When a child or teen with Down syndrome expresses rebellion, impulsive and dangerous behaviors, or simple lack of compliance, adults in charge must evaluate whether the individual is expressing age-appropriate misbehavior; a developing medical condition or mood disorder; or is responding to something negative like bullying or abuse.

We are so cautious about treating behavioral, emotional, or psychiatric conditions with medications, when we do not think twice about giving our children medications to ease colds or injuries and cure infections. I think we are right to be careful, since children with disabilities have historically been warehoused or imprisoned in institutions where they were subjected to inappropriate medications to make them barely functional.

I have known many parents who, like me, believe that too many teens and pre-teens growing up at home have been medicated instead of supported in communication and self-determination. Changes in behavior may be caused by medical conditions, abuse or neglect, and it's important to have a full medical check for infection or injury; blood work done for thyroid problems, diabetes, etc.

A great deal of research and experience with many individuals with Down syndrome has shown that some behaviors are more common in people with developmental disabilities, executive processing challenges, and inadequate support for communication (including interested and patient listeners). Most individuals respond well to appropriate supports and encouragement, although all children and teens may experience temporary glitches in temperament and behavior that require patience and new strategies for improving self-control and better decision making.

Every parent I've known whose child has not responded to 'best practices' and whose behavior escalated, has tried the option of medication as a last resort, in the best interest of their child. It's ironic that many of the most cautious parents has a son or daughter who responds to a combination of medications, like Celexa + Abilify, or Zoloft and Ritalin, after a single Rx or other combination has been ineffective. Most have the lowest doses prescribed, and the only difference seen after a month or two, sometimes only weeks, is that their child is able to respond to the 'best practices' and support that had not made a difference without them.

Some have used medication for only a year, and tapered off as their child learns coping strategies (or maybe outgrew pre-teen/teen hormonal imbalance?) and some have used meds for a longer term. It is critical that individuals taking these medications be closely followed by a doctor familiar with the side effects and the need for monitoring blood work. Safety issues are first, because even when a medication (or combination) is found that is helpful for your particular child, it takes a while for the medications to work, and for the child or teen to change behaviors that have become habits, or to learn strategies to manage impulses.

Browse at your public library, local bookstore or online retailer for books like Mental Wellness in Adults with Down Syndrome: A Guide to Emotional and Behavioral Strengths and Challenges, A Guide to Good Health in Teens and Adults with Down Syndrome, or others about behavior as a symptom of illness in children.