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Our 13-yr old son with Down syndrome made his first by G.K.Chesterton
Holy Communion 2-3 years ago. I credit my wife and the woman with the parish (a friend of ours) with the very basic instructions he got.
He is significantly delayed so I don't know that he *really* understands he is receiving Our Lord, but maybe he does, and maybe Our Lord's grace is working in him in ways we won't fully understand until the next life. He receives Holy Communion and then drinks of the Precious Blood as well.
No, he has never been on Confession and I don't see that happening anytime soon, but he's really guiltless of his actions.