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Adaptive behaviour in Down syndrome: A cross-sectional study from


childhood to adulthood

Article  in  Wiener klinische Wochenschrift · December 2010


DOI: 10.1007/s00508-010-1504-0 · Source: PubMed

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original article

Wien Klin Wochenschr (2010) 122: 673–680


DOI 10.1007/s00508-010-1504-0
Wiener klinische Wochenschrift
© Springer-Verlag 2010 The Middle European Journal of Medicine
Printed in Austria

Adaptive behaviour in Down syndrome: a cross-sectional


study from childhood to adulthood
Anastasia Dressler1, Valentina Perelli2, Martha Feucht1, Stefania Bargagna2

1
Department of Pediatrics and Adolescent Medicine/Division of General Pediatrics and Neonatology,
Medical University Vienna, Vienna, Austria
2
IRCCS, Stella Maris Foundation, Scientific Institute for Child and Adolescence Neurology and Psychiatry,
Calambrone, Pisa, Italy

Received March 22, 2010, accepted after revision November 8, 2010, published online December 7, 2010

Adaptive Fähigkeiten und Down-Syndrom: waren im Kindes- und vorallem im mittleren Durchschnitt,
eine Querschnittsstudie vom Kindes- zum während diese hingegen im jüngeren und älteren Erwach-
Erwachsenenalter senenalter Stärken darstellten.
Schlussfolgerungen: Personen mit Down-Syndrom stär-
Zusammenfassung. Einleitung: In der Literatur werden ken ihre adaptiven Fähigkeiten bis zum 30. Lebensjahr, die
adaptive Fähigkeiten bei Personen mit Down-Syndrom so kognitiven Fähigkeiten haben zu diesem Zeitpunkt schon
beschrieben, dass sie kontinuierlich bis ins Jugendlichen- ein Plateau erreicht. Wir fanden ein größeres Absinken der
alter wachsen, danach eine Phase der Stagnation beginnt, adaptiven Fähigkeiten im mittleren Erwachsenenalter.
ein Abfall erst im mittleren Erwachsenenalter eintritt und Dieses Resultat führen wir zum Teil auf vermehrte Stimuli
einer früh beginnenden Demenz vom Alzheimertyp zuge- im Alltag der jüngeren Teilnehmer zurück, was in weiter-
schrieben wird. Der Zeitpunkt der Stagnation der adapti- führenden Studien untersucht werden sollte.
ven und auch der kognitiven Fähigkeiten wird kontrovers
diskutiert. Unser Ziel war es das adaptive Verhalten bei Summary. Objective: Adaptive behaviour in Down syn-
Down-Syndrom, die Unterschiede in verschiedenen Al- drome is described to increase until middle childhood and
tersgruppen, altersabhängige Veränderungen und den Zu- to begin to decline in adolescence, whereas significant de-
sammenhang mit den kognitiven Fähigkeiten zu terioration in middle adulthood has been attributed to
untersuchen. early onset of dementia. Nevertheless, opinions diverge
Methoden: In einer prospektiven Querschnittsstudie about when the slowing down of adaptive and cognitive
wurden alle Personen mit Down-Syndrom an vier ver- abilities starts. Our aims were to describe the profile of
schiedenen italienischen Zentren eingeschlossen. Ein- adaptive behaviour in Down syndrome, the variability
schlusskriterien waren, dass die Teilnehmer in der Familie within different age- groups, age-related changes and the
lebten und eine Demenz vom Alzheimertyp ausgeschlos- correlation to cognitive abilities.
sen werden konnte. Die Untersuchungen umfassten eine Methods: In a prospective cross-sectional study, indi-
detaillierte medizinische und neuropsychiatrische Unter- viduals with Down syndrome all living in the family and
suchung, eine psychometrische Testung und die Untersu- without signs of dementia in 4 Italian sites were included
chung des adaptiven Verhaltens mittels der Vineland and performed a detailed medical and neuropsychiatric
Adaptive Behaviour Scales. work-up, as well as cognitive testing and adaptive behav-
Ergebnisse: 75 Personen von 4 bis 52 Jahren wurden ein- iour, using the Vineland Adaptive Behaviour Scales.
geschlossen. Die Gruppe der jungen Erwachsenen zwi- Results: Seventy-five individuals with Down syndrome
schen 20 und 30 Jahren zeigte die höchsten adaptiven from 4 to 52 years were included. Adults from 20 to 30 years
Fähigkeiten. Der Bereich Kommunikation, durchgehend showed the highest performance of all groups. The area of
eine Stärke, zeigte keine Altersunterschiede, die Bereiche communication, always an area of strength, did not change
Alltagsfertigkeiten ( p = 0,012) und Sozialisierung (p = 0,021) over time, in childhood and especially in adolescence daily
living skills (p = 0.012) and socialisation (p = 0.021) scored
on average, whereas in young and middle adulthood per-
formance in daily living skills and socialisation and were
Correspondence: Anastasia Dressler, Department of Pediatrics and
Adolescent Medicine/Division of General Pediatrics and areas of strength.
Neonatology, Medical University Vienna, Währinger Gürtel 18-20, Conclusions: Individuals with DS continue to increase
1090 Wien, Austria, E-mail: anastasia.dressler@meduniwien.ac.at competence in adaptive behaviour until 30 years, even

wkw 23–24/2010 © Springer-Verlag Adaptive behaviour in Down syndrome 673


original article

when cognitive abilities reach a plateau. We found no ma- [11, 12] not only in children with DS, but also in adults liv-
jor decline in middle adulthood. This may be due to expo- ing in residential facilities [18]. Dykens et al. [4] confirm an
sure to daily life, but needs to be supported by further area of weakness in expression, but demonstrate that re-
studies. ception is an area of strength. A recent study [5] has de-
scribed already in toddlers relatively stronger social skills,
Key words: Adaptive behaviour, Down syndrome, Vine- but also weaker expressive language and poor motor coor-
land Adaptive Behaviour Scales, adulthood. dination, the last being similar to areas of strength and
weakness described in older children and young adults.
Introduction Recently, research focused on adaptive skills in adulthood
as an early sign of decline.
Adaptive behaviour is defined as the performance of daily However, data in literature are controversial, as several
activities required for personal and social sufficiency [13], authors describe a decline after 50 years of age [24],
or as “the effectiveness with which the individual copes whereas others find no significant differences in adaptive
with the natural and social demands of his environment” behaviour between DS and ID of other aetiology above 50
[7]. It is an essential integration to cognitive testing in in- years [2, 15] .
tellectual disability (ID), as, in contrast to cognitive abili- The apparent inconsistencies in these reports have been
ties, it permits us to evaluate how well individuals function in part clarified by Prasher, Chung and Hacque [14] dem-
in their own environment, particularly in individuals with onstrating that the presence of dementia is the only deter-
a low level of functioning [22]. mining factor, and that individuals with DS in middle-age
The relationship in Down syndrome (DS) between do not undergo any decline in adaptive behaviour if de-
adaptive behaviour and age seems to be discontinuous mentia is excluded.
[23], and also cognitive development is characterised by Our goals were first to describe adaptive behaviour in DS
plateaux. In cognition a delay is seen between 0 and 2 and discover an eventual phenotypic profile in DS, second
years, and acceleration between 2 and 4 years [6]. A gen- to assess a possible variability within different age-groups
eral slowing down of adaptive skills and of cognitive abili- and the influence of age-related changes, and third to cor-
ties with increasing chronological age is described relate adaptive behaviour and cognitive development.
controversially in literature. Age-related gains in adaptive
functioning are particularly seen in early childhood (1–6
years); whereas in children and adolescents, a weak corre- Patients, materials and methods
lation between adaptive skills and age and an increased Participants
variability in middle childhood imply that not everybody
Individuals with DS were enrolled prospectively in an open-label
has a plateau effect [3, 9,10].
study on premorbid signs of Alzheimer’s disease financed by the
Significant reductions in neuropsychological variables
Italian Ministry of Health at 4 different sites in 2 Italian regions
such as language, visuo-spatial abilities, attention and through regional health-care services (Pisa and Livorno, IRCCS
memory, as well as in cerebral glucose utilisation were ob- Stella Maris Foundation, Division of Child Neurology and Psychi-
served in DS adults over 35 years even in the absence of atry at the University of Pisa, Pistoia, AIAS, Bologna CEPS).
dementia [16]. Inclusion criteria were the presence of DS, living in the family
However, most of the studies examine a rather limited and the exclusion of dementia and other not corrected metabolic
period of time; and it is likely that adaptive skills may be disorders. We divided the participants into 4 age-groups (see
acquired until adolescence and early adulthood in com- Table 1).
parison to other developmental skills. The most important Informed consent to participate in the study was provided by
feature seems to be a stimulating environment [8], as ado- relatives after written information was distributed and discussed.
Ethical approval was obtained from the national research ethics
lescents with DS with adequate support continue to gain
committees.
adaptive skills until early adulthood. Sloper and Turner
[19] found that a higher level of cognitive development is
the strongest predictor of progress in self-sufficiency. How- Methods
ever, family factors are also important, in particular moth- The severity of ID was classified using the criteria of the “Interna-
er’s strategies for coping with a child’s problem (in tional Classification of Diseases” (ICD 10) [1]. When possible in-
particular in problem-solving) and mother’s levels of so- dividuals were interviewed along with the main caregiver, and a
cial support. A recent study [21] showed that the coping detailed medical history was taken in order to elicit any medical
strategies catastrophising and acceptance led to more pa- disorder, use of any medication was recorded, and interviews
rental distress whereas only positive reappraisal was asso- with the caregiver were undertaken to elicit any suggestion of
ciated with a better well-being in parents of children with past or ongoing psychiatric disease. Medical records were re-
viewed for ascertaining regular screening for haematological, bi-
DS. This suggests that interventions aimed at changing
ochemical and thyroid function.
family coping strategies and supplementing social support
Adaptive functioning was assessed using the Vineland Adap-
may show a benefit in the development of social-inde- tive Behaviour Scales (VABS) (adapted Italian Version) [20] for all
pendent functioning in young people with DS. individuals as a structured interview with the main caregiver (in
Only a few studies describe areas of strength and weak- our cases always a family member, living with the individual). The
ness in adaptive behaviour in DS from childhood to adult- VABS is divided in 3 domains (subdivided in 3 subdomains):
hood. Lower scores in the domain expression were found 1) Communication (Receptive, Expressive and Written), 2) Daily

674 Adaptive behaviour in Down syndrome © Springer-Verlag 23–24/2010 wkw


original article

Table 1. Characteristics and adaptive behaviour of individuals with DS


GROUP 1 2 3 4
Age in years 0–10 10–20 20–30 Over 30
Number (n = 75) 17 18 23 17
Total cohort
Gender M/F 10/7 12/6 12/11 10/7
Mean age ± SD 6.63 ± 1.48 14.51 ± 3.50 24.04 ± 2.59 37.67 ± 7.55
Communication 3.57 ± 1.45 6.52 ± 2.84 7.55 ± 3.50 6.00 ± 3.48
age equivalent (years)
Reception 4.53 ± 2.81 6.16 ± 2.80 7.03 ± 2.99 6.02 ± 3.17
Expression 3.39 ± 1.67 5.24 ± 2.37 6.32 ± 2.71 5.08 ± 2.69
Written 3.73 ± 0.83 6.98 ± 2.75 7.83 ± 3.76 6.00 ± 3.48
Daily living skills 3.22 ± 1.02 6.67 ± 2.33 7.51 ± 2.75 6.81 ± 2.61
age equivalent (years)
Personal 2.86 ± 1.14 5.95 ± 1.88 6.62 ± 2.45 6.11 ± 1.62
Domestic 4.72 ± 1.44 8.38 ± 2.46 10.80 ± 3.85 9.69 ± 2.34
Community 3.00 ± 0.61 5.36 ± 2.01 7.62 ± 3.69 5.83 ± 3.80
Socialisation 2.77 ± 0.83 5.37 ± 2.57 8.18 ± 4.39 6.50 ± 4.64
age equivalent (years)
Interpersonal 2.09 ± 0.73 6.16 ± 4.41 7.01 ± 4.26 5.69 ± 4.46
Play-Leisure 2.55 ± 1.03 5.27 ± 3.21 7.80 ± 4.67 6.02 ± 2.34
Coping 3.89 ± 0.83 6.37 ± 2.00 9.2 ± 7.62 7.62 ± 3.91
Total composite 3.19 ± 1.00 6.19 ± 2.28 7.75 ± 3.24 6.38 ± 3.46
age equivalent (years)
n = 53 8 10 19 10
Cohort with mental age
Gender M/F 4/4 8/2 10/9 7/3
Mental age 3.55 ± 1.47 6.41 ± 1.22 6.38 ± 1.50 5.79 ± 2.38
Communication 3.77 ± 1.44 7.13 ± 3.13 8.11 ± 3.35 7.41 ± 3.33
age equivalent (years)
Daily living skills 3.13 ± 0.88 7.08 ± 2.56 8.12 ± 2.57 8.06 ± 2.73
age equivalent (years)
Socialisation 2.95 ± 0.90 6.09 ± 2.96 8.73 ± 4.42 8.62 ± 5.01
age equivalent (years)
Total composite 3.28 ± 0.94 6.77 ± 2.52 8.32 ± 3.10 8.07 ± 3.61
age equivalent (years)

living skills (Personal, Domestic and Community), and 3) Social- Results


isation (Interpersonal Relationships, Play and Leisure Time, Cop-
ing). VABS Total score for the Adaptive Behaviour Composite was Participants
calculated. We used age equivalent scores for the comparison
A total of 75 individuals with DS were included, 49 individ-
with mental age. For the calculation of areas of strength and areas
of weakness VABS raw scores were converted into 3 levels of func- uals were from Pisa and Livorno, 17 individuals from
tioning (above average, average and below average) according to Bologna and 9 from Pistoia. All participants were living in
the average in this age group, additionally the IQ of deviation was the family. 44 males and 31 females in an age range from 4
calculated, as suggested in the VABS manual. to 53 years participated; mean age was 20.79 ± 11.96. In 42
Considering ID, 3 levels of intellectual disability (mild, moder- individuals cytogenetic studies confirmed the clinical diag-
ate and severe ID) were distinguished and compared to VABS nosis, 36 individuals (in 85.7%) had complete Trisomy 21,
scores. Current mental age was tested with the Wechsler Intelli- and 6 individuals presented mosaicism of Chromosome 21
gence Scales-Revised (WISC-R), and when possible Coloured (14.3%). The unavailability of chromosomal analysis in the
Progressive Matrices (CPM). remaining 33 individuals was due to the failure of venous
Statistic analysis was done with SPSS for Windows 14.0, we
blood collection (e.g. poor subject compliance and poor ve-
performed for group differences oneway ANOVA; and the Bonfer-
roni test was used for post hoc analysis.
nous access). VABS were performed in all 75 participants.
For non-parametric analysis we used the Pearson’s Chi- Cognitive level from the clinical chart was available in
square, for non-parametric correlations we used the Tau-b Kend- all 75 individuals, but a current mental age (performing
all test and for parametric correlations the Pearson’s test. WISC-R when possible CPM) obtained at the same time as

wkw 23–24/2010 © Springer-Verlag Adaptive behaviour in Down syndrome 675


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the VABS was obtained only in 53 individuals, because of Medical history


poor compliance to participate in a research study.
The medical characteristics are shown in Fig. 1. A positive
32 individuals (42.7 %) had a mild mental retardation,
correlation between cardiac diseases and several items on
26 individuals (34.7%) had a moderate mental retardation
the VABS (Total score VABS τ = 0.337, p = 0.012) was seen,
and 17 individuals (22.7%) had a severe mental retarda-
this may be a result of a lower performance on VABS, as an
tion. Mental age showed an average of 5.57 years ± 1.93
evidence of a supplementary physical difficulty in the ac-
ranging from 1 to 9.29 years (n = 53), and IQ level with an
quisition of adaptive skills. There were no differences in
average of 52.89 ± 12.06 ranging from 40.00 to 80.00
the performance of individuals with complete Trisomy 21
(n = 38). In 45 individuals a detailed medical history could
or mosaicism, only in domestic skills individuals with mo-
be taken, in the remaining 32 medical history remained
saicism did significantly better (domestic skills VABS
incomplete.

70
Percent

60

50

40

30

20

10

0
Cardiac Cardiac Mild valvolar Mild systolic Only mild ECG Acquired Hyothyroidism Not treated
involvement malformations anomalies with murmur without abnormalities hypothyroidism tretaed in
clinical impact clinical impact

Fig. 1. Medical characteristics

Table 2. VAB, mean IQ of deviation (n = 75)


GROUP 1 2 3 4
Age in years 0–10 10–20 20–30 Over 30
Communication 99.71 ± 11.96 104.39 ± 16.65 110.39 ± 14.83 103.76 ± 14.67
IQ of deviation
Reception 109.59 ± 13.14 109.06 ± 12.60 112.65 ± 11.15 110.65 ± 9.99
Expression 97.59 ± 17.44 102.44 ± 12.32 108.09 ± 13.83 102.94 ± 14.13
Written 91.53 ± 8.58 104.33 ± 12.59 104.83 ± 17.99 95.88 ± 18.88
Daily living skills IQ of 100.18 ± 10.38 105.33 ± 8.92 113.43 ± 13.21 107.41 ± 12.15
deviation
Personal 100.18 ± 10.68 104.39 ± 7.62 107.70 ± 9.96 107.24 ± 5.55
Domestic 104.71 ± 11.76 106.56 ± 8.98 117.35 ± 15.00 115.00 ± 5.97
Community 96.94 ± 7.50 100.50 ± 9.22 113.35 ± 16.23 104.00 ± 16.42
Socialisation 101.24 ± 9.25 103.89 ± 9.91 117.61 ± 17.60 109.47 ± 19.34
IQ of deviation
Interpersonal 99.47 ± 8.71 102.22 ± 10.78 111.61 ± 14.46 105.24 ± 16.60
Play-Leisure 104.53 ± 10.05 103.53 ± 12.57 117.96 ± 15.32 110.88 ± 17.96
Coping 98.47 ± 8.51 102.67 ± 9.00 114.96 ± 17.47 107.71 ± 19.25
Total composite 100.41 ± 10.29 104.89 ± 11.68 114.78 ± 15.60 107.35 ± 15.20
IQ of deviation

676 Adaptive behaviour in Down syndrome © Springer-Verlag 23–24/2010 wkw


original article

τ = 0.338, p = 0.023). Thyroid disorders did not influence the Cross-sectional trajectories (Fig. 2). The trajectory of
acquisition of adaptive skills. daily living skills was flatter than those of the other do-
mains, suggesting that there was a gradual and steady in-
Adaptive behaviour (Tables1, 2, Fig. 2) crease, and moreover maintenance of acquired skills, even
after 30 years of age. The trajectory of communication was
Raw scores partly influenced in adolescence by the low maximum age
equivalents for the subdomain reception, nevertheless
Communication. Maximum raw scores were found in re-
there seemed to be more changes in middle adulthood
ception (corresponding to 9.16 years) for the majority of
compared to the other domains. The trajectory of sociali-
our individuals in groups 3 and 4, which decreased the
sation was quite steep in childhood and adolescence, with
mean age equivalent in the whole domain. There was a sig-
a peak between 20 and 30 years of age and a maintaining
nificant increase in the area of communication between 10
of skills beyond 30 years of age.
and 20 years until the age of 30. Major skills seemed to be
achieved between 20 and 30 years.
Level of adaptive behaviour – areas of strength
Daily living skills. We found overall significantly lower In age-groups. On the total score significant differences
scores in group 1, but no significant differences between were found (Pearson’s Chi-square, p = 0.049): Age-groups
the other groups. This indicated an area of weakness in 1, 3 and 4 showed more individuals with a performance
early childhood with a potential of increasing. above the average (area of strength), whereas in group 2
most of them scored on average. In communication no sig-
Socialisation. In socialisation and on total score, we ob- nificant differences were observed, even though in all
served a gradual increase of skills after 10 years of age, a groups most of the individuals scored above the average.
peak of competence between 20 and 30 years, and a grad- In daily Living skills significant age differences were found
ual decrease after this age. This might reflect a high social (p = 0.012): in age-group 1 and 2 more individuals showed
integration between 20 and 30 years. an average performance, whereas in age-group 3 and 4 sig-
nificantly more individuals showed an area of strength. In
Age equivalents socialisation significant differences (p = 0.021) showed that
in groups 1 and 2 far more individuals performed on an av-
Adaptive behaviour and age-groups (see Table 1, Fig. 2). erage levels, whereas in groups 3 and 4, they showed a per-
During the first 10 years of life individuals performed bet- formance above the average. Looking at subdomains,
ter in communication, whereas daily living skills and so- domestic skills (p = 0.012) and coping (p = 0.000) showed
cialisation were weaker. In the age range from 10 to 20, also areas of strength in group 3 and group 4. For group 3
daily living skills were higher followed by communication only in community (p = 0.048) and interpersonal relation
and socialisation. (p = 0.005) more individuals showed an area of strength.
From 20 to 30 years, on the contrary socialisation skills In level of ID. In the total score (p = 0.015) mild and mod-
were strong skills and communication and daily living erate ID showed significantly more individuals who per-
skills were weaker. Above 30 years, daily living skills had formed above the average than in sevesre ID. In
another peak, followed by socialisation, and communica- communication no significant differences were observed.
tion remained a weaker. Mean age equivalents in group 4
were higher than those in group 2 for all domains except
for communication. Moreover, group 4 showed higher
standard deviations for all domains, implying a greater Above average On average Below average
variability in performance.
Social
Level

Age 3

Age 1
9
8 Age 3
Level
daily

7
Age 1
6
comm.

Age 3
Level

5
4
Age 1
3 Communication
Daily living
Level

Age 3
tot.

2 Socialisation
1 Composite
Age 1
0 20% 100%
0% 40% 60% 80%
Group 1 Group 2 Group 3 Group 4
Fig. 3. Areas of strength (above average) and weakness (below
Fig. 2. Trajectory of mean age equivalent for domains in years (n = 75) average) in age groups

wkw 23–24/2010 © Springer-Verlag Adaptive behaviour in Down syndrome 677


original article

120.00 Communication IQ
Above average On average Below average
Daily living IQ

115.00 Socialisation IQ
ID3
Social
Level

Total score IQ
ID2
110.00
ID1
ID3
Level
daily

105.00
ID2
ID1
100.00
ID3
comm.
Level

ID2 95.00
ID1 Age 1 Age 2 Age 3 Age 4
ID3 90.00
Level
tot.

ID2
Fig. 5. Trajectory of IQ of deviation
ID1

0% 20% 40% 60% 80% 100%

group 1. In daily living skills, domestic skills, and commu-


Fig. 4. Areas of strength and weakness in Level of ID
nity group 3 scored significantly higher than group 1, but
also group 4 scored higher than group 1. For interpersonal
In daily living skills (p = 0.017) significantly most of the in- relationships no group differences were observed. In so-
dividuals showed an area of strength. In socialisation total cialisation and total score, group 3 scored significantly bet-
score only a trend (p = 0.057) was observed that the mild ter in all domains, in play they scored also significantly
and moderate ID groups performed better. In the sub- higher than group 2, and in socialisation also group 4
domain reception (p = 0.033) most of all individuals in all scored higher than group 1.
groups were above average, in expression no differences
were found, in written a clear significance was found Adaptive behaviour vs. cognition (Tables 1, 4)
(p = 0.015) that group 1 and group 2 showed an area of
strength compared to group 3. In domestic skills (p = 0.003) Adaptive behaviour, cognition and chronological age.
all groups showed an area of strength, in play (p = 0.005) Mean age equivalent in adaptive behaviour was higher
mild and moderate ID groups scored significantly more than in all groups except in group 1 for communication.
above average than severe ID. Mean age equivalents on adaptive abilities differed signif-
icantly until 30 years of age, whereas cognitive abilities did
not differ after 20 years of age.
Total IQ of deviation on VABS (Tables 2, 3, Fig. 5)
Gap between adaptive behaviour and mental age
Age group 3 showed the highest scores of all groups in all (Table 4). No significant differences were seen in individu-
main domains and subdomains. In written only a trend als from 20 to 30 and above 30 years of age. This implies that
was observed that group 3 scored significantly higher than there was no decline after 30 years in our group and that ac-

Table 3. Group differences oneway ANOVA FOR IQ of deviation


P-values Oneway Post hoc Post hoc Post hoc Post hoc Post hoc Post hoc
VABS n = 75 ANOVA Bonferroni Bonferroni Bonferroni Bonferroni Bonferroni Bonferroni
1 vs. 2 1 vs. 3 1 vs. 4 2 vs. 3 2 vs. 4 3 vs. 4
Reception – – – – – – –
Exp. – – – – – – –
Written 0.023* – 0.051* – – – –
Communication – – – – – – –
Personal 0.045* – – – – – –
Domestic 0.001* – 0.005** 0.060* – – –
Community 0.000** – 0.001** 0.018* – – –
Daily living 0.005 ** – 0.003** – – – –
Relation 0.028** – 0.030** – – – –
Play 0.007** – 0.028** – 0.015** – –
Coping 0.005** – 0.004** – – – –
Socialisation 0.004** – 0.006** 0.028* – – –
Total VABS 0.011* – 0.009** – – – –

678 Adaptive behaviour in Down syndrome © Springer-Verlag 23–24/2010 wkw


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Table 4. Group differences oneway ANOVA total cohort (n = 75), and in gap between cognitive
level and adaptive behaviour (n = 53)
P-values Oneway Post hoc Post hoc Post hoc Post hoc Post hoc Post hoc
VABS n = 75 ANOVA Bonferroni Bonferroni Bonferroni Bonferroni Bonferroni Bonferroni
1 vs. 2 1 vs. 3 1 vs. 4 2 vs. 3 2 vs. 4 3 vs. 4
Reception - – – – – – –
Exp. 0.004** – 0.002** – – – –
Written 0.001** 0.013* 0.000** – – – –
Communication 0.001** 0.025* 0.000** – – – –
Personal 0.000** 0.000** 0.000** 0.000** – – –
Domestic 0.000** 0.001** 0.000** 0.000 ** – – –
Community 0.000** – 0.000** 0.037* – – –
Daily living 0.000** 0.000** 0.000** 0.000** – – –
Relation 0.000** – 0.000** 0.020* – – –
Play 0.001** – 0.000** – – – –
Coping 0.000** – 0.000** 0.003* 0.018* – –
Socialisation 0.000** – 0.000** 0.018* – – –
Total VABS 0.000** 0.010** 0.000** 0.006** – – –
Delta between Mental
age and VABS
(n = 53)
Δ Communication – – – – – – –
Δ Domestic 0.000** – 0.001** 0.005** 0.040* – –
Δ Community 0.016* – – – 0.043* – –
Δ Daily living 0.012* – 0.045* 0.016* – – –
Δ Coping 0.000** – 0.027* – 0.003** 0.009** –
Δ Socialisation 0.018* – – – – – –
Δ Total VABS 0.011* – 0.035* – – – –
*p-value ≤ 0.05; **p-value ≤ 0.01.
Δ = difference between equivalent age on cognitive abilities and VABS item.

quired skills have been maintained at least until 40 years. and remain stable after this age. We confirm data from lit-
There were no significant differences in communication erature [4] that communication does not change over time.
and socialisation, but only in daily living skills, suggesting We observed an average performance of daily living skills
major skills in daily living over time. In the subdomains do- and socialisation in childhood and especially in adoles-
mestic and community, we found a minor gap between cence, whereas in young and middle adulthood daily liv-
adaptive and cognitive skills after 30 years of age, but in the ing skills socialisation and daily living skills show an area
overall score of daily living skills the gap remained stable of strength, characterising a potential of a later and further
with increasing age, suggesting that the maintaining of acquisition and a greater stability over time. We did not see
overall daily living skills might have been due to a major sta- stronger social skills in childhood, found in a recent study
bility in the sub-domain personal autonomy. In coping, we for toddlers [5], but we confirm that communication ar-
found a minor gap between adaptive and cognitive skills rives at a ceiling with age, but unlike to Miller [12] , we ob-
between 20 and 30, suggesting that age 30 achieved a peak. served this phenomenon later, i.e. in young adulthood.
Looking at ID groups in mild to moderate ID compared
to severe ID, areas of strength were written and play,
Discussion
whereas in daily living skills, especially in domestic skills,
Adaptive behaviour in our study group was characterised and in reception areas of strength were present in all lev-
by overall high competence and a quite homogeneous els. This suggests that despite the higher level of ID, adap-
profile, as we did not find a great variability neither within tive skills in these areas are not influenced in daily living
age groups nor between the single items on VABS. Never- skills and in reception, whereas written and play are.
theless, variability seems to increase after 30 years of age in We observed a major discrepancy with increasing age
the absence of dementia confirming data in literature [16]. between adaptive behaviour and cognitive abilities, and
Adaptive skills gradually and steadily increase until 30 only a very slow decline happens in adaptive behaviour
years of age, show a peak between 20 and 30 years of age and in cognitive abilities after 30 years. In early childhood

wkw 23–24/2010 © Springer-Verlag Adaptive behaviour in Down syndrome 679


original article

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Conflict of interest italiano a cura di Giulia Balboni e Luigi Pedrabissi. Firenze,
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