Associations Between Medical History, Cognition, and Behavior in Youth With Down Syndrome: A Report From the Down Syndrome Cognition Project.
Tracie C Rosser, Jamie O Edgin, George T Capone and 13 others
PMID 30421968WHAT IT FOUND
Severe birth defects like heart and gut surgeries did not predict worse cognition or behavior in 234 youths with Down syndrome.
Lower income and later early intervention did predict poorer outcomes. Parents of children with gut defects reported unexpectedly better executive function skills.
Key findings
01Having a severe heart defect (AVSD) or any congenital heart disease was not associated with worse cognitive or behavioral outcomes compared to those with structurally normal hearts.
02Participants with gastrointestinal defects requiring surgery were associated with parent-reported better metacognitive executive function, explaining 6.7% of the variance.
03Lower household income and later initiation of early intervention were statistically associated with poorer performance on specific cognitive and behavioral measures.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The sample size for specific subgroups, such as those with AVSD (n=42) or GI defects (n=29), was small, limiting the power to detect subtle effects. The study used a convenience sample rather than a population-based cohort, and participants tended to be from families with higher education and income levels, which may not represent the broader Down syndrome population. The cognitive battery lacked comprehensive tests of executive function and language, potentially missing specific deficits in these areas. Multiple statistical tests were performed without correction, increasing the risk of false-positive findings, particularly for the unexpected GI defect result. Parent-reported measures may be subject to response bias, especially in families who have managed significant medical challenges.
Declared interests
The authors declared no conflicts of interest. The study was supported by grants from the National Institutes of Health.
The easy way to misread this
Do not interpret the finding that gastrointestinal defects are associated with better executive function as evidence that the surgery improves cognition. This result is likely influenced by parental response bias or unmeasured compensatory factors, and it was not the primary hypothesis of the study.