206. A Pediatrician Answers All Your Down Syndrome Questions

206. A Pediatrician Answers All Your Down Syndrome Questions

In this episode, we sit down with Dr. Mona Patel Gera from Children’s Hospital Los Angeles and talk through the “laundry list” that comes with a Down syndrome diagnosis. We keep it practical, focusing on what families actually need to ask and what requires attention early on, drawing from the same appointments and evaluations we’ve navigated with Liam. Dr. Gera also shares her connection to Liam through her son, Sejal, who was in his first grade class. She tells us about Sejal coming home talking about “adaptive PE,” describing how they worked on balance together and later insisting on “no dis-inclusion” after Lori visited the class. Those are moments we don’t always get to see, since Liam doesn’t come home and tell us his day.   We also get into IEPs and the need to move away from standard plans. Dr. Gera attends these meetings for her patients and we compare that to what we’ve experienced advocating for Liam, where the details matter and one plan never fits every child. Episode Transcript: https://ifweknewthen701833686.wpcomstaging.com/2026/07/23/206-a-pediatrician-answers-all-your-down-syndrome-questions/ [https://ifweknewthen701833686.wpcomstaging.com/2026/07/23/206-a-pediatrician-answers-all-your-down-syndrome-questions/] Please follow us on X @ifweknewthenPOD you can drop us a line on our Facebook page @ifweknewthenPOD or visit our website https://www.IfWeKnewThen.com to send us an email with questions and comments. You can join our mailing list there and get alerts of future podcast episodes. Thank you again and we look forward to you joining us on the next episode of IF WE KNEW THEN. ——— Summary In this episode, we sat down with Dr. Mona Patel Gera from Children’s Hospital Los Angeles, and we opened with something every parent recognizes: that long list that comes with a Down syndrome diagnosis. We said it out loud the way we remember hearing it in those early days, a “laundry list” that can take the air out of the room. Dr. Gera didn’t rush past that. She walked through what that list actually means in practice, what questions to ask, and how to separate what needs attention now from what simply needs to be monitored. We’ve had enough appointments with Liam over the years to know the difference between urgency and noise, and this conversation stayed grounded in that reality.   What made this conversation different is that Dr. Gera knows Liam outside of a chart. Her son, Sejal, was in first grade with him. She told us about the day Sejal came home talking about “adaptive PE,” using language she usually hears in a clinical setting. He described bouncing a large ball back and forth with Liam and working on balance, and she stopped in her tracks because that overlap between her professional world and her child’s classroom rarely shows up that clearly. We’ve sat in plenty of IEP meetings where those same services are discussed in abstract terms, so hearing it come back through a six-year-old’s voice landed differently. She also shared something we hadn’t heard before. After Lori went into the class to talk about Down syndrome, Sejal started using the phrase “no dis-inclusion.” He kept repeating it at school, insisting that kids couldn’t be left out just because they didn’t know the rules of a game. We didn’t know that moment had stuck with him. Liam doesn’t come home and tell us these stories, and we’ve learned over time that a lot of his day lives outside our view. Hearing how another child understood friendship with Liam filled in a gap we didn’t know was there. We spent time on inclusion from both sides. Dr. Gera talked about the “bi-directional” value she sees as a pediatrician, and we recognized that immediately because we’ve watched it happen in Liam’s classrooms. She attends IEP meetings for her patients and pushes against what she called “cookie cutter plans.” We’ve sat across from teams where the same template gets reused, and we’ve also seen what happens when someone takes the time to individualize goals and services. She was specific about looking at each child’s skill set and matching therapies to that child, not the system. By the end of the conversation, we weren’t trying to simplify anything. The list still exists. The school system still requires advocacy. But sitting with someone who has written IEPs, treated patients with Down syndrome, and watched her own son learn alongside Liam gave the whole discussion a kind of clarity we respect. It sounded like real life because it is.

205. If Inclusion Is the Goal, Why Are So Many Still Left Out?

In this episode we speak with Micah Kessel, founder of Playground of Empathy and creator of Empathable, a project designed to help people experience perspectives different from their own. The conversation focuses on what inclusion actually means beyond the word itself, and why many current approaches fail to create real belonging. Micah explains how most inclusion efforts rely on rules or negative messaging, rather than lived experience and emotional connection. He shares his work in designing immersive experiences that allow participants to “walk in someone else’s shoes,” not to fully understand another person’s life, but to recognize that their experiences are just as real and valid. We connect this idea to our own advocacy, especially in education, where inclusion is often discussed but not consistently practiced. We talk about how language, perspective and emotional awareness shape the way people show up for one another, and how empathy can shift interactions, even in difficult situations like fighting for a child’s rights. This episode explores the role of emotional education, the limits of traditional definitions of empathy and the importance of creating environments where differences are not just accommodated, but recognized as valid. Empathable: https://empathable.com [https://empathable.com] Playground of Empathy: https://empathable.com/playground/ [https://empathable.com/playground/] Episode Transcript: https://ifweknewthen701833686.wpcomstaging.com/2026/07/15/205-if-inclusion-is-the-goal-why-are-so-many-still-left-out/2/ [https://ifweknewthen701833686.wpcomstaging.com/2026/07/15/205-if-inclusion-is-the-goal-why-are-so-many-still-left-out/2/] Please follow us on X @ifweknewthenPOD you can drop us a line on our Facebook page @ifweknewthenPOD or visit our website https://www.IfWeKnewThen.com to send us an email with questions and comments. You can join our mailing list there and get alerts of future podcast episodes. Thank you again and we look forward to you joining us on the next episode of IF WE KNEW THEN. -------- Summary In this episode of If We Knew Then, Stephen and Lori Saux sit down with Micah Kessel, founder of Playground of Empathy and creator of Empathable, to examine what inclusion actually looks like in practice—and why so many current efforts fall short. What begins as a conversation about “inclusive playgrounds” quickly shifts into a deeper discussion about the difference between accessibility, inclusion, and true belonging. Micah explains that many inclusion programs rely on rules, compliance, or negative messaging—telling people what not to do—rather than creating meaningful understanding. He shares that most approaches treat inclusion as a concept to be learned, instead of an experience to be felt. His work focuses on immersive, emotion-centered design that allows people to encounter perspectives different from their own. The goal is not to fully understand someone else’s experience, which he notes is impossible, but to recognize that their experience is just as valid as your own. Stephen and Lori connect this to their own journey advocating for their son Liam, especially within the education system. They reflect on how often the word “inclusion” is used without a shared understanding of what it requires in practice. They discuss the gap between language and action, and how easily systems can appear supportive while still excluding students in meaningful ways. The conversation also explores the role of language in shaping inclusion. Micah highlights the difference between directive language and invitational language—phrases that create space, curiosity, and connection. This shift, he argues, is key to fostering a sense of belonging. Lori emphasizes how powerful words have been in their advocacy, particularly in IEP meetings and school settings, where language can either open doors or quietly limit opportunity. A central idea in the episode is redefining empathy. Rather than viewing empathy as the ability to understand or share someone else’s feelings, Micah reframes it as the ability to recognize and validate another person’s experience. This distinction removes pressure to “get it right” and instead focuses on acknowledging that multiple realities can exist at the same time. Throughout the episode, the discussion returns to a core question: what would change if we truly saw other people’s experiences as valid as our own? For families navigating disability, education, and advocacy, this question has real consequences. The episode offers a perspective shift—from teaching inclusion as a concept to building it through experience—and challenges listeners to reconsider how they show up for others in everyday interactions.

204. Siblings Of Siblings With Down Syndrome

This week we are joined by our daughter Sophia and guests Dr. Brian Skotko and Sue Levine to talk about the sibling experience in families of individuals with Down syndrome. The conversation centers on the book "Fasten Your Seatbelt: A Crash Course on Down Syndrome for Brothers and Sisters," which was developed from real questions collected during sibling workshops. Sophia shares her perspective as a sibling, including questions about school inclusion, peer interactions and the pressure to explain Down syndrome to others. Brian Skotko discusses growing up with a sister with Down syndrome and how access to education has changed over time, while noting that gaps still exist. Sue Levine explains her work as a social worker running sibling support groups and outlines how those programs focus on facts, feelings and problem solving. This episode covers common experiences reported by siblings, including frustration, embarrassment and isolation, as well as the expectation that siblings should have answers for others. We discuss how sibling workshops are structured, how questions are gathered from participants and how those insights shaped the book. We also touch upon how parents can respond to sibling emotions and why allowing space for those feelings matters. Book: https://www.amazon.com/Fasten-Your-Seatbelt-Syndrome-Brothers/dp/1890627860 [https://www.amazon.com/Fasten-Your-Seatbelt-Syndrome-Brothers/dp/1890627860]  Workshop for siblings:  https://siblingslearnaboutdownsyndrome.com [https://siblingslearnaboutdownsyndrome.com] YouTube: https://www.youtube.com/user/downsyndromesibbook [https://www.youtube.com/user/downsyndromesibbook] Episode Transcript: https://ifweknewthen701833686.wpcomstaging.com/2026/07/05/204-siblings/2/ [https://ifweknewthen701833686.wpcomstaging.com/2026/07/05/204-siblings/2/] Please follow us on X @ifweknewthenPOD you can drop us a line on our Facebook page @ifweknewthenPOD or visit our website https://www.IfWeKnewThen.com to send us an email with questions and comments. You can join our mailing list there and get alerts of future podcast episodes. Thank you again and we look forward to you joining us on the next episode of IF WE KNEW THEN. -------- Summary: Stephen and Lori Saux are joined by their daughter Sophia and guests Dr. Brian Skotko and Sue Levine to discuss the experience of siblings of individuals with Down syndrome. The conversation is guided in part by the book "Fasten Your Seatbelt: A Crash Course on Down Syndrome for Brothers and Sisters," which was built from questions collected during sibling workshops across the United States. Sophia leads parts of the discussion by asking questions based on her own experiences. She describes situations where peers expect her to explain her brother Liam’s behavior and diagnosis, and how that expectation can create pressure. She also talks about moments when she noticed differences in how her brother was treated in school, including times when supports were not provided. She explains that these experiences can be difficult to share with friends who do not have similar family dynamics. Brian Skotko shares his perspective as a sibling of a sister with Down syndrome and explains how access to education has changed over the past several decades. He states that his sister did not receive the same educational opportunities he did, and while inclusion has improved, barriers still exist in both K-12 and postsecondary settings. Sue Levine describes her work as a social worker and co-founder of a nonprofit in New Jersey that provides early intervention and family support. She explains that her sibling workshops include participants with siblings who have a range of disabilities, with Down syndrome and autism being the most common. The guests explain how the book was developed using real questions submitted anonymously by siblings during workshops. These questions address topics that siblings may hesitate to ask at home. The workshops and the book focus on three areas: providing accurate information about Down syndrome, creating space to discuss emotions, and offering strategies for problem solving. A significant part of the discussion centers on common emotional experiences for siblings. These include frustration, embarrassment, guilt, and feeling isolated. The guests state that these reactions are typical and should be acknowledged rather than corrected in the moment. They recommend that parents allow siblings to experience emotions as they happen and revisit those moments later to talk through them. They also note that siblings may sometimes distance themselves in public situations, and that this behavior can be a way to cope rather than a sign of rejection. The episode also addresses the role of educators and how classroom environments influence peer understanding. Sue Levine gives an example of a classroom where students did not initially identify the child with Down syndrome, which she attributes to effective inclusion practices. In contrast, the hosts describe experiences where a lack of support or understanding from educators affected both Liam and Sophia. The conversation emphasizes that sibling experiences vary but often include shared patterns. The guests highlight the value of connecting siblings with others who have similar experiences, either through workshops or structured programs. They explain that these connections help reduce isolation and provide practical ways to handle common situations.

203. A High School Diploma Is Attainable - May Mallari

This week we talk with attorney and parent advocate May Mallari about what happens when expectations are set too early in a child’s education. We were drawn to her because her son, Devin, was placed on an alternate curriculum in elementary school but still earned a high school diploma. A path once thought to be unattainable. In this episode we discuss what to ask for and what to question because the information families are given is not always complete.  This is a great conversation about knowing your options, understanding how decisions are made and asking better questions before paths are set. May is Founder and Principal of the Mallari Law Firm and has nearly 3 decades of experience representing workers exclusively in the area of labor and employment matters. Mallari Law Group: https://mallarilawgroup.com [https://mallarilawgroup.com] Episode Transcript: https://ifweknewthen701833686.wpcomstaging.com/2026/06/24/203-a-high-school-diploma-is-attainable-may-mallari/2/ [https://ifweknewthen701833686.wpcomstaging.com/2026/06/24/203-a-high-school-diploma-is-attainable-may-mallari/2/] Please follow us on X @ifweknewthenPOD you can drop us a line on our Facebook page @ifweknewthenPOD or visit our website https://www.IfWeKnewThen.com to send us an email with questions and comments. You can join our mailing list there and get alerts of future podcast episodes. Thank you again and we look forward to you joining us on the next episode of IF WE KNEW THEN   ------- Summary: This episode of If We Knew Then features attorney and parent advocate May Mallari, who discusses education decisions for students with Down syndrome and how early assumptions can shape long-term outcomes. Mallari’s son, Devin, was placed on an alternate curriculum starting in elementary school but later earned a standard high school diploma. Hosts, Stephen and Lori Saux, focus on how that outcome challenged expectations that are often set early in a child’s education. Mallari explains that Individualized Education Program meetings were consistent and collaborative in her experience within the Los Angeles Unified School District, though she describes the structure of those meetings as starting from a deficit-based perspective. She notes that discussions often begin with what a child cannot do, which can influence decisions about placement and curriculum. The conversation examines how curriculum placement decisions are made and how they affect access to a diploma. Lori Saux explains that her family pushed to keep their son on a general education curriculum because of the connection between coursework and post-secondary options. Mallari’s experience with Devin shows that placement on an alternate track does not always prevent a student from later meeting diploma requirements, though that path is not typically presented to families at the outset. Mallari outlines the importance of asking specific questions during IEP meetings, including how decisions will affect long-term outcomes such as graduation status. She emphasizes that families are not always given complete information about available options or the consequences of early placement decisions. She encourages parents to request clarity about how curriculum choices align with diploma eligibility. The discussion also covers transition planning after age 18. Mallari describes a gap in structured support once students exit the school system. She explains that services become less defined and families must take a more active role in identifying supports. This includes decisions about conservatorship and how to structure adult services. Mallari provides an overview of California’s Self-Determination Program through regional centers. She explains that the program allows individuals and families to direct how funding is used for services rather than relying on preset vendors. She completed training to become an independent facilitator, a role that helps families create a person-centered plan outlining needed supports. She notes that while the program offers flexibility, it can be difficult to navigate due to paperwork and administrative requirements. Stephen and Lori relate this to their own experience, describing challenges in understanding and accessing the program despite prior exposure. Mallari states that the process begins with creating a detailed plan tailored to the individual, which is then submitted for approval. She adds that the program may be more useful as individuals reach adulthood, when educational supports are no longer in place. Throughout the episode, the focus remains on decision-making. They all stress the need for families to understand how educational paths are set, what assumptions are being made, and how to question recommendations that may limit future options. Devin’s path to a diploma is presented as a case that contrasts with common expectations and illustrates the importance of reviewing decisions over time.

202. Alzheimer's And Down Syndrome - Dr. Brian Skotko

In this episode we revisit with Dr. Brian Skotko to talk about the impact of Alzheimer’s in the Down syndrome community and discuss some proactive steps that may help to improve the long-term wellness of people with Down syndrome. Down Syndrome Brain Train: https://www.downsyndromebraintrain.com [https://www.downsyndromebraintrain.com] Down Syndrome Clinic: https://www.dsc2u.org [https://www.dsc2u.org] Tar Heel Reader Book Collection: https://tarheelreader.org [https://tarheelreader.org] Find A Nutritionist Near You: https://www.eatright.org [https://www.eatright.org] Dr. Brian’s Book “Fasten Your Seatbelt: A Crash Course on Down Syndrome for Brothers and Sisters”: https://www.amazon.com/Fasten-Seatbelt-Brian-Skotko-Levine/dp/1890627860 [https://www.amazon.com/Fasten-Seatbelt-Brian-Skotko-Levine/dp/1890627860] Episode Transcript: https://ifweknewthen701833686.wordpress.com/2026/06/17/202/2/ [https://ifweknewthen701833686.wordpress.com/2026/06/17/202/2/] Please follow us on Twitter @ifweknewthenPOD you can drop us a line on our Facebook page @ifweknewthenPOD or visit our website https://www.IfWeKnewThen.com to send us an email with questions and comments. You can join our mailing list there and get alerts of future podcast episodes. Thank you again and we look forward to you joining us on the next episode of IF WE KNEW THEN. ------- Summary: This episode of If We Knew Then features a returning conversation with Dr. Brian Skotko, Director of the Down Syndrome Program at Massachusetts General Hospital, focusing on Alzheimer’s disease and its impact on the Down syndrome community. Stephen and Lori Saux open the discussion by acknowledging how difficult, but necessary, it is to talk about Alzheimer’s, emphasizing that honest information empowers families to prepare, advocate, and support their loved ones. Dr. Skotko begins by grounding the conversation in clear, evidence-based facts. While Alzheimer’s is more common in individuals with Down syndrome, it is not universal. He explains that there are no documented cases before age 35, but after that age, risk increases. Approximately 40% of individuals show signs by age 40, about 50% by age 50, and 60% by age 60. Importantly, he clarifies a widespread misconception: although nearly all individuals with Down syndrome develop the brain changes associated with Alzheimer’s (such as plaque buildup), not all will experience symptoms or dementia. The episode highlights how Alzheimer’s presents differently in individuals with Down syndrome. Rather than memory loss as a first sign, early indicators are often behavioral—changes in routine, mood, or increased anxiety. Seizures may also precede diagnosis. This difference makes accurate diagnosis more complex and underscores the danger of “diagnostic overshadowing,” where symptoms are incorrectly attributed to Alzheimer’s instead of treatable conditions like sleep apnea or thyroid issues. Dr. Skotko stresses the importance of thorough medical evaluation and working with professionals experienced in Down syndrome care. A key takeaway is the importance of establishing a baseline through a neuropsychological assessment around age 35. This allows families and clinicians to compare changes over time and make more accurate diagnoses. The hosts also emphasize the need to find qualified professionals who understand how to properly assess individuals with Down syndrome, as inaccurate evaluations can lead to misleading conclusions. The conversation then shifts toward prevention and proactive strategies. Dr. Skotko introduces his “SMART” approach, beginning with Social connections and Movement. Strong social networks are linked to better brain health, reinforcing the importance of inclusion and meaningful relationships throughout life. Exercise is described as critical “medicine” for the brain, activating cells that help clear harmful plaque buildup. However, he notes that fewer than 1% of individuals with Down syndrome meet recommended exercise guidelines, pointing to systemic barriers and low expectations as contributing factors. Stephen and Lori connect these insights back to inclusion, advocating for equal opportunities in education, social settings and physical activity. They highlight how societal assumptions about limitations can restrict access to experiences that are not only enriching, but potentially protective against cognitive decline. Throughout the episode, the tone remains both realistic and hopeful. While acknowledging the challenges Alzheimer’s presents, the conversation centers on empowerment through accurate information, early planning, community support and intentional lifestyle choices that can improve long-term outcomes for individuals with Down syndrome.