"Only a few decades ago, many youngsters with Down syndrome were viewed as eternal children. They were kept [in] sheltered independent positions and were not provided with the opportunity to become responsible citizens in an accepting society" (Pueschel, 2001).

Today, adolescents with Down syndrome face a series of transitions as they emerge from childhood and prepare for adulthood. Indeed, transition is one of the top priorities for teens with Down syndrome today. Individuals with Down syndrome are eligible for special education services through the public school system through their 22nd birthday. Within the special education system, transition is a specific process that begins at age 14 and continues through age 21, designed to prepare the individual to leave school and prepare to enter the work force.

In reality, however, transition is a lifelong process that begins in childhood and extends through adulthood. Pueschel describes transition as "...a bridge between the security and structure offered by school and home and the risks of a more independent adult life" (Pueschel, 2001). Within this definition, there are clearly roles for the adolescent with Down syndrome, his parents and other family members, teachers, health care professionals, and representatives from public and private agencies that serve individuals with developmental disabilities.

The National Down Syndrome Society (NDSS) outlines a specific transition time line that includes specific recommendations for transition activities from elementary school age through age 22. Some highlights of this time line include:

Elementary School Age:

Middle School Age:

14 Years Old

15 Years Old

16 Years Old

17 Years Old

18 Years Old

19-21 Years Old

A nurse's involvement of in each of the transition activities outlined above, depends on training, experience, and practice setting. A nurse case manager working closely with the teen, for example, may attend a variety of educational, vocational, and other planning meetings. Nurses in a clinic setting may be involved in establishing job restrictions secondary to health issues of the adolescent. Home health nurses can play a valuable role in supporting employment decisions, guardianship recommendations, and explorations of living arrangements. With good assessment skills and a genuine interest in the adolescent with Down syndrome, professional nurses can help the family achieve optimal outcomes in almost every aspect of the transition process.

Nurses should stick with health care issues and not involve themselves in the educational, developmental, or employment decisions.