title: Building an adaptive brain across development: targets for neurorehabilitation must begin in infancy.
abstract: Much progress has been made toward behavioral and pharmacological intervention in intellectual disability, which was once thought too difficult to treat. Down syndrome (DS) research has shown rapid advances, and clinical trials are currently underway, with more on the horizon. Here, we review the literature on the emergent profile of cognitive development in DS, emphasizing that treatment approaches must consider how some "end state" impairments, such as language deficits, may develop from early alterations in neural systems beginning in infancy. Specifically, we highlight evidence suggesting that there are pre- and early postnatal alterations in brain structure and function in DS, resulting in disturbed network function across development. We stress that these early alterations are likely amplified by Alzheimer's disease (AD) progression and poor sleep. Focusing on three network hubs (prefrontal cortex, hippocampus, and cerebellum), we discuss how these regions may relate to evolving deficits in cognitive function in individuals with DS, and to their language profile in particular.
authors.affiliation: Department of Psychology, University of Arizona Tucson, AZ, USA ; Sonoran University Center for Excellence in Developmental Disabilities Tucson, AZ, USA.
authors.forename: Jamie O
authors.initials: JO
authors.lastname: Edgin
authors.affiliation: Department of Psychology, University of Arizona Tucson, AZ, USA.
authors.forename: Caron A C
authors.initials: CA
authors.lastname: Clark
authors.affiliation: Centre for Brain and Cognitive Development, Birkbeck, University of London London, UK.
authors.forename: Esha
authors.initials: E
authors.lastname: Massand
authors.affiliation: Centre for Brain and Cognitive Development, Birkbeck, University of London London, UK.
authors.forename: Annette
authors.initials: A
authors.lastname: Karmiloff-Smith
keywords: Down syndrome; brain development; cerebellum; connectivity; hippocampus; language; rehabilitation; treatment