Karon is 12 years old and has a diagnosis of Down syndrome. He attends a school for children with additional needs and his father reports that he had been very happy there until recently, when his classroom teacher left to go to another school. She had been Karon’s teacher for some years and since her departure he has been showing signs of depression and stress. Karon’s father reports that Karon likes things to follow set routines and becomes very anxious if there is any change. His previous teacher understood this and adapted her classroom so Karon could follow his routines undisturbed. Karon dislikes his classmates as they tend to be loud and unpredictable and Karon hates noisy environments. At school, his teacher has always been his sole focus for all interactions.

Strategies

• Consider referral for a multi-disciplinary assessment where a full developmental history can be taken.
• Provide information and resources about autism to Karon and his father. Although you cannot confirm diagnosis at this point, autism-friendly strategies will nevertheless be helpful to provide Karon with predictability and security and you can make this clear to Karon’s father.
• Discuss possible treatment options for Karon’s depression and stress. As above, these should be considered based on the assumption that Karon may be on the autism spectrum, and that associated difficulties are the underlying cause of his recent depression and stress. Environmental adaptations should therefore be prioritised above pharmaceutical options.