Types of down syndrome

Facts about Down Syndrome

Down syndrome is a condition in which a person has an extra chromosome.

Down syndrome is a condition in which a person has an extra chromosome. Chromosomes are small “packages” of genes in the body. They determine how a baby’s body forms during pregnancy and how the baby’s body functions as it grows in the womb and after birth. Typically, a baby is born with 46 chromosomes. Babies with Down syndrome have an extra copy of one of these chromosomes, chromosome 21. A medical term for having an extra copy of a chromosome is ‘trisomy.’ Down syndrome is also referred to as Trisomy 21. This extra copy changes how the baby’s body and brain develop, which can cause both mental and physical challenges for the baby.

Even though people with Down syndrome might act and look similar, each person has different abilities. People with Down syndrome usually have an IQ (a measure of intelligence) in the mildly-to-moderately low range and are slower to speak than other children.

Some common physical features of Down syndrome include:

  • A flattened face, especially the bridge of the nose
  • Almond-shaped eyes that slant up
  • A short neck
  • Small ears
  • A tongue that tends to stick out of the mouth
  • Tiny white spots on the iris (colored part) of the eye
  • Small hands and feet
  • A single line across the palm of the hand (palmar crease)
  • Small pinky fingers that sometimes curve toward the thumb
  • Poor muscle tone or loose joints
  • Shorter in height as children and adults

How Many Babies are Born with Down Syndrome?

Down syndrome remains the most common chromosomal condition diagnosed in the United States. Each year, about 6,000 babies born in the United States have Down syndrome. This means that Down syndrome occurs in about 1 in every 700 babies.1

There are three types of Down syndrome. People often can’t tell the difference between each type without looking at the chromosomes because the physical features and behaviors are similar.

  • Trisomy 21: About 95% of people with Down syndrome have Trisomy 21.2 With this type of Down syndrome, each cell in the body has 3 separate copies of chromosome 21 instead of the usual 2 copies.
  • Translocation Down syndrome: This type accounts for a small percentage of people with Down syndrome (about 3%).2 This occurs when an extra part or a whole extra chromosome 21 is present, but it is attached or “trans-located” to a different chromosome rather than being a separate chromosome 21.
  • Mosaic Down syndrome: This type affects about 2% of the people with Down syndrome.2 Mosaic means mixture or combination. For children with mosaic Down syndrome, some of their cells have 3 copies of chromosome 21, but other cells have the typical two copies of chromosome 21. Children with mosaic Down syndrome may have the same features as other children with Down syndrome. However, they may have fewer features of the condition due to the presence of some (or many) cells with a typical number of chromosomes.

Causes and Risk Factors

  • The extra chromosome 21 leads to the physical features and developmental challenges that can occur among people with Down syndrome. Researchers know that Down syndrome is caused by an extra chromosome, but no one knows for sure why Down syndrome occurs or how many different factors play a role.
  • One factor that increases the risk for having a baby with Down syndrome is the mother’s age. Women who are 35 years or older when they become pregnant are more likely to have a pregnancy affected by Down syndrome than women who become pregnant at a younger age.3-5However, the majority of babies with Down syndrome are born to mothers less than 35 years old, because there are many more births among younger women.6,7

There are two basic types of tests available to detect Down syndrome during pregnancy: screening tests and diagnostic tests. A screening test can tell a woman and her healthcare provider whether her pregnancy has a lower or higher chance of having Down syndrome. Screening tests do not provide an absolute diagnosis, but they are safer for the mother and the developing baby. Diagnostic tests can typically detect whether or not a baby will have Down syndrome, but they can be more risky for the mother and developing baby. Neither screening nor diagnostic tests can predict the full impact of Down syndrome on a baby; no one can predict this.

Screening Tests

Screening tests often include a combination of a blood test, which measures the amount of various substances in the mother’s blood (e.g., MS-AFP, Triple Screen, Quad-screen), and an ultrasound, which creates a picture of the baby. During an ultrasound, one of the things the technician looks at is the fluid behind the baby’s neck. Extra fluid in this region could indicate a genetic problem. These screening tests can help determine the baby’s risk of Down syndrome. Rarely, screening tests can give an abnormal result even when there is nothing wrong with the baby. Sometimes, the test results are normal and yet they miss a problem that does exist.

Diagnostic Tests

Diagnostic tests are usually performed after a positive screening test in order to confirm a Down syndrome diagnosis. Types of diagnostic tests include:

  • Chorionic villus sampling (CVS)—examines material from the placenta
  • Amniocentesis—examines the amniotic fluid (the fluid from the sac surrounding the baby)
  • Percutaneous umbilical blood sampling (PUBS)—examines blood from the umbilical cord

These tests look for changes in the chromosomes that would indicate a Down syndrome diagnosis.

Other Health Problems

Many people with Down syndrome have the common facial features and no other major birth defects. However, some people with Down syndrome might have one or more major birth defects or other medical problems. Some of the more common health problems among children with Down syndrome are listed below.8

  • Hearing loss
  • Obstructive sleep apnea, which is a condition where the person’s breathing temporarily stops while asleep
  • Ear infections
  • Eye diseases
  • Heart defects present at birth

Health care providers routinely monitor children with Down syndrome for these conditions.

Treatments

Down syndrome is a lifelong condition. Services early in life will often help babies and children with Down syndrome to improve their physical and intellectual abilities. Most of these services focus on helping children with Down syndrome develop to their full potential. These services include speech, occupational, and physical therapy, and they are typically offered through early intervention programs in each state. Children with Down syndrome may also need extra help or attention in school, although many children are included in regular classes.

Other Resources

The views of these organizations are their own and do not reflect the official position of CDC.

  • Down Syndrome Research Foundation (DSRF)external icon
    DSRF initiates research studies to better understand the learning styles of those with Down syndrome.
  • Global Down Syndrome Foundationexternal icon
    This foundation is dedicated to significantly improving the lives of people with Down syndrome through research, medical care, education and advocacy.
  • National Association for Down Syndromeexternal icon
    The National Association for Down Syndrome supports all persons with Down syndrome in achieving their full potential. They seek to help families, educate the public, address social issues and challenges, and facilitate active participation.
  • National Down Syndrome Society (NDSS)external icon
    NDSS seeks to increase awareness and acceptance of those with Down syndrome.
  1. Mai CT, Isenburg JL, Canfield MA, Meyer RE, Correa A, Alverson CJ, Lupo PJ, Riehle‐Colarusso T, Cho SJ, Aggarwal D, Kirby RS. National population‐based estimates for major birth defects, 2010–2014. Birth Defects Research. 2019; 111(18): 1420-1435.
  2. Shin M, Siffel C, Correa A. Survival of children with mosaic Down syndrome. Am J Med Genet A. 2010;152A:800-1.
  3. Allen EG, Freeman SB, Druschel C, et al. Maternal age and risk for trisomy 21 assessed by the origin of chromosome nondisjunction: a report from the Atlanta and National Down Syndrome Projects. Hum Genet. 2009 Feb;125(1):41-52.
  4. Ghosh S, Feingold E, Dey SK. Etiology of Down syndrome: Evidence for consistent association among altered meiotic recombination, nondisjunction, and maternal age across populations. Am J Med Genet A. 2009 Jul;149A(7):1415-20.
  5. Sherman SL, Allen EG, Bean LH, Freeman SB. Epidemiology of Down syndrome. Ment Retard Dev Disabil Res Rev. 2007;13(3):221-7.
  6. Adams MM, Erickson JD, Layde PM, Oakley GP. Down’s syndrome. Recent trends in the United States. JAMA. 1981 Aug 14;246(7):758-60.
  7. Olsen CL, Cross PK, Gensburg LJ, Hughes JP. The effects of prenatal diagnosis, population ageing, and changing fertility rates on the live birth prevalence of Down syndrome in New York State, 1983-1992. Prenat Diagn. 1996 Nov;16(11):991-1002.
  8. Bull MJ, the Committee on Genetics. Health supervision for children with Down syndrome. Pediatrics. 2011;128:393-406.

Down Syndrome: What It Is and the Different Types

Are There Varying Levels of Down Syndrome?

Every person with Down syndrome is unique, and that uniqueness extends to the ways their form of the condition “is expressed,” says H. Craig Heller, PhD, a professor of biology and director of the Center for Down Syndrome Research at Stanford University in Palo Alto, California. While many people with Down syndrome will experience similar intellectual, medical, and physical challenges, those challenges can differ in severity, Heller explains.

“Facial-cranial features, for example, are nearly always present,” says Heller, referring to the distinctive appearance of individuals with Down syndrome.

A flattened face — especially across the nose — and upward-slanted, almond-shaped eyes are two of the common physical features of Down syndrome. Some of the other common physical characteristics include a short neck, small hands and feet, small stature, and a lack of muscle tone.

While some individuals with Down syndrome do not experience any other effects from the disease, Heller says problems with digestive function, immune function, and heart function are all common. So are issues with bone density, weight control, and speech.

Intellectual disabilities are also common. “There can be effects on learning and memory, and specifically the ability to form long-term memories,” Heller says.

But he emphasizes that every individual with Down syndrome is different.

“We certainly see some kids who are less affected than others, but we shy away from terms like ‘low-functioning’ and ‘high-functioning,’” Pipan explains. Some children with Down syndrome have a hard time learning to walk, and others have no problem running and jumping and riding a bike. Likewise, some individuals with Down syndrome may struggle to learn to read while others don’t, she says.

Pipan emphasizes that there are also positive characteristics associated with Down syndrome. “Children with Down syndrome are generally really social and outgoing, for example,” she says.

“Every individual with Down syndrome has their own strengths and weaknesses,” she adds. “Given the right support, they can accomplish a lot.”

What is Mosaicism?

Every cell in the human body comes from one initial cell: the fertilized egg, which is also called the zygote . After fertilization, the zygote then proceeds to divide.

As new cells form, the chromosomes duplicate themselves so that the resulting cells have the same number of chromosomes as the original cell. However, mistakes sometimes happen and one cell ends up with a different number of chromosomes. From then on, all cells originating from that cell will have the different chromosomal number, unless another mistake happens. (All like cells originating from a single type of cell is called a cell line ; for example, the skin cell line, the blood cell line, the brain cell line, etc.)

When a person has more than one type of chromosomal makeup, that is called mosaicism , like the mosaic style of art in which a picture is made up of different colors of tiles. In Down syndrome, mosaicism means that some cells of the body have trisomy 21, and some have the typical number of chromosomes.

How is Mosaicism Diagnosed?

The usual way in which mosaic Down syndrome is discovered is through genetic testing of the baby’s blood. Typically, 20 to 25 cells are examined. If some of the cells have trisomy 21 and some don’t, then the diagnosis of mosaicism is made.

However, this blood test can only determine the level of mosaicism in the blood cell line.

While mosaicism can occur in just one cell line (some blood cells have trisomy 21 and the rest don’t), it can also occur across cell lines (skin cells may have trisomy 21 while other cell lines don’t). In the latter case, it may be more difficult to diagnose mosaicism. When mosaicism is suspected but not confirmed through the blood test, other cell types may be tested: skin and bone marrow are most commonly the next cells checked. Because skin cells and brain cells arise from the same type of cell at the beginning of fetal development (ectoderm), many doctors believe that skin cell tests reflect the chromosomal makeup of the brain cells as well.

How Does Mosaicism Happen in Down Syndrome?

There are two different ways mosaicism can occur:

The initial zygote had three 21st chromosomes, which normally would result in simple trisomy 21, but during the course of cell division one or more cell lines lost one of the 21st chromosomes.

The initial zygote had two 21st chromosomes, but during the course of cell division one of the 21st chromosomes were duplicated.

It’s possible to determine the origin of mosaicism in individual cases using special DNA markers, but this isn’t done on a regular basis.

What Does Mosaicism Mean for my Child?

At the present time, there is not much research on the similarities and differences between simple trisomy 21 and mosaic trisomy 21. One report published in 1991 on mental development in Down syndrome mosaicism compared 30 children with mosaic Down syndrome with 30 children with typical Down syndrome. IQ testing showed that the mean IQ of the mosaic group was 12 points higher than the mean of the non-mosaic group. However, some children with typical Down syndrome did score higher on the IQ tests than some of the children with mosaic Down syndrome.

The Department of Human Genetics at the Medical College of Virginia has had an ongoing study project of children with mosaic DS. In a survey of 45 children with mosaicism, they found that these children did show delayed development compared to their siblings. When 28 of these children with mosaicism were matched up with 28 children with typical Down syndrome for age and gender, the children with mosaicism reached certain motor milestones earlier than children with typical DS, such as crawling and walking alone. However, the speech development was equally delayed in both groups.

Resources

The Department of Human Genetics at the Medical College of Virginia/Virginia Commonwealth University has a very nice booklet on this topic that is available free of charge. Contact Dr. Colleen Jackson-Cook or Lauren Vanner at:

Dept of Human Genetics ~ Virginia Commonwealth University ~ PO Box 980033 ~ Richmond ~ VA 23298-0033

2. Mental Development in Down Syndrome Mosaicism. Fishler K and Koch R. Am. J. Mental Retardation 96(3):345-351, 1991.

3. Medical Care in Down Syndrome , Rogers PT and Coleman M, Marcel Dekker, NY, 1992; p14-16.

Would you like a pdf version of this for printingmDs by Dr Len Leshin.pdf

What are common symptoms of Down syndrome?

The symptoms of Down syndrome vary from person to person, and people with Down syndrome may have different problems at different times of their lives.

Physical Symptoms

Common physical signs of Down syndrome include1,2:

  • Decreased or poor muscle tone
  • Short neck, with excess skin at the back of the neck
  • Flattened facial profile and nose
  • Small head, ears, and mouth
  • Upward slanting eyes, often with a skin fold that comes out from the upper eyelid and covers the inner corner of the eye
  • White spots on the colored part of the eye (called Brushfield spots)
  • Wide, short hands with short fingers
  • A single, deep, crease across the palm of the hand
  • A deep groove between the first and second toes

In addition, physical development in children with Down syndrome is often slower than development of children without Down syndrome. For example, because of poor muscle tone, a child with Down syndrome may be slow to learn to turn over, sit, stand, and walk. Despite these delays, children with Down syndrome can learn to participate in physical exercise activities like other children.3 It may take children with Down syndrome longer than other children to reach developmental milestones, but they will eventually meet many of these milestones.2

Intellectual and Developmental Symptoms

Cognitive impairment, problems with thinking and learning, is common in people with Down syndrome and usually ranges from mild to moderate. Only rarely is Down syndrome associated with severe cognitive impairment.1

Other common cognitive and behavioral problems may include1,2,3,4:

  • Short attention span
  • Poor judgment
  • Impulsive behavior
  • Slow learning
  • Delayed language and speech development

Most children with Down syndrome develop the communication skills they need, although it might take longer for them to do so compared with other children. Early, ongoing speech and language interventions to encourage expressive language and improve speech are particularly helpful.5

Parents and families of children with Down syndrome can connect with other families and people with Down syndrome from around the world to learn more and share information. The NICHD-led DS-Connect® is a safe and secure registry to help families and researchers identify similarities and differences in the physical and developmental symptoms and milestones of people with Down syndrome and guide future research. Learn more about DS-Connect®: The Down Syndrome Registry.

Associated Conditions and Disorders

People with Down syndrome are at increased risk for a range of other health conditions, including autism spectrum disorders, problems with hormones and glands, hearing loss, vision problems, and heart abnormalities.1 Learn more about these other conditions in the What conditions or disorders are commonly associated with Down syndrome? section.

Facts About Down Syndrome

Down Syndrome Facts in Spanish : Sindrome De Down Factores

What is Down Syndrome?

Down syndrome is a genetic condition that causes delays in physical and intellectual development. It occurs in 1 in every 792 live births. Individuals with Down syndrome have 47 chromosomes instead of the usual 46. It is the most frequently occurring chromosomal disorder. Down syndrome is not related to race, nationality, religion or socioeconomic status. The most important fact to know about individuals with Down syndrome is that they are more like others than they are different.

Diagnosis

Down syndrome is usually identified at birth or shortly thereafter. Initially the diagnosis is based on physical characteristics that are commonly seen in babies with Down syndrome. These include low muscle tone, a single crease across the palm of the hand, a slightly flattened facial profile and an upward slant to the eyes. The diagnosis must be confirmed by a chromosome study (karyotype). A karyotype provides a visual display of the chromosomes grouped by their size, number and shape. Chromosomes may be studied by examining blood or tissue cells.

Cause

Down syndrome is usually caused by an error in cell division called nondisjunction. It is not known why this occurs. However, it is known that the error occurs at conception and is not related to anything the mother did during pregnancy. It has been known for some time that the incidence of Down syndrome increases with advancing maternal age. However, 80% of children with Down syndrome are born to women under 35 years of age.

Types of Down Syndrome

There are three chromosomal patterns that result in Down syndrome:

  1. Trisomy 21 (nondisjunction) is caused by a faulty cell division that results in the baby having three #21 chromosomes instead of two. Prior to or at conception, a pair of #21 chromosomes in either the egg or the sperm fails to separate properly. The extra chromosome is replicated in every cell of the body. Ninety-five percent of all people with Down syndrome have Trisomy 21.
  2. Translocation accounts for only 3% to 4% of all cases. In translocation a part of chromosome #21 breaks off during cell division and attaches to another chromosome. The presence of an extra piece of the 21st chromosome causes the characteristics of Down syndrome. Unlike Trisomy 21, which is the result of random error in the early cell division, translocation may indicate that one of the parents is carrying chromosomal material that is arranged in an unusual manner. Genetic counseling can be sought to ascertain more information when these circumstances occur.
  3. Mosaicism occurs when nondisjunction of chromosome #21 takes place in one of the initial cell divisions after fertilization. When this happens, there is a mixture of two types of cells, some containing 46 chromosomes and some 47. The cells with 47 chromosomes contain an extra 21st chromosome. Because of the “mosaic” pattern of the cells, the term mosaicism is used. This type of Down syndrome occurs in only one to two percent of all cases of Down syndrome.

Regardless of the type of Down syndrome a person may have, a critical portion of the 21st chromosome is present in some or all of their cells. This additional genetic material alters the course of development and causes the characteristics associated with the syndrome.

Learning & Development

It is important to remember that while children and adults with Down syndrome experience developmental delays, they also have many talents and gifts and should be given the opportunity and encouragement to develop them.

Most children with Down syndrome have mild to moderate impairments but it is important to note that they are more like other children than they are different. Early Intervention services should be provided shortly after birth. These services should include physical, speech and developmental therapies. Most children attend their neighborhood schools, some in regular classes and others in special education classes. Some children have more significant needs and require a more specialized program.

Some high school graduates with Down syndrome participate in post-secondary education. Many adults with Down syndrome are capable of working in the community, but some require a more structured environment.

Health Issues

Many children with Down syndrome have health complications beyond the usual childhood illnesses. Approximately 40% of the children have congenital heart defects. It is very important that an echocardiogram be performed on all newborns with Down syndrome in order to identify any serious cardiac problems that might be present. Some of the heart conditions require surgery while others only require careful monitoring. Children with Down syndrome have a higher incidence of infection, respiratory, vision and hearing problems as well as thyroid and other medical conditions. However, with appropriate medical care most children and adults with Down syndrome can lead healthy lives. The average life expectancy of individuals with Down syndrome is 60 years, with many living into their sixties and seventies.

Prenatal Diagnosis

Two types of procedures are available to pregnant women: screening tests and diagnostic tests. The screening tests estimate the risk of the baby having Down syndrome. Diagnostic tests tell whether or not the baby actually has Down syndrome.

Screening Tests

  • Maternal serum tests, such as the triple screen or quad screen, measure quantities of various substances in the blood. These tests are usually done between 15 and 20 weeks gestation.
  • Newer non-invasive tests have been developed which look for genetic material from the baby in the mother’s blood. They can be done earlier in the pregnancy and are more accurate than other screening tests, but they are currently recommended only for “high risk” pregnancies.
  • Sonograms (ultrasounds) are usually performed in conjunction with other screenings. These can show some physical traits that are helpful in calculating the risk of Down syndrome.
  • Screening tests do not accurately confirm the diagnosis of Down syndrome. In fact, false positives and false negatives frequently occur.

Diagnostic Tests

Three diagnostic tests are currently available:

  • Chorionic Villus Sampling (CVS) is conducted between 10 and 12 weeks. In this test, a small piece of the placenta (chorionic villus) will be taken and analyzed.
  • Amniocentesis is performed between 14 and 20 weeks. A small sample of amniotic fluid is drawn, and cells in the fluid are tested.
  • Percutaneous Umbilical Blood Sampling (PUBS) is performed after 18 weeks. This test examines blood from the umbilical cord.

Down Syndrome

Causes

Extra genetic material in Down syndrome is a result of random genetic alteration at conception.

Identification

Down syndrome can be identified during pregnancy by prenatal screening followed by diagnostic testing, or after birth by direct observation and genetic testing.

Assessment

Assessments vary depending on one’s personal (health) needs, age, as well as healthcare providers’ practices, cultures and philosophies.

Managements

Both assessment and management should be family-centred and require concerted and coordinated multi-disciplinary approaches. The resources above can help primary care physicians to provide preventative care whenever possible.

When assessing and managing medical issues in individuals, especially younger kids, with Down syndrome, it is important to approach those in a similar fashion to general population and balance the assumptions that certain abnormal values are just “part of Down syndrome.”

Related Disorders

While the list of associated health conditions is extensive and some times adds to negativity of DS diagnosis, it does not mean that each given child or person will get all of them.

  • Gross motor delay
  • hearing and vision problems
  • heart disorders, such as congenital heart disease
  • thyroid problems, such as an underactive thyroid gland (hypothyroidism)
  • celiac disease
  • recurrent infections
  • sleep apnea
  • leukemia and other blood disorders
  • ASD (often delayed dual diagnosis)
  • Early Alzheimer

My Daughters Are on Opposite Ends of the Down Syndrome Spectrum

Every single day I hear references to someone being on the spectrum. Being “on the spectrum” refers to a person having autism, but for a while now I’ve come to believe it might behoove the Down syndrome world to start talking in terms of a spectrum as well.

There are so many variations of how Down syndrome manifests itself in a person. Cognitive and physical abilities can be affected in differing degrees based on many factors. One significant factor is the many associated health conditions that individuals with Down syndrome have an increased risk of being born with or developing at some point in their lives. Some will have significant health concerns requiring surgery or other treatments, while others may only have minor issues common to Down syndrome.

Achieving certain life skills may come easier for some and yet may be unattainable to others just by the way their particular bodies reacted to the extra chromosome. All of the aforementioned factors can then be further compounded by additional diagnoses such as autism, sensory processing disorders and apraxia, just to name a few.

These extra diagnoses usually bring on additional and significant challenges which impact how the child or adult speaks, behaves, socializes and learns.

I’ve read many times how other parents who have a child with a dual diagnosis of Down syndrome and autism feel like they don’t fit in anymore at Down syndrome events or meetings. They believe there is too big of a difference between their child and other children who just have Down syndrome. They deal with things like bigger delays, complicated behaviors, lowered potential and intermittent or nonexistent stereotypical Down syndrome personality traits.

We recently attended the grand opening of a GiGi’s Playhouse near us and lasted all of about 15 minutes because the noise level and the crowd were so overwhelming to my daughter, Lily, who has both Down syndrome and autism. Call me paranoid, but I also sometimes sense a hint of fear from parents holding their cute, chromosomally enhanced babies when their gaze lands on Lily. Lily, who on this particular day is barely able to walk because she’s so busy trying to cover her ears, dodges bodies, averts her eyes and mutters nonsense while deeply cringing from the chaos of the grand opening party. Autism can be terrifying to people.

I’m on both sides of the coin. My other daughter, Dasha, just has Down syndrome, along with a few minor health issues that are common with Down syndrome. And then there’s Lily, with her numerous diagnoses stacked up to complicate all aspects of her life.

She has five: Down syndrome, congenital heart defect (repaired AV-canal), autism, a sensory processing disorder and Ehlers Danlos syndrome. I’m considering adding a sixth o, apraxia of speech, to the mix after seeing similarities between Lily and her brother who was just diagnosed.

I find myself struggling to fit into the Down syndrome world as the girls get older. Dasha seamlessly fits the mold, and I’m often saying she could be the poster child for someone with Down syndrome. But Lily doesn’t.

DashaLily

It took our daughter Dasha coming home for me to see the differences between them. After adopting a child with Down syndrome who lived in an orphanage for the first 5 years of her life, one of our biggest concerns and fears was possible institutional effects. Institutional effects (abuse, neglect, little to no affection) on a child can often mirror autism traits. “Institutional autism” is what most people call it.

I remember reading books, blogs and emails about institutional autism symptoms before and after Dasha came home. Slowly, I came to the realization that Lily had many of them, yet Dasha, who was adopted, did not. After Dasha had been home a couple of years, I started embracing the idea of Down syndrome coexisting with autism in Lily. They’ve become intertwined, and I believe they help make her the unique person she is and was meant to be.

So you will now hear me say when discussing my daughters’ diagnoses that I have two girls and they are on completely opposites ends of the spectrum of Down syndrome. It’s OK that they are nothing alike, and it’s time to recognize the diversity in the Down syndrome population. We can’t just champion and promote the ones who are more verbal, more social, more successful or more like you than different.

Individuals with Down syndrome make up an amazingly colorful spectrum and they’re all equally beautiful inside and out.

My girls giving their daddy some love.

A version of this post originally appeared on Our Version of Normal.

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