Background Globally, mental health disorders and behavioural problems afflict persons with Down syndrome (DS) with a high prevalence reported in some studies. However, data on behavioural and emotional disorders in DS cohort in Asian countries are lacking. Aims To assess the mental health status of children and adults with DS, using the Strength and Difficulties Questionnaire (SDQ) and its impact on caregivers using the impact supplement. Methods The questionnaires were administered to caregivers of eligible participants aged ≥4 years. In addition, Down syndrome participant's ≥ 11 years old attempted the self-report. Scoring was done as per standard SDQ guidelines. Results The total difficulties score was observed to be at least borderline high in 30.6% (19/62) of the participants. Peer relationships and conduct subscale issues were rated high, with abnormal internalizing scores predominating over externalizing scores. From parents' perspective, behavioural issues impacted 41.9% (26/62) of participants' in areas of education, peer relationship and leisure. However, only 3.8% (1/26) of the caregivers whose children had behavioural issues perceived them as a burden. Conclusions Mental health difficulties are a significant morbidity in our DS cohort. SDQ is a useful user-friendly tool for identification of behavioural problems enabling timely referral for intervention and therapy.

skin not responding well to standard treatment.Genetic tests helps in making a diagnosis in the child and detection of carrier state in mother who is asymptomatic. This helps in counselling regarding the peripartum risks associated with future pregnancies and the recurrence risk for the offsprings.

Physicians play a pivotal role in the management of children and adults with Down Syndrome. Achieving full developmental potential in a child with Down Syndrome depends on prompt treatment of medical complications, family support and early establishment of intervention programmes. The presence of evidence-based guidelines support the physician both in the community and in restructured hospitals to provide timely and appropriate management recommendations. It will also aid in counselling parents and caregivers. Although most co-morbidity characteristics are common for the syndrome, the prevalence of different morbidities can be region specific, hence it is useful to have recommendations tailored to suit local population. Here we share the clinical guideline for children and adults with Down Syndrome in Singapore.