The impact of developmental behavioral pediatrics in a population of children with Down syndrome

Purpose: Children with Down syndrome (DS) have a unique developmental profile with an increased risk for co-morbid neurodevelopmental diagnoses, including autism spectrum disorder (ASD), anxiety, and attention deficit/hyperactivity disorder (ADHD), among others. A delay in a diagnosis of these conditions can impact the health and psychosocial wellbeing of the child and family. The purpose of this study was to assess identification of secondary co-morbid neurodevelopmental diagnoses within an academic DS specialty Clinic. Design and methods: A retrospective chart review of secondary co-morbid neurodevelopmental diagnoses including children with DS ages 2 to 17 years old, with a visit encounter in a pediatric DS specialty clinic between January 2018 to August 2019 was conducted. Comparisons included diagnoses identified before (T1) and after (T2) inclusion of developmental behavioral specialists as pediatric DS providers. Two sample t-tests, Chi-square test and Fisher's exact t-test were utilized to compare categorical and non-categorical variables. Results: 145 children were identified in T1 of which 51.7% were male. 225 children were seen in T2, 56.0% were male. Increased detection of several co-morbid conditions occurred between T1 and T2 including language disorder (p < 0.0001), intellectual disability (p < 0.0001), and non-specific developmental/behavioral diagnoses (p < 0.0001). Conclusion: Developmental/behavioral assessment is integral for detection of co-morbid conditions among a pediatric DS population and prevention of diagnostic overshadowing. Practice implications: Interprofessional teams, including pediatric nurse practitioners, play a key role in providing health supervision and assessment for a pediatric DS population.