-rays as indicated
HYPOTHYROIDISM
Possible impact: Depression, loss of cognitive skills, appetite change
Test or procedure: Blood test for TSH and free T4
HYPERTHYROIDISM
Possible impact: Anxiety, hyperactivity, depression, loss of cognitive skills
Test or procedure: Blood test for TSH and free T4 (and possibly free T3)
SLEEP APNEA & OTHER SLEEP DIFFICULTIES
Possible impact: Depression, loss of cognitive skills, agitation, psychoses
Test or procedure: Observe sleep and keep a sleep log (although it is easy to miss sleep apnea with observation alone); formal sleep study in a sleep lab or at home
GASTROINTESTINAL PROBLEMS
Possible impact: Loss of appetite, depression, agitation, anxiety
Test or procedure: Stool test for blood; blood tests for anemia, celiac disease, liver disease, and gall bladder disease; x-rays, ultrasounds, CT scans, and endoscopy as indicated by history, physical, and other tests
DOWN SYNDROME REGRESSION DISORDER
Possible impact: Can contribute to a wide variety of functional, behavioral, or psychological change
Test or procedure: Assess with history, physical, lab, and imaging evaluations
MEDICATION SIDE EFFECTS
Possible impact: Can contribute to essentially any behavioral or psychological change
Test or procedure: Careful history to look for potential link to medication; possible trial off the medication
