Table 7 Implications for clinical practice

• Clinical guidance tends to be focussed on the needs of children with DS, but the pattern of comorbidities varies across the lifespan and surveillance needs to be adapted accordingly:

 o Epilepsy is more common in older adults compared to other age groups, and this is likely associated with the development of dementia.

 o Obstructive sleep apnoea requires on-going surveillance throughout the lifespan.

 o Thyroid disorders, particularly hypothyroidism, become more common with ageing.

 o Reflux is a common concern in children with DS.

 o Hearing and vision problems remain an important consideration throughout life, but these have different causes at different ages.

  ▪ For hearing, otitis media with effusion is a common issue in childhood, while other causes of hearing loss become important in adulthood.

  ▪ Vision problems increase across the lifespan, with the increased occurrence of cataracts in adulthood.

• Unlike in the typically developing population, most mental health conditions are equally common in males and females, requiring similar surveillance in both sexes to ensure equitable care.

• Neurodevelopmental disorders such as autism and ADHD are relatively common and do not show the same sex patterns as in the general population. These should be included in assessment and treatment guidance for all individuals.

• To improve cognitive outcomes, a focus on interventions for those with DS from lower SES families and for those with autism or epilepsy is required.