DOWN’S SYNDROME AND THE FAMILY:
FOLLOW-UP OF CHILDREN FIRST SEEN IN
INFANCY
Ann Gath
Dianne Gumley
The immediate impact of the birth of a
child with a severe handicap is traumatic
for the parents (Solnit and Stark 1961,
Drotar et al. 1975, Gath 1978). Some
families also have had little support during
the early years, and when interviewed years
later felt that they had been driven to seek
residential placement for their child
because more appropriate help was not
available when they needed it (Oster and
van der Tempe1 1975). The recent
m emphasis on community care makes the
z assumption that a handicapped child has
0
s: the need, and indeed right, to live as part of
\d
N
a family. I n more recent studies, such as
P”
m
that of Carr and Hewett (1982), the
0‘ families have felt more supported and
fewer have had to ask that the child be
taken away from home. As well, those
children who did require substitute care
were placed in foster or children’s homes
rather than admitted automatically t o a
long-term specialist hospital. Carr and
Hewett concluded that most families had
learnt to cope with rearing a handicapped
child and that many had derived joy from
the task.
The present study is a follow-up of a
group of 30 families into which a baby with
Down’s syndrome had been born eight to
nine years before. Each of these babies had
been matched with another baby as close
500 as possible in age and in the same ordinal
position in a family in similar socio-
economic circumstances. Both groups of
babies and their families had been seen at
least five times during the first two years of
life (Gath 1978).
Although the initial reactions of the
parents of the Down’s syndrome babies
were profound grief and shock, neither
physical ill-health nor psychiatric problems
occurred significantly more frequently
among these parents than among the
parents in the control group. However,
there was an important difference between
the groups in the quality of the marriages.
I n the Down’s syndrome group, three
marriages had broken irretrievably in the
two years following the birth of the
affected child, and in six others there were
major quarrels, open hostility or marked
lack of interest in each other. There were
neither broken marriages nor severe
discordance among the parents in the
control group.
The brothers and sisters of the very
young children with Down’s syndrome did
not show the increased incidence of
behaviour disorders reported in siblings of
older children with Down’s syndrome
(Gath 1974). Although all were behind the
normal children in developmental mile-
stones at the age of two, the Down’s
syndrome children did not present major
problems of management.

The study reported in the present paper
aimed first at measuring the degree of
handicap in terms of intelligence quotient,
self-help and general living skills. Second,
it sought t o identify factors in infancy
which might predict the extent of the
handicap t o the child and the family.
Third, using the same measures for both
groups, the behaviour of the children with
Down’s syndrome was compared with that
of the matched normal control children.
Finally, the long-term effects on other
members of the family of rearing a child
with Down’s syndrome were evaluated by
comparison with the families of the normal
children.
Method
Thirty children with Down’s syndrome
born in a two-year period in one Health
Region in England were enrolled in the
original prospective study. The survivors
were traced six years after completion of
the first two-year period of the study. The
parents were interviewed at home, using a
semi-structured interview recorded on
tape, which was coded later by an
independent assessor. The Rutter scales for
parents and teachers (Rutter et al. 1970)
were used for the Down’s syndrome
children, the controls, and the sibling next
in age t o each. The interview with parents
and teachers used the American Association
for Mental Deficiency (AAMD) Adaptive
Behavior Scales (Nihira et al. 1974) to
assess the level of the handicapped child’s
functioning in a number of areas, including
language, self-help skills, mobility and
independence. Adaptive behaviour can be
defined as standards of personal in-
dependence and social responsibility, and
is a good measure of the degree of handicap
and of the extra burden placed on the
family. The Down’s syndrome children
were assessed by a clinical psychologist.
The A A M D Adaptive Behavior Scales were
not used for the control children.
Results
Down’s syndrome children
SURVIVAL. 22 survivors of the original
group of 30 were seen at follow-up (eight
girls, 14 boys) (Table I). One other child
had moved with his family to New
Zealand, where it was possible to obtain a
recorded interview with his mother. There
m
was no significant difference between the s
sexes in mortality during early childhood.
All the control children corresponding to $
a-
the survivors were traced and the families r4
were interviewed. $
KARYOTYPES. All the children who 0‘
survived to the time of follow-up were 6
2
characteristic trisomy 21. Two with
mosaicism and one with translocation in 2.
2
the original group had died before the age
2
c
of eight. c,
PRESENT PLACEMENT. No child had been a
taken into full-time residential care away 9,
.z
from the family. Three boys were away
from home during the school term. Two
p2
girls went to ordinary primary schools and
the rest went t o special ESN(S)* schools.
-
.c
INTERVENTION. ,411 the children had
$
been t o playgroups or to a nursery class but 3
a
none had been in any planned intervention 4
programme in the preschool period.
PHYSICAL HEALTH. Physical handicap
was a severe additional burden on three
families. Two of these children were
severely incapacitated by congenital heart
disease and one boy was blind because of
cataracts. Three other children had mild
dyspnoea or were occasionally cyanotic
but were not handicapped t o the degree
that their parents were constantly fearful
about their health.
INTELLECTUAL LEVEL. The mean age at
which the children were assessed by the
psychologist was 8 years 4 months, with a
range from 8 years to 9 years 4 months.
Table I1 shows the results for the Down’s
syndrome children, using the Stanford-
Binet or the Merrill-Palmer tests of
intelligence. The mean IQ was 48 and the
range was wide, from less than 20 to 80. In
Table I1 the results are grouped in the
classification under axis 3 of ICD 9 (Rutter
et al. 1975). The variation in intellectual
levels was such that no one test was
suitable for all the children in the group.
Girls were less severely retarded than
boys ( x 2 7.79, 2 D F , p<O.O5). The results
of intelligence testing at eight and nine
years correlated positively with birth-
weight (Spearman rank coefficient =O. 56)
(Fig. I), and was also related t o the degree
of hypotonia recorded in the first few
months of life (Table 111). Severe perinatal
*Educational classification: ‘educationally sub-
normal (severe)’. 501
 TABLE I
Follow-up of 30 children with Down's syndrome born
1970-1971
'1 a
Died during first two years of life 5 a
Congenital heart disease 4 a a .
a
Acute leukaemia 1 0 a
Died after age two, before follow-up 2 a
Bronchopneumonia 1
55 ,
Meningococcal meningitis
Emigrated to New Zealand; taped interview only
1
1 5.-
L 3 1
Children traced and seen in 1979

Total
22

30 '1
0 JI
0
I
20
I
40
I
60
1
80
IQ's at 8 to 9 years
Fig. I . Birthneighis of Down's q n d r o m e children
and IQsat eight to nine years.

TABLE I 1
IQs of 22 Down's syndrome children 801
a
No.
Code* Intellectual level Bo-vs Girls Total
a .
0 Normal variation - 2 2
IQ > 70 a
1 Mild retardation 4 4 8
IQ 50-70
2 Moderate retardation 5 2 7 30
IQ 35-49
3 Severe retardation 3 - 3
IQ 20-34
10
4 Profound retardation 2 - 2 110 130 150 170
IQ<20
AAMD A d a p t i v e Behavior Scale score
Total 14 8 22 Fig. 2. Adaptive hehaviour .scores and IQr of I h w i r
svndrome children.
*ICD 9.

TABLE 111
'1
4 a

Degree of retardation in relation to hypotonia recorded

in first year of life

Degree of hypotonia
Normal/ Moderate/
mild severe Total
~~ ~~ ~ ~~

Intellectual level
NormaVmild
retardation 7 3 10 110 130 150 170
Moderate retardation 2 5 7
AAMD
Severe/profound
retardation - 5 5 A d a p t i v e Behavior
Scale score
Total 9 13 22 Fig. 3. Adaptive behaviour .scores and hirthw,eight.s
502 of Down's syndrome childrrn.
problems were not a reliable predictor of
outcome in mid-childhood. In this small
group, no relationship was found between
IQ scores and social class, educational
achievements of the parents, age of the
parents or quality of the parents’ marriage,
either at the time of follow-up or in
infancy.
SPEECH. Five boys with Down’s syn-
drome were unable to speak: two were
profoundly handicapped but three were
only moderately handicapped in com-
prehension of spoken language, non-
verbal tests and self-help skills. One had
just begun to communicate using Makaton
sign-language. Four other boys had only a
very limited vocabulary or were difficult to
understand. In contrast, all the girls had
some skills in verbal communication. Boys
therefore were much more likely than girls
to have severe language difficulty ( x 26.25,
1 D F , p<o.O5).
ADAPTIVE BEHAVIOUR. For the purposes
of this study the total raw scores of the
Adaptive Behavior Scales were used. The
questions are grouped according to
categories such as independent functioning,
physical development, responsibility and
language development. Norms for each
category have been developed for children
in two broad bands of ability: EMR
(educable mentally retarded) and ‘I‘MR
(trainable mentally retarded), corre-
sponding t o ESN(M) and ESN(S) British
schools.
In this cohort of Down’s syndrome
children the Adaptive Behavior total
scores correlated with the results of
intelligence testing (Spearman rank co-
efficient = 0 . 4 7 ) (Fig. 2), and with birth-
weight (Table IV). One deviant from the
general trend of good adaptive behaviour
but low birthweight can be seen in Figure
3. He had a very low birthweight, but
because of severe family difficulties he was
fostered by his teacher on a part-time basis,
spending holidays and weekends at home.
The children with the highest scores still
were less able than normal children t o look
after themselves. All scored below the
scores of children in the average range of
intelligence from a child psychiatric clinic
population, all of whom had achieved
scores above 190. The lowest scorers in the
Down’s syndrome group had a very high
TABLE IV
Adaptive Behavior Scale scores and birthweight
Birthweight a-
2 2 . 5 k g ~ 2 . 5 k g Total N
Adaptive behaviour score
>I10 I5 1 16
GI10 1 5 6
Total 16 6 22
d
TABLE V
Parents’ ratings of Down’s syndrome and control
children*
Down’s syndrome Conrrols
(N = 23) ( N = 23)
Number rated deviant
(score 13 or more) 7 (30%) 5(22%)
Mean score 10.6 8.8
*A2 Behavioural Rating Scale.
degree of dependency, poor communication
skills and a very limited repertoire of
behaviour.
Comparison with control children
All the control children went to day-
schools catering for children with normal
intelligence. None had serious health
problems. One child had received a head
injury in her second year and was mildly
incapacitated by slight residual spasticity
on one side, but she took part in all school
activities and her IQ was in the superior
range.
BEHAVIOUR A T HOME. Slightly more
children with Down’s syndrome had high
scores of 13 or more on the A2 Behavioural
Rating Scale completed by their parents,
and their mean score was higher (Table V).
On part 2 of the scale, measuring deviant
or maladaptive behaviour, two Down’s
children had very high scores and six
others had moderate scores. Three of these
were false negatives on the A2 scale. It
became clear that the A2 scale, standardised
for children in the normal range of
intelligence, did not cover much of the
behaviour that parents in the Down’s
group were most concerned about.
Examples were wandering away, un-
dressing in public, turning taps on or 503
3 T A B L E VI blocking the lavatory with toilet paper.
33 Teachers’ ratings of Down’s syndrome and control
children.
Both the A2 a n d B2 behavioural scales also
included deviant behaviour of which a
Down’s syndrome Controls child with Down’s syndrome was rarely
(N=22f) (N-23) capable, such as playing truant. The two
most severely handicapped boys with IQ
Number rated deviant scores of less than 20 had high scores on the
C (score 9 o r more) 5 (23%) 7(32%)
p:
A2 scale and much maladaptive behaviour.
Mean score 6.3 5.3 BEHAVIOUR A T S C H O O L . The mothers of
-x
.-
E
~~

three control children reported that their

2 *Rutter 82 Scales.
children had major problems a t school,
0 tTeacher did not complete scale for one boy.
5 and five reported minor difficulties. I n
U
C most cases the children had a combination
m
of learning a n d behaviour problems. There
was n o significant difference in the
numbers of children given high scores by
the teachers on the Rutter Behavioural
Scale (Table VI). Again, as at home, some
behaviour which was a nuisance at school
TABLE VII was not mentioned on this scale. Teachers
Mental health of parents of Down’s syndrome and of the Down’s syndrome children in
control children general were very positive in their attitude
Psychiatric disorder Down’s syndrome Controls
to the children, with the exception of a
teacher in a village school who resented
Mothers having such a child in her class. Teachers’
No. ratings of the general level of functioning
Serious of the Down’s syndrome children on the
Minor
N o problems Adaptive Behavior Scales correlated well
Fathers with those of the parents.
NO. 23 23 Over-all, in the Down’s syndrome group
Serious 1 1 eight boys and three girls had behaviour
Minor 5 0
N o problems 17 22 problems, as shown by deviant scores on
behavioural rating scales or much mal-
*One mother had died a n d another was divorced, did adaptive behaviour. Seven of these eight
not have custody of the child a n d was not interviewed. boys had no or very limited language skills
and many behaviour problems. Nine
children in the control group (two girls,
seven boys) had deviant scores o n one or
both of the scales.

Comparison of families
The interviews with the families revealed
few differences in the family lives of the
TABLE VIIl two groups of children, despite the greater
Behaviour disturbance among Down’s syndrome demands on parenting by the more
children in relation to parents’ poor marriages and/or
psychiatric problems dependent Down’s syndrome children.
There were no differences between the two
Down’s Parental discord or groups of families in the extent of their
syndrome psychiatric ill-healrh social activities. There were n o more
child Yes No Toral
problems with physical health among
Behaviour problems 9 2 I1
members of the Down’s group of families
than among the control families.
No behaviour
problems 2 10 12 PARENTS’ M E N T A L STATE. The same
amount of serious psychiatric illness
Total I1 12 23 occurred in both groups of parents, but
504 minor psychiatric illness was more
common among the parents in the Down’s 127 n
syndrome group (Table VII).
QUALITY OF PARENTS’ MARRIAGE.
There had been no deaths and no further Q-
N

divorces among the parents of the Down’s d

m
syndrome children. In the control group 0‘
one mother had died suddenly a n d one
marriage had ended in divorce. The
differences in the ratings of the quality of
the marriages in the two groups were not Good Moderate Poor Died
significant (Fig. 4).
Behaviour problems among the children Down’s p a r e n t s d
with Down’s syndrome were related to
poor marital relationships o r to psychiatric Control parents o
ill-health of the parents (Table VIII). Eight Fig. 4. Marriage ratings for parents of Down’s
siblings of Down’s syndrome children and syndrome and control children at eight to nine years.
four siblings in the control families had
deviant scores on one o r both of the scales
(Table IX), and behaviour problems in a
sibling were related to behaviour problems
in the handicapped child (Table X). A
smaller but similar trend was seen in the
control families. TABLE IX
Behavioural Rating Scale scores of siblings of Down’s
Discussion syndrome and control children
As in the longitudinal study of Oster and
van der Tempe1 (1975), most deaths in the Siblings
Down’s syndrome Controls
Down’s syndrome group had occurred in ( N - 19) ( N : 20)
early childhood, before the age of four.
However, the severity of physical symptoms A2 (parents’)
in infancy was not a reliable indicator of No. deviant, score 13
or more 6 (32%) 4(20%)
which children would have serious Mean score 8.4 8.3
additional handicaps in middle childhood. B2 (teachers’)
There was wide variation in the results of No. deviant, score 9
psychological testing of the Down’s or more 5 (26%) 2(10%)
Mean score 4.6 4.2
syndrome children at follow-up, from
profound mental retardation to the dull-
normal range. The mean IQ of 48 is higher
than has been found in other studies of
children with Down’s syndrome brought
up at home (Cornwell a n d Birch 1969, Carr
and Hewett 1982). However, the children
in our study were slightly younger than ii
the other two studies, and decreasing IQ TABLE X
with age has been noted in several studies Behaviour problems in Down’s syndrome children and
in sibline next in aee
(e.g. Gibson 1978). The numbers in the
present study are small, but no significant .~ibllngS .siblingS
correlation was found between IQ and with with no
social class o r either parent’s educational Children with behaviour behaviour
Down’s syndrome problems problems Tolal
level. The two factors that could predict
outcome to some degree were birthweight Behaviour problems 6 2 8
and muscle tone recorded in infancy. No behaviour problems 2 9 I1
Penrose and Smith (1966) suggested that
hypotonia and poor head-control were Total 8 I1 19’
good predictive factors.
The A A M D Adaptive Behavior Scales *No sibling within three years of age in four families. 505
 showed a very wide range, from almost
complete dependency t o a level of
functioning barely distinguishable from
that of a normal child. Where the two
measures of IQ and adaptive behaviour
score were markedly out of step, there were
unusual features in the child or in the
family background.
Parents were most concerned about
being able to communicate with their
child, and they echoed the comments of
parents in the Oster and van der Tempe1
study 20 years earlier, who said that their
:
e
children’s communication problems were
greater than they should have been because
U
proper treatment or guidance had not been
x Marital problems have been noted as a n
rA given. The association between difficulty
VI
C in communication and behaviourproblems
i:
a among the boys underlines the importance
of teaching language skills.
The cohort of children on this study
were born at a time when there were major
changes in attitudes toward and services
for the mentally retarded. However, more
recent advances, particularly concerning
active early intervention, were not
generally available when these children
were small.
Although few differences were found
when the behaviour of the Down’s
syndrome children was compared with
that of the controls by means of
standardised questionnaires, it was clear
that both parents and teachers found that
retarded children could produce a rep-
ertoire of difficult behaviour rarely found
in children whose intelligence was within
the normal range. We found that measures
of deviant behaviour available at present
were inadequate for this sample of
retarded children. As Corbett (1977) also
found, their behaviour disorders were
difficult to classify using criteria developed
for children of normal intelligence. More
than half the Down’s syndrome children
had a number of behaviour problems, and
the sibling next in age was more likely to
have deviant behaviour if the retarded
child had behaviour problems. The
explanation for the latter finding could be
that the difficult handicapped child had a
direct adverse effect on the sibling.
However, as the behaviour problems of the
retarded children were related to parental
506 discord or psychiatric illness, as has been
found in many studies of psychiatric
disorder in children with normal in-
telligence, both the normal and the
retarded children in the family may have
been reacting to the same intra-familial
stress. The number of children was too
small for detailed analysis of possible
aetiological factors, but the interview data
provided evidence of stress in the families
of nine of the retarded children with
behaviour problems. However, there was
n o evidence t o indicate that the normal
siblings had any greater incidence of
behaviour disorders than the siblings of
normal children of the same age as the
Down’s syndrome children.
early effect of the birth of a n abnormal
child (Gath 1978). Increased psychiatric
morbidity is a later effect, found in this
follow-up study eight years after the birth.
There are n o clear-cut associations
between outcome for the child with
Down’s syndrome as measured by IQ,
adaptive behaviour score or general health
and outcome for the family in terms of
health, psychiatric status and relationships.
There is no indication, therefore, that the
severity of the child’s handicap is directly
related to the severity of the family
reaction.
There was a wealth of information about
family functioning in the recorded
interviews with the families. As Carr and
Hewett (1982) also found, there was
evidence of fun a n d of enjoyable family
life. These positive features are hard to
quantify, but some attempt was made
when rating the relationship between the
parents. Warm, affectionate remarks and
family jokes were heard as often on the
tapes from the Down’s syndrome families
as they were from the control families.
Conclusions
Biological factors appear to be powerful
predictors of later development of babies
with Down’s syndrome. The outcome,
however, is so varied in terms of measured
intelligence that any prognosis for future
development of these babies should be
made with caution.
Difficult behaviour is a common
problem among retarded children, and
needs further investigation so that
recommendations can be made about
treatment or prevention. There are Acknowledgements 00

This work was supported by a grant from the Medical 2:

indications from the small numbers in this
study that behaviour disorders in retarded
children have similar aetiological factors
to those in children in the average range of
intelligence, particularly discord and
psychiatric illness in the parents.
The findings of this follow-up study of
Down’s syndrome children now halfway
through their childhood indicate that the
priorities lie in helping parents with the
emotional repercussions, in teaching
communication skills and in the better
understanding and effective treatment of
difficult behaviour.
Research Council, which is gratefully acknowledged.
W e thank Kath Blow a n d Terry Lewis, the research
assistants who worked with us on the project, a n d
8
B o b Edgerton, Administrator a t Borocourt Hospital,
Reading. We are much indebted to Andrew Clarke,
formerly psychologist at the Institute of Family
Psychiatry, Ipswich, who wrote the programme for
the microcomputer o n which our d a t a were stored
a n d analysed.
A u rhors’ Appoinrmen i s
*Ann Gath, Consultant Child Psychiatrist, Drum-
mond Clinic, West Suffolk Hospital, Bury St.
Edmunds, Suffolk IP33 3PP.
Formerly Consultant Child Psychiatrist, Borocourt d
Hospital, Reading.
Dianne Gumley, Formerly Senior Clinical Research
Psychologist, Borocourt Hospital, Reading.
*Correspondence 10 /ir.sr author.

SUMMARY
Twenty-three survivors of a prospective study of infants with Down’s syndrome were followed u p a t eight or
nine years of age. All but three lived at home, a n d those three came home for weekends or school holidays.
IQs varied from less than 20 t o 80 (mean 48). IQ and adaptive behaviour scores were related to birthweight
a n d muscle tone in infancy. Difficult behaviour was common, but differed from that of normal children.
More of the parents had minor degrees of psychiatric disability than parents in the control families. Marital
problems arising in the earlier years of the child’s life persisted, but without further deterioration. The
findings indicate that the priorities for these families are to help the parents deal with emotional
repercussions, to teach communication skills to the child, a n d to diagnose a n d treat difficult behaviour.

RESIJME
Mongolisme er famille: suivi d’enfanrs vus pour la premiere Jois duranr la perire enfance
Vingt trois survivants d’une ktude prospective de nourrissons mongoliens ont ktk suivis jusqu’a I’lge de huit
ou neuf ans. Tous sauf trois vivaient a u domicile de leur parents, et ces trois enfants rentraient a la maison
pour les weekends et les vacances scolaires. Les QI variaient d e moins de 20 a 80 (moyenne 48). Le QI et les
scores d e Comportement Adaptatif ktaient relifs a u poids de naissance et a la tonicitk musculaire d e la petite
enfance. Ixs difficultis de comportement itaient habituelles mais diffkrentes d e celles observkes chez les
enfants normaux. Plus de parents que dans les familles contrbles prksentaient des signes m o d e r i s d’altkrations
psychiatriques. Les probltmes conjugaux survenus dans les premitres annkes d e I’enfant persistaient mais
sans dktkrioration supplkmentaire. Ces donnkes indiquent q u e les prioritks pour ces familles sont d’aider les
parents a confronter les rkpercussions kmotives, enseigner la communication B confronter les repercussions
kmotives, enseigner la communication B I’enfant, diagnostiquer et traiter les difficultks de comportement.

ZIJSAMMENFASSl!NG
Down Syndrom und Familie: Konrrolluntersuchung von Kindern, die im Sauglingsalrer zum erslen Ma1 unrersuchr
wurden
23 Uberlebende einer prospektiven Studie von Kindern mit Down Syndrom wurden im Alter von acht oder
neun Jahren kontrolliert. Alle. auper drei Kindern, lebten zu [lause und diese drei kamen a n Wochenenden
und in den Schulferien nach Hause. Der IQ schwankte von weniger als 20 bis 80 (im Mitlel 48). IQ und
Scores fur adaptives Verhalten wurden zum Geburtsgewicht und zum Muskeltonus im Neugeborenenalter in
Bcziehung gesetzt. Schwieriges Verhalten war die Regel, aber es unterschied sich von dem normaler Kinder.
Die Eltern hatten haufiger geringgradige psychiatrische StBrungen als die Eltern der Kontrollgruppe.
Eheproblcme. die in den ersten Lebensjahren des Kindes aufgetreten waren, blieben bestehen, o h n e sich
weiter zu verschlimmern. Die Befunde zeigen, d a p es das Wichtigste ist, den Eltern zu helfen, mit
emotionalen Ruckschlagen fertig zu werden, den Kindern Kommunikationsfahigkeiten zu vermitteln und
schwieriges Verhalten zu diagnostizieren und zu behandeln.

RESUMEN
Shdrome de Donn y la familia: seguimienro de niKos vistos por primera vez en la Ppoca de lacranfes
Veintidbs supervivientes d e u n estudio prospectivo de lactantes con sindrome d e Down fueron seguidos hasta
la edad d e ocho o nueve aiios. l’odos except0 tres, Vivian en la ciudad, y estos tres regresaban a casa 10s fines
de semana o en las vacaciones escolares. El CI variaba entre menos de 20 a 80 (promedio de 48). El C I y 10s
puntajes del comportamiento adaptivo estaban en relacibn con el peso del cuerpo y el t o n o muscular en la
kpoca d e lactante. Era corriente u n comportamiento dificil, pero era diferente del d e nifios normales. L a
mayoria de 10s padres tenian grados menores de alteraci6n psiquiatrica, q u e 10s padres d e las familias
control. Persistian 10s problemas maritales surgidos en 10s primeros afios de la vida del nirlo, pero sin
deterioracicin posteior. Los hallazgos indican q u e las prioridades para estas familias radican en ayudar a 10s
padres para enfrontarse con las repercusiones emocionales, enseiiar habilidad comunicativa a1 nirio y
diagnosticar y tratar las dificultades en el comportamiento. 50 7
 References
Carr. J., Hewett, S. (1982) ‘Children with Down’s
syndrome growing up.’ Associarion f o r Child
c Psychology and Psychiatry News, (lo), 10-13.
e Corbett, J . (1977) ‘Population studies on mental
retardation.’In Graham, P. J.(Ed.)Epidemiological
6 Approaches in ChildPsychiarry. London: Academic
Press.
Cornwell, A. C., Birch, H. G. (1969) ‘Psychological
and social development in home-reared children
with Down’s syndrome (mongolism).’ American
Journal of Mental Deficiency. 11, 26-32.
Drotar, D., Baskiewicz, A.. Irvin, N., Kennell, J.,
Klaus, M. (1975) ‘The adaptation of parents to
the birth of an infant with a congenital mal-
0
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