Content Warning: This section of the guide includes discussion of disability and ableism.

Delrita’s Uncle Punky has Down syndrome, a genetic disorder caused by an extra copy of a chromosome. People with Down syndrome are born with the condition and have it for life. It causes developmental delays, intellectual disability, and physical traits like short stature, weak muscles, and heart problems. There are many other specific traits that people with the condition tend to have; for example, Punky is described as having a tongue that is too large for his mouth, which is common among people with Down syndrome. Despite being intellectually disabled, people with the condition usually have strong emotional intelligence, another trait that Punky embodies.

The way that people with Down syndrome are treated in society has changed significantly since the early 1990s when the novel was written. The novel itself portrays a changing culture around disability, wherein the emphasis shifts from “protecting” people with disabilities to helping them build skills and independence. Since then, the culture around disability has taken great strides toward this goal. In The Man Who Loved Clowns, Punky never goes to school because, when he was assessed, his IQ was too low.