When we talk about development in Down syndrome, most conversations center around time-based motor delays, speech difficulties, or academic learning. But what if all of these challenges stem from something deeper? And, what if neurodevelopmental approaches and the science of epigenetics give us a way to create neuroplastic change, regardless of chronological age?

For years, I’ve watched individuals with Down syndrome work harder than anyone else in the room and still struggle to connect the dots. I’ve also seen what happens when we stop chasing milestones and start supporting the systems underneath them.

It all begins with the cerebellum and vestibular system.

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The Cerebellum & Vestibular System: The Body’s Hidden Control Centers

Traditional thought is that the cerebellum (Latin for “little brain”) was just a motor coordinator. But we now know it plays a starring role in:

• Balance and posture
• Timing and rhythm
• Speech and sequencing
• Emotional regulation
• Attention and learning

And the vestibular system is your inner GPS. It tells your child where they are in space, whether they’re upright or upside down, and how to move without falling. Together, these two systems create the foundation for everything from crawling to calming down.

The Vestibular system is the only sensory system with direct input to and direct input from the cerebellum. This is why difficulties with balance and coordination go hand in hand.

In children with Down syndrome, these systems aren’t delayed they are structurally, functionally, and chemically different. These changes are a result of the trisomy and are seen as early as the second trimester in utero. And that changes everything.

A brief note about gestation. The brainstem, responsible for bodily functions and primitive movement patterns emerges about 4-6 weeks of gestation. The cerebellum comes nest at 6-8 weeks, and then the cortical emergence and organization. Aside from the fact that all three major components of the brain are structurally altered by the trisomy, this order matters.

The cerebellum is literally the connector, the organizer, and the coordinator of all the functions. Neurological pathways between the cerebellum and every major part of the brain exists including the vast vagal network for bodily functions. According to the literature, the cerebellum is the key component for praxis in tandem with the vestibular syste, and it is uniquely challenged in our children.

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5 Structural Differences That Matter

There are well over 2 dozen differences in the cerebellar and vestibular systems due to the trisomy, but these are the biggies. Research shows that the cerebellum and vestibular system in Down syndrome differ in at least five key ways:

1. Smaller Cerebellar Volume: From birth, the cerebellum is significantly smaller in both the anterior (movement) and posterior (cognition) lobes.
2. Fewer Purkinje Cells: These are the cerebellum’s communication powerhouses. Fewer cells = less efficient processing.
3. Underdeveloped Semicircular Canals (Vestibular Inner Ear): These tiny tubes help detect head movement. In DS, they’re often hypoplastic.
4. Delayed Myelination: The “insulation” on neural connections is slower to develop, affecting timing and speed.
5. Reduced Cerebellar Connectivity: Imaging shows weaker links between the cerebellum and frontal cortex, impacting coordination, language, and emotional regulation.

These aren’t minor details. They are foundational differences—and they explain so much of what we see in daily life.

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2 Genetic Overexpressions That Impact These Systems

In addition to the dozens of structural differences, there are also genetic differences. These are only two of the genes on chromosome 21 of particular importance:

• DYRK1A: This gene affects brain growth, including cerebellar development. Overexpression leads to smaller structures and impaired learning pathways.
• RCAN1: This gene disrupts calcium regulation and synaptic function, contributing to poor motor learning and increased stress sensitivity.

Together, (along with many more) they create a “storm” that makes it harder for our kids to organize movement, stay regulated, and build automatic skills.

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Chemical Imbalances: GABA and BDNF

Let’s talk chemistry.

• GABA is the brain’s brake pedal. It helps calm and inhibit unnecessary activity. But in Down syndrome, GABA is overexpressed, which means the brain is often very slow in movement, reaction, learning, adaptation, and flexibility to name a few.
• BDNF (Brain-Derived Neurotrophic Factor) is like Miracle-Gro for the brain. It helps build and strengthen connections and it is the counterbalance to GABA. But BDNF levels are lower in Down syndrome, reducing neuroplasticity and response to experience.

This combination creates a brain that’s slower to learn from input, harder to regulate, and easier to overload. Luckily, there are many epigenetic ways to increase BDNF which then has a cycle effect: increase BDNF increase brain plasticity, introduce novel epigenetic inputs increase BDNF.

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How This Shows Up in Real Life

These aren’t abstract problems. We see them every day:

• Milestone Development is disorganized, not delayed. Children skip learning to roll segmentally because of primitive reflexes, or create maladaptive mobility instead of creeping and crawling, etc. Viewing our children’s development as one of delay is dangerous. This leads to rushing milestone development which is an enormous threat to integration necessary for global praxis.
• Primitive reflexes stick around—like ATNR or TLR which lead to awkward, stiff, or unstable movement patterns. Children have difficulty crossing midline and segmenting their body; two components necessary for global praxis.
• Visual-motor integration is weak.
• Postural insecurity is high. You’ll see clinging, freezing, tiptoe walking, or panic when asked to climb or balance.
• Speech and motor planning (praxis) are difficult. Even when your child knows what they want to say or do, coordinating the steps feels impossible.

None of this means your child is “not ready.” It means the foundational systems that support readiness haven’t been built yet. Traditional thought is time-based and will refer to “windows of development,” or “plateaus,” this thinking is no different than “That’s just DS.” Completely wrong.

Research has proven time and again the massive ability of the brain to reorganize, grow, heal, and change throughout the lifespan. Combining our knowledge of where to targter, how to input, and why, we have the tools necessary to change our children’s development regardless of age.

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Practical Steps to Support the Cerebellum + Vestibular System

The brain is plastic. These systems can grow. But we can’t treat them with performance-based activities focused on the outbound road. We need targeted inter-hemispheric (both cortical and cerebellar) movement, rhythm and timing, balance challenge, novelty and joy.

Start Here: Layer in these 5 strategies

1. Balance Challenge Every Day
   • Stand on a pillow / balance board / etc. while brushing teeth.
   • Walk heel-to-toe on a taped line – layer on metronome to allow the child’s brain to begin coordinating steps with rhythm
   • Put school work or processing work up on a vertical surface (automatically elicits the Vestibulo-ocular system for focus and attention) while stepping up on a stool, or standing on a balance board, or a poorly inflated air mat.
2. Rhythm and Timing
   • March to a beat.
   • Bounce a ball to a metronome start slow—65 bpm; this is basic metabolic rate. Doing activities to a slow metronome will help work on impulsivity, and higher metronome increases processing speed. Start at the sweet spot. (Check out YouTube for Bal-A-Vis-X Activities!)
   • Do hand claps or cross marches with songs.
   • Put a large roll of paper on the wall with an infinity loop, stand on balance challenging surface, turn on metronome and have the child dab around the loop to the beat.
3. Vestibular Activation
   • Swing, spin, or roll with intention.
   • Use scooter boards, belly crawling, or inclined crawling.
   • Do bear walks or animal walks with the head up.
   • Look carefully at how your child rolls. If they are still log rolling, this is a red flag. Play games that encourage eye movements independent from head; head indepemdent from body, body/trunk rotation independent from lowers – this is segmentation around midline necessary for all praxis.
4. Postural Confidence
   • If your child demonstrates any hesitancy with movement ranging from caution to flight/fight/fear response, they are experiencing postural insecurity. (Worthy of note that postural control is a function controlled by the cerebellum based on vestibular information about movement.) If you add movement challenges you will create fear and stress responses (that are already overeexxgaersted in our children because of the trisomy.) Start in a very safe and non-threatening manner. Perhaps do a bit of regulation or co-regulation activity beforehand to calm their nervous system. Begin with the safest postion, belly on floor. If they can tolerate that, then progress to sitting on a balance challenging surface. Keep playing and challenging as long as your child is calm and joyful. Some ideas are:
     • Crawl across pillows or foam mats.
     • Play on diagonals; reaching across midline while seated side-sit style, add a balance challenge, add rhythm and timing component. (Check out DSAP YouTube Channel for ideas.)
     • Combine processing work with balance, rhythm, and timing, by working on a vertical surface like a wall or easel with a metronome or beat.
5. Co-Regulate First
   • Calming breath, rhythm, and touch before motor challenge.
   • Use firm massage, deep pressure, or visual/aural rhythms to prepare the system.
6. What About Babies?
   • Go through the Developmental sequencing information and create ways to work on those transitions on a balance challenging surface with rhythm and timing. For example, working on segemntal roll? do it on a squishy mat or air mattress, working on sit to quadruped? Do it on a balance board, tip ti one side for movement into diagonal.

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Final Words: Build the Brain from the Bottom Up

If we want different outcomes, we need a different starting place. The cerebellum and vestibular system are the root systems that feed everything else.

When we support our children from the ground up—with movement, timing, and love—we stop worrying about time-based static milestone development because we begin to see proper movement paptterns and beautiful praxis emerging. We start asking: What else can I add to routines, environments, and play to promote integration throughout the day in a way that fits into life?

And that changes everything.