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History: Review interval medical history, questioning specifically about the possibility of obstructive airway disease and sleep apnea; check sensory functioning (vision and hearing); assess for behavioral problems; address sexuality issues.

Exam: General physical and neurological examination (with reference to atlanto-axial dislocation). Monitor for obesity by plotting height for weight on the growth charts for typical children. Pelvic exam if sexually active, only. (See Consults, below.) Perform a careful cardiac exam in adolescents, looking for evidence of valvular disease. Lab and consults: Thyroid function testing (TSH and T4) yearly. Hearing and vision evaluations every year. Repeat screening cervical spine x-rays as needed for Special Olympic participation. Echocardiogram if evidence of valvular disease on clinical exam. Consult with Adolescent Medicine practitioner or a gynecologist experienced in working with individuals with developmental disabilities to address issues of sexuality and/or for pelvic examination for sexually active teenager. Continue twice-yearly dental exams.

Developmental: Repeat psycho-educational evaluations every two years as part of Individualized Educational Plan (IEP). Monitor independent functioning. Continue speech/language therapy as needed. Health and sex education, including counseling regarding abuse prevention. Smoking, drug, and alcohol education.

Recommendations: Begin functional transition planning (age 16). Consider enrollment for SSI depending on family income. SBE prophylaxis needed for individuals with cardiac disease. Continue dietary and exercise recommendations (see childhood, above). Update estate planning and custody arrangements. Encourage social and recreational programs with friends. Register for voting and selective service at age 18. Discuss plans for alternative long term living arrangements such as community living arrangements (CLA). Reinforce the importance of good self-care skills (grooming, dressing, and money handling skills).