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Objectives To report participation of school age children with Down syndrome (DS) and its relationship with adaptive functioning from Turkey, an upper-middle income country.Methods In a cross-sectional observational design, children with DS aged 5–12 years who were followed in Ankara University School of Medicine Department of Pediatrics, Developmental Pediatrics Division (AUDPD) between Jan 1st, 2020- Jan 1st 2025 were recruited. Expanded Guide for Monitoring Child Development (Expanded GMCD), the Participation and Environment Measure for Children and Youth (PEM-CY), Vineland Adaptive Behavior Scales Second Edition were used for this study.Results Of total 53 children, 47 (88.7%) children comprised the sample (mean age of 102±24 months and 51.1% boys). Most of the children (74.5%) had an additional chronic health condition and all had delay in adaptive functioning. Most mothers (61.7%) received >12 years of education. The average frequency of participation in PEM-CY was higher at home, compared to school and community (p<0.001). Most of the mothers expressed desire for change in school preparation (72.3%), classroom activities (70.2%) and involving getting together with other children (70.2%). Children who had significant adaptive functioning delay had lower mean frequency of participation at home (mean:4.98±1.0) and in community (mean:1.76±0.84), than children with delay.Conclusions School age children with DS had limitations in participation in life which was related to lower adaptive functioning from an upper middle-income country, Turkey. Interventions should aim supporting adaptive functioning as well as participation especially for children with DS and their families.