question: Why do people with Downs Syndrome seem to be far more functional in society than they were a few decades ago?
comment: My eldest daughter has DS and turns 19 next month so I feel i can give my opinion. A few decades ago mothers were told to give the baby up to an institution, forget about it, go home and have anther baby. Nowadays society is a lot more accepting of those that are not "normal". My then wife and I were advised to do the best we could for our daughter. No one will ever reach their full potential if they are kept in a corner for their whole lives. My daughter finished high school last year, she has a job one day a week, she has a full social life, goes to the pool a couple of times a week, goes to the library, buys her own lunch, loves books, movies and music. She's as best a person as I've tried to help her be. If she was born a few decades ago she may already have died from lack of care.
passages: Section::::Management.:Other.
  
  Tympanostomy tubes are often needed and often more than one set during the person's childhood. Tonsillectomy is also often done to help with sleep apnea and throat infections. Surgery, however, does not always address the sleep apnea and a continuous positive airway pressure (CPAP) machine may be useful. Physical therapy and participation in physical education may improve motor skills. Evidence to support this in adults, however, is not very good.
   There is no cure for Down syndrome. Education and proper care have been shown to improve quality of life. Some children with Down syndrome are educated in typical school classes, while others require more specialized education. Some individuals with Down syndrome graduate from high school, and a few attend post-secondary education. In adulthood, about 20% in the United States do paid work in some capacity, with many requiring a sheltered work environment. Support in financial and legal matters is often needed. Life expectancy is around 50 to 60 years in the developed world with proper health care.
   The onset of Flynn–Aird syndrome typically occurs between ten and twenty years of age, however, the earliest case was diagnosed at age seven. As the syndrome progresses, initial symptoms tend to intensify and new symptoms become apparent. Unlike related syndromes and despite the intensity of symptoms in the disease progression, Flynn–Aird syndrome does not appear to shorten life expectancy. 
   Down syndrome may also occur in animals. In great apes chromosome 22 corresponds to the human chromosome 21 and thus trisomy 22 causes Down syndrome in apes. The condition was observed in a common chimpanzee in 1969 and a Bornean orangutan in 1979, but neither lived very long. The common chimpanzee Kanako (born around 1993, in Japan) has become the longest-lived known example of this condition. Kanako has some of the same symptoms that are common in human Down syndrome. It is unknown how common this condition is in chimps but it's plausible it could be roughly as common as Down syndrome is in humans.
   Down syndrome is associated with an increased risk of many chronic diseases that are typically associated with older age such as Alzheimer's disease. The accelerated aging suggest that trisomy 21 increases the biological age of tissues, but molecular evidence for this hypothesis is sparse. According to a biomarker of tissue age known as epigenetic clock, trisomy 21 increases the age of blood and brain tissue (on average by 6.6 years).
  
  Section::::Diagnosis.
  
  Section::::Diagnosis.:Before birth.
   Section::::Causes.
  
  BULLET::::- Down syndrome – patients with Down syndrome have higher rates of ASDs, especially a particular type that involves the ventricular wall. As many as one half of Down syndrome patients have some type of septal defect.
  
  BULLET::::- Ebstein's anomaly – about 50% of individuals with Ebstein anomaly have an associated shunt between the right and left atria, either an atrial septal defect or a patent foramen ovale.
  
  BULLET::::- Fetal alcohol syndrome – about one in four patients with fetal alcohol syndrome has either an ASD or a ventricular septal defect.
   Section::::MicroRNA genes.
  
  Human chromosome 21 contains five microRNA genes: miR-99a, let-7c, miR-125b-2, miR-155, and miR-802.
  
  Section::::Epigenetic studies of accelerated aging effects.
  
  Trisomy 21 entails an increased risk of many chronic diseases that are typically associated with older age such as an increased risk of Alzheimer's disease. The clinical manifestations of accelerated aging suggest that trisomy 21 increases the biological age of tissues, but molecular evidence for this hypothesis has been sparse. According to a biomarker of tissue age known as epigenetic clock, trisomy 21 significantly increases the age of blood and brain tissue (on average by 6.6 years).
   Research has led to an understanding that two genes located on chromosome-21, that code for proteins that control gene regulators, DSCR1 and DYRK1A can be responsible for some of the phenotypes associated with Down syndrome. DSCR1 and DYRK1A cannot be blamed outright for the symptoms; there are a lot of genes that have no known purpose. Much more research would be needed to produce any appropriate or ethically acceptable treatment options.
   Individuals with Down syndrome have a higher risk of early death than the general population. This is most often from heart problems or infections. Following improved medical care, particularly for heart and gastrointestinal problems, the life expectancy has increased. This increase has been from 12 years in 1912, to 25 years in the 1980s, to 50 to 60 years in the developed world in the 2000s. Currently between 4 and 12% die in the first year of life. The probability of long-term survival is partly determined by the presence of heart problems. In those with congenital heart problems 60% survive to 10 years and 50% survive to 30 years of age. In those without heart problems 85% survive to 10 years and 80% survive to 30 years of age. About 10% live to 70 years of age. The National Down Syndrome Society provide information regarding raising a child with Down syndrome.
   They typically do fairly well with social skills. Behavior problems are not generally as great an issue as in other syndromes associated with intellectual disability. In children with Down syndrome, mental illness occurs in nearly 30% with autism occurring in 5–10%. People with Down syndrome experience a wide range of emotions. While people with Down syndrome are generally happy, symptoms of depression and anxiety may develop in early adulthood.
   As a result of this discovery, the condition became known as trisomy 21. Even before the discovery of its cause, the presence of the syndrome in all races, its association with older maternal age, and its rarity of recurrence had been noticed. Medical texts had assumed it was caused by a combination of inheritable factors that had not been identified. Other theories had focused on injuries sustained during birth.
  
  Section::::Society and culture.
  
  Section::::Society and culture.:Name.
   The parents of the affected individual are usually genetically normal. The probability increases from less than 0.1% in 20-year-old mothers to 3% in those of age 45. The extra chromosome is believed to occur by chance, with no known behavioral activity or environmental factor that changes the probability. Down syndrome can be identified during pregnancy by prenatal screening followed by diagnostic testing or after birth by direct observation and genetic testing. Since the introduction of screening, pregnancies with the diagnosis are often terminated. Regular screening for health problems common in Down syndrome is recommended throughout the person's life.
   Efforts are underway to determine how the extra chromosome 21 material causes Down syndrome, as currently this is unknown, and to develop treatments to improve intelligence in those with the syndrome. Two efforts being studied are the use stem cells and gene therapy. Other methods being studied include the use of antioxidants, gamma secretase inhibition, adrenergic agonists, and memantine. Research is often carried out on an animal model, the Ts65Dn mouse.
  
  Section::::Other animals.
   Plastic surgery has been suggested as a method of improving the appearance and thus the acceptance of people with Down syndrome. It has also been proposed as a way to improve speech. Evidence, however, does not support a meaningful difference in either of these outcomes. Plastic surgery on children with Down syndrome is uncommon, and continues to be controversial. The U.S. National Down Syndrome Society views the goal as one of mutual respect and acceptance, not appearance.
   Down syndrome is a chromosomal abnormality characterized by the presence of an extra copy of genetic material on the 21st chromosome, either in whole (trisomy 21) or part (such as due to translocations). The effects of the extra copy varies greatly from individual to individual, depending on the extent of the extra copy, genetic background, environmental factors, and random chance. Down syndrome can occur in all human populations, and analogous effects have been found in other species, such as chimpanzees and mice. Recently, researchers have been able to create transgenic mice with most of human chromosome 21 (in addition to their normal chromosomes).
   In the 8 years prior to DSF’s founding, from 2002-2009, NIH spent only $6.3 million on projects mentioning Dravet syndrome (DS) or Severe Myoclonic Epilepsy of Infancy (SMEI). Only about 30 studies were published on DS. In the 8 years since DSF’s founding, from 2010-2017, NIH spent $44.6 million on projects mentioning DS or SMEI, or 7x the research dollars. Over 300 studies were published on DS. There was an explosion of federal dollars spent on DS between 2010 and 2014, when DSF was first raising awareness and funding in the research world while investing in researchers. Of the 19 researchers DSF invested in through 2015, 6 of them went on to receive large NIH grants, for a return rate of 32%.
   Down syndrome research
  
  Research of Down syndrome-related genes is based on studying the genes located on chromosome 21. In general, this leads to an overexpression of the genes. Understanding the genes involved may help to target medical treatment to individuals with Down syndrome. It is estimated that chromosome 21 contains 200 to 250 genes. Recent research has identified a region of the chromosome that contains the main genes responsible for the pathogenesis of Down syndrome, located proximal to 21q22.3. The search for major genes involved in Down syndrome characteristics is normally in the region 21q21–21q22.3.
  
  Section::::Genes.
   The DNA oxidation product 8-OHdG is a well-established marker of oxidative DNA damage arising from oxidative stress and the excessive production of reactive oxygen species. The levels of 8-OHdG in the DNA of persons with DS measured in saliva were found to be significantly higher than in control groups. 8-OHdG levels were also found to be higher in urine, leukocytes and fibroblasts of persons with DS compared to controls. Both fetal and adult DS fibroblasts are defective in the removal of 8-OHdG as compared with age-matched cells from control healthy donors These findings suggest that oxidative DNA damage may underlie some of the clinical and premature aging features of DS.
   At birth, all children should get an electrocardiogram and ultrasound of the heart. Surgical repair of heart problems may be required as early as three months of age. Heart valve problems may occur in young adults, and further ultrasound evaluation may be needed in adolescents and in early adulthood. Due to the elevated risk of testicular cancer, some recommend checking the person's testicles yearly.
  
  Section::::Management.:Cognitive development.
   BULLET::::- The Down Syndrome Centre Seminars series began in June with “Promoting the Early Development of Children with Intellectual Disability”, delivered by Early Intervention expert, Ann Haig Wheeler. Ann worked in Ireland for over 10 years before returning to live in the US. As well as being a recognised professional, who offers practical methods for achieving successful intervention, she is also the mother of a 10-year-old daughter, Allie, who has Down syndrome and Autism.
   Education programs before reaching school age may be useful. School-age children with Down syndrome may benefit from inclusive education (whereby students of differing abilities are placed in classes with their peers of the same age), provided some adjustments are made to the curriculum. Evidence to support this, however, is not very strong. In the United States, the Individuals with Disabilities Education Act of 1975 requires public schools generally to allow attendance by students with Down syndrome.
   The NDSS was founded by Betsy Goodwin and Arden Moulton. Goodwin's daughter Carson was born in 1978 with Down Syndrome. The parents soon discovered that the support and resources available to parents with Down syndrome children were very limited. Goodwin and Arden decided to create the NDSS, which gained official nonprofit status in 1979.
  
  Section::::Areas of Programming.
  
  NDSS focuses on four items of programming to enhance the quality of life for those with Down syndrome.
  
  BULLET::::- The National Policy Center creates systematic change through legislative policy.
   SPS is estimated to have a prevalence of about one per million. Underdiagnosis and misdiagnosis hinder epidemiological information about the condition and may have led to its prevalence being underestimated. In the United Kingdom, 119 cases were identified between 2000 and 2005. It does not predominantly occur in any racial or ethnic group. The age of onset varies from about 30 to 60, and it most frequently occurs in people in their 40s. Five to ten percent of patients with SPS have the paraneoplastic variant of the condition. In one group of 127 patients, only 11 of them had paraneoplastic symptoms. About 35 percent of SPS patients have type I diabetes.
   Many alternative medical techniques are used in Down syndrome; however, they are poorly supported by evidence. These include: dietary changes, massage, animal therapy, chiropractic and naturopathy, among others. Some proposed treatments may also be harmful.
  
  Section::::Prognosis.
   Globally, , Down syndrome occurs in about 1 per 1000 births and results in about 17,000 deaths. More children are born with Down syndrome in countries where abortion is not allowed and in countries where pregnancy more commonly occurs at a later age. About 1.4 per 1000 live births in the United States and 1.1 per 1000 live births in Norway are affected. In the 1950s, in the United States, it occurred in 2 per 1000 live births with the decrease since then due to prenatal screening and abortions. The number of pregnancies with Down syndrome is more than two times greater with many spontaneously aborting. It is the cause of 8% of all congenital disorders.
  
raw_presuppositions: People with Down's Syndrome are more functional in society today than they were a few decades ago.
raw_corrections: People with Down's Syndrome are accepted as more functional in society today than they were a few decades ago, even though they've always had the same abilities.