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Down Syndrome Abstract
of the Month: Nov 2000

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Compulsive-like behavior in individuals with Down syndrome: its relation to mental age level, adaptive and maladaptive behavior.

Evans DW, Gray FL
Child Dev 2000 Mar-Apr;71(2):288-300

Department of Psychology, Bucknell University, Lewisburg, PA, USA

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This study examined the nature of repetitive, ritualistic, and compulsive-like behaviors in 50 typically developing children and 50 individuals with Down syndrome (DS), matched on mental age (MA; Mean = 59.72 months). Parents reported on their children's compulsive-like behaviors - including ritualistic habits - and perfectionistic behaviors, as well as their children's adaptive and maladaptive behaviors. Results indicated that children with DS show similar MA-related changes in compulsive-like behaviors compared to the MA-matched comparison group. Younger children (both typical and DS) exhibited significantly more compulsive-like behaviors than older children. In general, children with and without DS did not differ from each other in terms of the number of compulsive-like behaviors they engaged in, although participants with DS engaged in more frequent, more intense repetitive behaviors. Compulsive-like behaviors were differentially related to adaptive and maladaptive behaviors across the MA and mental retardation groups. The results extend the "similar sequence" model of development to the construct of compulsive-like behaviors, and also suggest that some repetitive behaviors may be among the behavioral phenotype of individuals with DS.

My comments:

First, some background. Compulsions are repetitive behaviors or mental acts, presumably used by persons to reduce or prevent anxiety. Some of these behaviors are normal, such as checking if the coffee maker is turned off before leaving the house, or recounting ballots. Compulsions become pathological, or abnormal, when they become more intense and occur more often, and cause discomfort in the person with the behaviors.

During normal childhood development, compulsive behaviors are seen in repetitive play. Children 2 to 3 years of age especially show these behaviors: demanding that a cookie or apple be completely whole before accepting it, elaborate bedtime rituals, arranging toys in their rooms, etc. These rigid behaviors usually start to go away by 6 years of age. These normal behaviors are called compulsive-like behaviors.

Children with DS are often described as having repetitive, rigid behaviors. This study attempted to examine a group of children with DS and determine if these are compulsive-like behaviors, and if so, do they occur at the same chronologic age or mental (cognitive) age as in children without DS.

The authors concluded from their studies that children with DS had the same compulsive-like behaviors as other children, and they occurred at the appropriate mental age rather than chronologic age. However, the children with DS had behaviors that were more intense (the behaviors occupied more time or occurred more frequently) than in the control group of children. The "similar sequence" theory mentioned in the abstract states that children with cognitive delays develop in the same way that children without cognitive delays do, meaning the same behaviors in the same sequences through time, but that children with cognitive delays just take longer to accomplish the developmental skills.

The main concern here is that these compulsive-like behaviors in children with DS may be maladaptive; in other words, the children may be so preoccupied with these behaviors that they interfere with learning daily living skills and other more adaptive behaviors. It is important for parents and teachers to be able to determine which behaviors are adaptive and which are in conflict with the child's learning new skills.

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