The crises of your child with Down syndrome often leave you feeling helpless and exhausted. Screams, cries, violent gestures, fierce opposition: these intense moments mark the daily lives of many families and represent one of the most challenging aspects of support. However, these crises never come out of nowhere. They have identifiable causes that we can learn to recognize, understand, and, to a large extent, prevent.
This article identifies the five most common causes of crises in children with Down syndrome. For each, we will explore the mechanisms at play, the signs that allow us to identify them, and the strategies to prevent and respond to them. This understanding forms the foundation of an effective approach that gradually reduces the frequency and intensity of crises.
Cause #1: Communication Frustration
Understanding the Mechanism
The first cause of crises, and probably the most fundamental, is frustration related to communication difficulties. The child with Down syndrome generally understands much more than they can express. This gap creates a daily frustration that accumulates and eventually explodes.
Imagine knowing exactly what you want to say but your mouth refuses to form the appropriate sounds. Imagine having pain somewhere but being unable to explain it. Imagine wanting something intensely but no one understands your attempts to ask. This frustration, carried day after day, becomes unbearable and is expressed through the only available channel: behavior.
The crisis is then not a whim but a cry of despair. The child is saying, with their body and emotions, what their words do not allow them to say. And often, this crisis “works”: it attracts attention, communicates the urgency of the need, triggers a reaction from those around. This unfortunately reinforces its use as a mode of communication.
Revealing Signs
Several clues suggest that a crisis is related to communication frustration. The child tries to communicate something (gestures, vocalizations, pointing) just before the crisis. Frustration visibly builds as their attempts fail. The crisis calms quickly if the adult manages to “guess” what the child wanted to say. The child seems relieved, sometimes almost grateful, when they are finally understood.
These crises are particularly frequent in situations where the child has an urgent need (hunger, thirst, pain, need to go to the bathroom) or an intense desire (specific toy, desired activity, sought-after person).
Prevention and Response Strategies
To reduce crises related to communication frustration, two areas of work are essential. On one hand, developing the child’s communication skills by providing them with alternative means of expression: signs, pictograms, communication tablets. Each new word or sign mastered reduces opportunities for frustration.
On the other hand, improving our own ability to decode the child’s signals. Observing closely, learning to recognize their vocalizations and gestures, anticipating their needs based on the context: all these parental skills prevent many crises.
When a crisis occurs, actively help the child to be understood (closed questions, visual choices, contextual cues) rather than passively waiting for the crisis to pass.
The training Developing Communication in Children with Down Syndrome from DYNSEO offers concrete tools to work on these two essential dimensions.
Cause #2: Sensory Overload
Understanding the Mechanism
The second major cause of crises is sensory overload. Many children with Down syndrome exhibit particularities in processing sensory information. Some are hypersensitive to certain stimuli (loud noises, bright lights, specific textures), while others are hyposensitive and constantly seeking stimulation.
The daily environment, which we perceive as normal and comfortable, can be a real sensory assault for the hypersensitive child. A shopping mall with its background music, neon lighting, moving crowd, and multiple visual stimuli can provoke an overload that the child’s nervous system cannot manage.
This overload does not always immediately result in a crisis. Often, the child “holds on” for a while, filtering the overwhelming stimuli as best as they can. But this containment has a cost, and at some point, the nervous system “gives in” and the crisis erupts. This crisis can occur in the overwhelming environment itself or, paradoxically, after leaving it, when the child finally finds themselves in a safe place where they can “let go”.
Revealing Signs
The signs of sensory overload can be subtle at first. The child covers their ears or squints in response to certain stimuli. They seek to distance themselves from the source of stimulation or to leave the environment. They exhibit increasing agitation, intensifying repetitive behaviors, and gradual withdrawal. Their gaze may become evasive or, conversely, fixed, their face may pale or flush.
Risky environments are generally noisy places (cafeterias, parties, public transport), very bright places (supermarkets, shopping malls), crowded places, and situations involving unwanted tactile stimulation (new clothes, body care, physical contact).
Prevention and Response Strategies
Prevention starts with identifying the child’s specific sensitivities. What types of stimuli are problematic for them? In which environments do they feel uncomfortable? These observations help anticipate risky situations.
When these situations are unavoidable, adjustments can reduce sensory overload: noise-canceling headphones, tinted glasses, choosing off-peak hours for shopping, a different route home after a stimulating outing. Preparing the child for what they will experience and providing them with regulation tools (sensory object to manipulate, breathing, option to withdraw) helps them manage better.
When an overload crisis occurs, the priority is to immediately reduce stimuli: take the child to a quiet place, dim the lights, speak softly, avoid touching them if they are experiencing tactile hypersensitivity. Allow them time to recover without demands.
Cause #3: Difficulty with Transitions and Changes
Understanding the Mechanism
The third major cause concerns transitions and changes. Children with Down syndrome generally have an increased need for predictability and routine. Changes, even minor from our perspective, can be experienced as destabilizing and anxiety-provoking.
This difficulty can be explained by several factors. Cognitive flexibility, which allows for mental adaptation to change, is often limited. The representation of time and the ability to project into the future are reduced, making the anticipated change difficult to grasp. Working memory, necessary to keep in mind what is going to happen, can be fragile.
The result is that the child clings to the ongoing activity, refuses to move on, and may enter crisis when change is imposed. This reaction is not bad will but the expression of a real difficulty in managing transitions.
Tell-Tale Signs
Crisis related to transitions has recognizable characteristics. They occur specifically at moments of change: end of an activity, leaving a place, arriving in a new context. The child shows increasing resistance as the change approaches. They cling physically or symbolically to the ongoing activity or place. Transitions announced in advance and prepared for are generally managed better than abrupt changes.
The most at-risk transitions are often those that involve leaving a pleasant activity (end of play, cartoon, outing to the park) or entering a less desired situation (homework, bath, bedtime, school).
Prevention and Response Strategies
Preventing transition crises relies on structuring and predictability. Visual schedules allow the child to see the flow of their day and anticipate changes. Prior warnings (“In five minutes, we clean up”) with concrete markers (visual timer, number of remaining actions) prepare the child for the change.
Transition rituals, that is, stable sequences of actions that accompany each change, provide reassuring markers. Offering choices in how to make the transition (“Do you want to clean up starting with the cars or the blocks?”) gives the child a sense of control.
When a crisis occurs despite preparations, maintain the framework with calmness and firmness while validating the child’s emotion. Do not give in to the crisis by canceling the transition, as this would only reinforce the behavior.
The training Facilitating Daily Autonomy for Children with Down Syndrome: Routines and Visual Tools by DYNSEO offers many tools to structure transitions and reduce associated crises.
Cause #4: Fatigue and Resource Exhaustion
Understanding the Mechanism
The fourth cause, often underestimated, is fatigue. The child with Down syndrome, particularly due to the hypotonia characteristic of this syndrome, expends much more energy than other children to perform daily tasks. Maintaining posture, moving, speaking, staying attentive: each activity costs them more.
This increased energy expenditure leads to fatigue that accumulates throughout the day. A tired child is one whose emotional regulation capacities are diminished. What would have been manageable at the beginning of the day becomes insurmountable in the late afternoon. Frustrations are less tolerated, changes are harder to accept, and stimuli are more aggressive.
The crisis that occurs at the end of the day is often not due to the immediate triggering event (a refusal, a transition, a frustration) but to the exhaustion of resources accumulated over the hours. The event is just the straw that breaks the camel’s back.
Tell-Tale Signs
Crisis related to fatigue presents recognizable temporal patterns. They preferentially occur at certain times of the day, typically late morning and especially late afternoon. Their frequency and intensity increase when the child has had a particularly busy day or period. They decrease when the child is well-rested.
Physical signs of fatigue can be observed before the crisis: yawning, rubbing eyes, loss of postural tone (the child slumps more), increased clumsiness, growing irritability.
Prevention and Response Strategies
Prevention involves organizing the day to meet the child’s energy needs. Alternating periods of effort and recovery, scheduling demanding activities at times of peak performance, and planning regular quiet times helps to preserve resources.
Sufficient quantity and quality of sleep is essential. Sleep disorders, common in Down syndrome, must be identified and treated as they significantly worsen daytime fatigue.
When the child shows signs of fatigue, reduce demands, simplify tasks, and offer calm activities. It is not always possible to completely prevent exhaustion, but we can adjust our expectations accordingly.
When a crisis occurs clearly against a backdrop of fatigue, the priority is to allow recovery rather than trying to correct the behavior. Offering a rest period, a hug, a soothing activity, and postponing discussions until the child is more available is essential.
Cause #5: Emotional Dysregulation
Understanding the Mechanism
The fifth major cause is the difficulty of emotional regulation. Emotions are a universal language, but managing them requires skills that develop gradually throughout childhood. In children with Down syndrome, this development follows a slower pace and may present particularities.
Several factors contribute to this difficulty in regulation. Neurological particularities affect the functioning of brain circuits involved in emotion control. Language difficulties complicate the verbalization of emotions, which is a powerful regulation tool. Comprehension difficulties can make certain situations emotionally confusing.
The result is that the child may be overwhelmed by intense emotions that they cannot modulate. Anger, fear, sadness, excitement can reach proportions that exceed what their regulation system can handle, making the crisis inevitable.
Tell-Tale Signs
Crises related to emotional dysregulation are often preceded by visible emotional signs. The child’s facial expression changes, their breathing accelerates, and their body tenses. The emotion builds in intensity perceptibly before exploding.
These crises can occur in response to identifiable emotional triggers (frustration, fear, excessive excitement) or sometimes in less obvious ways when the child accumulates unexpressed emotions that eventually overflow.
The intensity of the crisis is often disproportionate to the apparent trigger, which can confuse those around. A small refusal can provoke an explosion of anger, a slight annoyance can trigger inconsolable crying. This disproportion reflects the difficulty of regulation more than a reaction to the event itself.
Prevention and Response Strategies
Prevention involves foundational work on emotional skills. Helping the child identify and name their emotions, with appropriate visual supports. Teaching them regulation strategies within their reach: breathing, retreating to a calm corner, manipulating a soothing object, asking for help.
This emotional education work is done daily, in small moments when emotions are manageable, not in the midst of crises. Naming the child’s emotions (“I see that you are angry”), validating them (“It’s normal to be frustrated when you can’t have what you want”), modeling regulation (“When I am upset, I take deep breaths”).
When a crisis occurs, our role is to be a containing and calm presence. Our own regulation serves as a model and anchor for the child. Avoid reacting with intensity, as this would only amplify the emotion. Wait for the wave to pass before attempting to discuss or resolve the issue.
The training Helping Your Child with Down Syndrome Manage Their Emotions from DYNSEO offers structured support to develop these essential skills.
When Multiple Causes Accumulate
The Multiplicative Effect of Combined Factors
In daily reality, crises rarely result from a single cause. More often, several factors combine to create a “perfect storm” that exceeds the child’s coping abilities.
A tired child (cause 4) who has to make a transition (cause 3) in a noisy environment (cause 2) without being able to express their discomfort (cause 1) and who feels a rise in frustration that they cannot regulate (cause 5) is practically certain to enter a crisis. Each factor, taken in isolation, might have been manageable. Their combination creates an insurmountable overload.
This understanding of the cumulative effect is important for our analysis of situations. When a crisis surprises us with its seemingly disproportionate intensity, it is likely that several factors were adding up in the background.
Identifying Risky Combinations
Careful observation of your child will allow you to identify particularly risky combinations of factors for them. For some children, it is the end of the day in a new place. For others, it is the transition moments when they are sick. For others still, it is social situations combined with fatigue.
This personalized knowledge allows for anticipation and targeted preventive measures. When you know that the combination of factors is unfavorable, you can adjust your expectations, reinforce supports, or sometimes simply avoid the situation if it is not essential.
Act on the most accessible factor
In the face of an ongoing crisis, it is generally not possible to act on all causes simultaneously. The effective strategy is to identify the factor we have the most control over and intervene on it.
If the environment is overwhelming, remove the child from that environment. If fatigue seems predominant, offer a time to rest. If communication frustration is evident, help the child to be understood. If it is a transition, provide markers and time.
By acting on one factor, we reduce the overall load and give the child a better chance to regain their balance.
Towards a comprehensive preventive approach
Know your child
The key to effective prevention lies in a deep understanding of your child. Each child is unique, with their particular sensory profile, specific triggers, moments of vulnerability, and strategies that work.
The crisis journal, where you systematically note the circumstances of each episode, is a valuable tool for developing this understanding. Over time, patterns emerge that guide you in prevention.
Act on the environment and routines
Once the risk factors are identified, action on the environment and the organization of daily life can significantly reduce exposure to problematic situations. Adapting the sensory environment, structuring transitions, respecting rest needs, offering alternative means of communication: all adjustments that, when implemented consistently, transform daily life.
Develop the child’s skills
Alongside adapting the environment, developing the child’s skills gradually gives them more resources to face challenges. Communication skills, emotional regulation, autonomy: each new skill acquired reduces the likelihood of crises.
This development takes time and requires patience. Progress is sometimes slow, sometimes uneven, but it is real and cumulative. The child you are supporting today has more resources than the one from a year ago, and will have even more resources next year.
Surround yourself and train
You do not have to walk this path alone. The professionals who support your child (speech therapists, psychologists, educators, psychomotor therapists) are valuable resources for understanding behaviors and adjusting interventions. Parent associations offer invaluable peer support.
The training Managing the Difficult Behaviors of a Child with Down Syndrome from DYNSEO has been designed to provide parents and professionals with a comprehensive framework for understanding and intervention. It delves into the five causes we have explored and offers detailed strategies for each.
Conclusion: understand to transform
The crises of the child with Down syndrome have identifiable causes. Communication frustration, sensory overload, transition difficulties, fatigue, and emotional dysregulation are the five main sources of these challenging behaviors. Understanding these causes transforms our perspective and approach.
Rather than seeing a capricious, oppositional, or manipulative child, we see a child facing real challenges and using the only means at their disposal to express their distress. This understanding paves the way for empathetic and effective intervention, focused on prevention and teaching alternative skills.
The path to calmer days requires time, observation, patience, and consistency. But the results are there for families who engage in this process of understanding and adaptation. Crises decrease in frequency and intensity, the relationship with the child calms, and daily life becomes more predictable and gentler.
At DYNSEO, we support families in this transformation. Our training offers the knowledge and tools to understand behaviors, implement prevention strategies, and respond effectively when crises occur. Because every child deserves to be understood, and every family deserves to live calmer days.
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To go further:
- Managing the Difficult Behaviors of a Child with Down Syndrome
- Developing Communication in Children with Down Syndrome
- Helping Your Child with Down Syndrome Manage Their Emotions
- Facilitating Daily Autonomy for Children with Down Syndrome: Routines and Visual Tools
- Understanding and Stimulating Motor Development in Down Syndrome
