CHILDHOOD PSYCHOSES: RESULTS OF DRUG TREATMENT
ON STEREOTYPING BEHAVIOUR IN DOWN AND NON-DOWN SUBJECTS
Renato
COCCHI, neurologist and medical psychologist
Summary
After 3-106 months of individualised drug
therapies, the results on stereotype behaviour of 37 psychotic Down children and
30 psychotic non-Down children were compared. The Down group (PDG) comprised 24
M and 13 F; average age at first consultation: 6 +/- 3;2 years; chromosomal
diagnoses: 35 pure trisomy 21, 1 mosaicism and 1 not known; DSM-III,R
Diagnosis: 34 early onset and 3 late onset Pervasive Developmental Disorder.
The non-Down group (PnDG) comprised 17 M and 13 F; average age at first
consultation 6;11 +/- 3;2 years; DSM-II, R diagnoses: 21 early onset and 4 late
onset Pervasive Developmental Disorder, 5 Atypical Pervasive Developmental
Disorder.
Results on rocking, head banging,
flapping tremor, fingers movements, toe walking, skill stereotypy, voice
stereotypies (echolalia excluded). Significant results in reduction of flapping
tremor and fingers stereotypies in both groups and in rocking and head banging
only in the Down group. All the the remaining investigated stereotypies showed
a trend to improve in direct proportion to the length of the drug therapy.
Key words: Childhood psychoses; Down children; non-Down children; drug
therapy; individualised regimen; stereotypies; results.
Down's syndrome
Drug therapy
Mental
retardation
One of the most visible aspects of the
psychotic child's behaviour is the presence of motor and vocal stereotyping.
This is also one of the first symptoms to alarm the parents.
In itself, the presence of stereotypies in a
child is not sufficient to justify a diagnosis of childhood psychosis (DSM-III,
R, 1987). In research into Down's syndrome, a series of 413 non-selected
consecutive 21 trisomics were studied, all were Italian and no older than 15
years at first consultation, constituting a representative sample of the
Italian Down subject population.
Motor stereotypies were found in 9.20 % (38
Ss) while a further 4.12 % (17 Ss) showed evidence of verbal stereotyping, even
though these 56 children cannot be diagnosed as childhood psychosis sufferers
(Cocchi, 1989).
A detailed evaluation was made of the
results obtained following drug treatment of a group of psychotic Down children
(PDG) and a group of psychotic non-Down children (PNDG), treated over various
periods of time.
After a global comparative evaluation
(Cocchi, 1990) and specific comparison of the effects on their social behaviour
(Cocchi, 1991a), school achievement (Cocchi, 1991b) and verbal language
development (Cocchi 1991e), the results concerning the symptom of stereotyping
behaviour were also examined.
Under this heading are found a series of
motor or vocal behaviour characterised by repetition, the absence of any useful
role (at least, that is, any role justifiable by the environmental situation),
unpredictability as to when the behaviour will arise, and also the fact that
they are not spasmodic.
Whether it is the case of movements
involving some biological needs linked to some precise dysfunction of brain
monoamines, this is a question which has not as yet been satisfactory
explained.
The children under scrutiny were those whose
the parents accepted drug treat-ment administered along the guidelines already
pointed out (Cocchi, 1990d). It is for this reason that the two groups studied
were only made up of those subjects on whom it was possible to carry out a
check-up of the therapy after a minimum of 3 months.
Materials and method
All the clinical records of psychotic Down
and non-Down subjects who had been the object of previous research (Cocchi,
1990c), were re-examined. To the PnDG were added the records of one subject
escaped the previous survey. The clinical records selected were those cases
where a diagnosis of childhood psychosis conforming to DSM-III, R (1987) had
been made during the first consultation.
The following symptoms or behaviour were
evaluated:
The presence of the stereotyping behaviour was
evalued, before and after a therapy period by means of a five steps scale of
intensity as follows:
0 = symptom or behaviour not present;
1 = rarely present and not linked to
particular situations;
2 = present only in precise moments ( eg.
Before sleeping);
3 = present if the child is not actively
involved in the environmental situation;
4 = very present and hard to be
interruprted.
For each child were also noted:
For the statistical analysis the Chi Square
test was used.
Results
The results, up to the end of August 1991,
were reported on tables 1-6.
Two groups of children were identified on
the basis of diagnosis made at first consultation, and the length of time of
drugs were taken:
1. Psychotic Down children Group (PDG): 37
Ss = 100.00% .
Characteristics of PDG are:
Sex: M = 24 e F = 13; M/F ratio =
184.62/100.
Average age at first consultation: 6 years
with SD = 3;2 years.
Distribution of chromosomal anomalies:
Pure trisomy 21: 35 Ss = 94.59%;
Mosaicisms: 1 S = 2.70%;
Not known: 1 S = 2.70%.
Diagnosis, according to DSM-III, R:
Early onset Pervasive Developmental
Disorder: 34 Ss = 91.89%;
Late onset Pervasive Developmental Disorder:
3 Ss = 8.11%.
2. Psychotic non-Down group (PnDG): 30 Ss =
100.00%;
Characteristics of PnDG are:
Sex: M = 17 and F = 13; M/F ratio =
130.77/100;
Average age at first consultation: 6;11
years, with SD = 3;2 years;
Diagnoses, according to DSM-III, R:
Early onset Pervasive Developmental
Disorder: 21 Ss = 70.00%;
Late onset Pervasive Developmental Disorder:
4 Ss = 13.33%;
Atypical Pervasive Developmental Disorder: 5
Ss = 16.67%.
Table 1: comparison of the length of
therapies.
|
Group /length |
PDG Ss |
% |
PnDG Ss |
% |
<>% |
|
1. from 3 to 6 months |
2 |
5.41 |
4 |
13.33 |
+7.92 |
|
2. from 7 to 12 months |
4 |
10.81 |
7 |
23.33 |
+12.52 |
|
3. from 13 to 24 months |
10 |
27.03 |
5 |
16.67 |
-10.36 |
|
4. from 25 to 36 months |
8 |
21.62 |
3 |
10.00 |
-11.62 |
|
5. from 37 to 60 months |
5 |
13.51 |
7 |
23.34 |
+9.83 |
|
6. from 61 to 94 months |
8 |
21.62 |
4 |
13.33 |
-8.29 |
|
Totals |
37 |
100.00 |
30 |
100.00 |
0.00 |
|
|
|||||
Chi Square = 6.43 with 5
df; .30 > p > .20; N.S.
Table 2: PDG, risults on stereotypies
before (bef.) and after (aft.) therapy.
|
Group |
Rocking |
Head banging |
Flapping tremor |
Fingers stereot. |
Toe walking |
Skill stereot. |
Voice stereot. |
||||||||
|
S. nr. |
Bef. |
Aft. |
Bef. |
Aft. |
Bef. |
Aft. |
Bef. |
Aft |
Bef. |
Aft. |
Bef. |
Aft. |
Bef. |
Aft |
|
|
Gr. 1. (3-6 months therapy) |
|||||||||||||||
|
182 |
4 |
2 |
3 |
2 |
0 |
0 |
2 |
2 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
|
353 |
4 |
3 |
0 |
0 |
3 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
2 |
2 (*) |
|
|
Gr. 2 (7-12 months therapy) |
|||||||||||||||
|
32 |
4 |
4 |
1 |
1 |
0 |
0 |
0 |
0 |
2 |
2 |
0 |
0 |
3 |
3 (*) |
|
|
34 |
2 |
1 |
0 |
0 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
|
316 |
2 |
1 |
0 |
0 |
2 |
2 |
2 |
2 |
0 |
0 |
0 |
0 |
2 |
2 (*) |
|
|
332 |
3 |
3 |
0 |
0 |
0 |
0 |
3 |
3 |
2 |
2 |
0 |
0 |
3 |
3 (*) |
|
|
Gr. 3 (13-24 months therapy) |
|||||||||||||||
|
124 |
3 |
3 |
3 |
2 |
2 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
|
186 |
3 |
1 |
2 |
1 |
0 |
0 |
2 |
1 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
|
289 |
3 |
2 |
0 |
0 |
3 |
3 |
0 |
0 |
0 |
0 |
2 |
2 |
0 |
0 (*) |
|
|
325 |
3 |
2 |
2 |
2 |
0 |
0 |
2 |
2 |
0 |
0 |
0 |
0 |
2 |
2 (*) |
|
|
330 |
2 |
3 |
2 |
2 |
0 |
0 |
3 |
3 |
0 |
0 |
3 |
3 |
0 |
0 (*) |
|
|
333 |
0 |
0 |
2 |
2 |
3 |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
|
345 |
2 |
1 |
0 |
0 |
2 |
1 |
3 |
2 |
0 |
0 |
0 |
0 |
1 |
0 (*) |
|
|
430 |
0 |
0 |
2 |
0 |
2 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
|
|
455 |
2 |
1 |
0 |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
2 |
1 |
|
|
Gr. 4 (25-36 months therapy) |
|||||||||||||||
|
93 |
0 |
0 |
3 |
1 |
0 |
0 |
3 |
1 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
101 |
3 |
2 |
2 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 |
2 |
2 (*) |
|
|
120 |
3 |
2 |
3 |
1 |
0 |
0 |
3 |
2 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
|
191 |
2 |
2 |
2 |
2 |
3 |
2 |
3 |
2 |
0 |
0 |
0 |
0 |
1 |
0 (*) |
|
|
225 |
2 |
2 |
2 |
2 |
3 |
3 |
3 |
3 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
|
281 |
3 |
2 |
2 |
2 |
3 |
3 |
3 |
2 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
|
319 |
2 |
2 |
2 |
2 |
0 |
0 |
3 |
2 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
|
433 |
3 |
1 |
0 |
0 |
0 |
0 |
2 |
0 |
2 |
1 |
0 |
0 |
0 |
0 @ |
|
|
Gr. 5 (37-60 months therapy) |
|||||||||||||||
|
85 |
1 |
1 |
2 |
2 |
0 |
0 |
3 |
2 |
2 |
0 |
0 |
0 |
1 |
1 (*) |
|
|
268 |
2 |
1 |
2 |
1 |
0 |
0 |
3 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
|
|
308 |
2 |
2 |
2 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
2 |
2 (*) |
|
|
372 |
3 |
1 |
0 |
0 |
3 |
0 |
3 |
1 |
3 |
0 |
0 |
0 |
0 |
0 |
|
|
400 |
0 |
0 |
2 |
1 |
3 |
0 |
3 |
1 |
0 |
0 |
2 |
0 |
3 |
2 |
|
|
Gr. 6 (61-100 months therapy) |
|||||||||||||||
|
7 |
0 |
0 |
0 |
0 |
3 |
1 |
3 |
1 |
3 |
0 |
0 |
0 |
2 |
0 @ |
|
|
49 |
3 |
1 |
0 |
0 |
3 |
1 |
3 |
1 |
0 |
0 |
0 |
0 |
2 |
0 |
|
|
206 |
3 |
1 |
3 |
0 |
0 |
0 |
3 |
1 |
0 |
0 |
0 |
0 |
2 |
2 @ |
|
|
217 |
4 |
1 |
3 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
2 |
2 |
|
|
226 |
3 |
1 |
0 |
0 |
3 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
2 |
0 @ |
|
|
242 |
2 |
1 |
3 |
2 |
3 |
1 |
3 |
2 |
0 |
0 |
0 |
0 |
2 |
1 |
|
|
284 |
0 |
0 |
3 |
1 |
0 |
0 |
3 |
1 |
0 |
0 |
0 |
0 |
3 |
1 |
|
|
312 |
3 |
1 |
3 |
1 |
2 |
0 |
0 |
0 |
2 |
1 |
0 |
0 |
3 |
1 (#) |
|
|
p |
|
.001 |
|
.04 |
|
.02 |
|
.04 |
|
NS |
|
NS |
|
NS |
|
(*) Therapy interrupted by
the parents. (@) Not yet psychotic. (#) Case escaped the previous surveys.
Table 3: PnDG, risults on stereotypies
before (bef.) and after (aft.) therapy.
|
|
Rocking |
Head banging |
Flapping tremor |
Fingers stereot. |
Toe walking |
Skill stereot. |
Voice stereot. |
||||||||||||
|
Group |
|||||||||||||||||||
|
S. nr. |
Bef. |
Aft. |
Bef. |
Aft. |
Bef. |
Aft. |
Bef. |
Aft |
Bef. |
Aft. |
Bef. |
Aft. |
Bef. |
Aft |
|||||
|
Gr. 1. (3-6 months therapy) |
|||||||||||||||||||
|
F |
0 |
0 |
3 |
3 |
3 |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
3 (*) |
|||||
|
M |
2 |
2 |
0 |
0 |
3 |
2 |
0 |
0 |
3 |
2 |
0 |
0 |
3 |
2 |
|||||
|
M |
3 |
2 |
0 |
0 |
0 |
0 |
2 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
|||||
|
M |
0 |
0 |
3 |
2 |
0 |
0 |
3 |
3 |
2 |
2 |
0 |
0 |
3 |
2 |
|||||
|
Gr 2 (7-12 months therapy) |
|||||||||||||||||||
|
M |
3 |
2 |
0 |
0 |
0 |
0 |
3 |
2 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|||||
|
M |
0 |
0 |
2 |
2 |
0 |
0 |
3 |
2 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|||||
|
M |
0 |
0 |
0 |
0 |
3 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
2 (*) |
|
|
|
|
|
|||||
|
M |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
2 |
2 |
2 |
3 |
0 |
0 |
0 |
0 |
|
F |
0 |
0 |
0 |
0 |
3 |
2 |
0 |
0 |
3 |
2 |
0 |
0 |
0 |
0 |
|
|
|
|
|
|
F |
0 |
0 |
0 |
0 |
3 |
2 |
3 |
2 |
0 |
0 |
0 |
0 |
2 |
2 |
|
|
|
|
|
|
M |
0 |
0 |
0 |
0 |
3 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
2 |
2 |
|
|
|
|
|
|
Gr. 3 (13-24 months therapy) |
|
|
|
|
|
||||||||||||||
|
F (#) |
2 |
3 |
0 |
0 |
0 |
0 |
2 |
4 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
|
|
|
|
|
F |
0 |
0 |
0 |
0 |
3 |
2 |
0 |
0 |
3 |
1 |
0 |
0 |
2 |
2 (*) |
|
|
|
|
|
|
M |
0 |
0 |
3 |
1 |
0 |
0 |
3 |
2 |
0 |
0 |
3 |
2 |
3 |
2 (*) |
|
|
|
|
|
|
F |
2 |
1 |
0 |
0 |
3 |
4 |
3 |
2 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
|
|
|
|
|
M |
3 |
1 |
0 |
0 |
3 |
3 |
0 |
0 |
0 |
0 |
2 |
1 |
0 |
0 |
|
|
|
|
|
|
Gr. 4 (25-36 months therapy) |
|
|
|
|
|
||||||||||||||
|
M |
0 |
0 |
0 |
0 |
3 |
1 |
4 |
1 |
0 |
0 |
3 |
1 |
0 |
0 @ |
|
|
|
|
|
|
M |
0 |
0 |
3 |
1 |
0 |
0 |
3 |
1 |
0 |
0 |
0 |
0 |
3 |
1 |
|
|
|
|
|
|
M |
3 |
0 |
0 |
0 |
2 |
1 |
3 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
|
|
|
|
|
|
Gr. 5 (37-60 months therapy) |
|
|
|
|
|
||||||||||||||
|
M |
0 |
0 |
2 |
0 |
2 |
1 |
0 |
0 |
0 |
0 |
2 |
2 |
2 |
2 (*) |
|
|
|
|
|
|
M |
0 |
0 |
0 |
0 |
3 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
|
|
|
|
|
|
F |
0 |
0 |
3 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
2 |
1 |
|
|
|
|
|
|
F |
0 |
0 |
0 |
0 |
3 |
0 |
3 |
0 |
3 |
0 |
0 |
0 |
0 |
0 @ |
|
|
|
|
|
|
F |
4 |
3 |
3 |
2 |
0 |
0 |
3 |
2 |
0 |
0 |
0 |
0 |
3 |
3 (*) |
|
|
|
|
|
|
F |
0 |
0 |
2 |
0 |
3 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
2 |
1 |
|
|
|
|
|
|
Gr. 6 (61-106 months therapy) |
|
|
|
|
|
||||||||||||||
|
M |
3 |
0 |
0 |
0 |
2 |
1 |
3 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
|
|
|
|
|
|
M |
0 |
0 |
0 |
0 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
3 |
0 @ |
|
|
|
|
|
|
F |
3 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
2 |
0 |
0 |
0 |
0 |
0 @ |
|
|
|
|
|
|
F |
0 |
0 |
0 |
0 |
3 |
0 |
3 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
|
|
|
|
|
|
p |
|
NS |
|
NS |
|
.02 |
|
.04 |
|
NS |
|
NS |
|
.07 NS |
|
|
|
|
|
(*) therapy interrupted by
the parents; (#) Rett's syndrome (diagnosis made during therapy); (@) not yet
psychotic.
Table 4: comparison of the
overall results on stereotypies according to the therapy length, Keys: (+) =
improvement (any degree) in at least one stereotypy, (=) = no improvement.
|
Group |
PDG |
PnDG |
PDG |
PnDG |
PDG |
PnDG |
PDG |
PnDG |
PDG |
PnDG |
PDG |
PnDG |
|
Ther. Months |
6 |
12 |
24 |
36 |
60 |
94 |
||||||
|
Nr. of Ss |
2 |
4 |
4 |
7 |
10 |
5 |
8 |
3 |
5 |
7 |
8 |
4 |
|
Evaluation |
+ / = |
+ / = |
+ / = |
+ / = |
+ / = |
+/ = |
+ / = |
+ / = |
+ / = |
+ / = |
+ / = |
+ / = |
|
|
||||||||||||
|
Stereotypies |
2 / 0 |
3 / 1 |
2 / 2 |
6 / 1 |
8 / 2 |
4 / 1 |
7 / 1 |
3 / 0 |
5 / 0 |
7 / 0 |
8 / 0 |
4 / 0 |
|
% of + results |
1.00 |
.75 |
.50 |
.85 |
.80 |
.80 |
.87 |
1.00 |
1.00 |
1.00 |
1.00 |
1.00 |
Table 5: comparison of the
results achieved in each form of stereotypy, according to therapy length; Keys:
(+) = improvement (any degree), (=) = fully inadequate.
|
Group |
PDG |
PnDG |
PDG |
PnDG |
PDG |
PnDG |
PDG |
PnDG |
PDG |
PnDG |
PDG |
PnDG |
|
Ther. Months |
6 |
12 |
24 |
36 |
60 |
94 |
||||||
|
Nr. of Ss (max-min) |
2 - 0 |
3 - 0 |
4 -0 |
4 - 0 |
8 - 1 |
3 - 1 |
7 -1 |
3 - 0 |
4 - 0 |
4 - 1 |
9 - 0 |
2 - 0 |
|
Evaluation |
+ / = |
+ / = |
+ / = |
+ / = |
+ / = |
+ / = |
+/ = |
+ / = |
+ / = |
+ / = |
+ / = |
+ / = |
|
|
||||||||||||
|
Rocking |
2 - 0 |
0 / 2 |
2 / 2 |
2 / 0 |
6 / 2 |
2 / 1 |
4 / 3 |
1 / 0 |
2 / 2 |
1 / 0 |
6 / 0 |
2 / 0 |
|
Head banging |
1 - 0 |
1 / 1 |
2 / 2 |
0 / 1 |
2 / 3 |
1 / 0 |
2 / 5 |
1 / 0 |
3 / 1 |
4 / 0 |
5 / 0 |
0 / 0 |
|
Flapping tremor |
1 - 0 |
1 / 1 |
1 / 1 |
4 / 0 |
4 / 3 |
1 / 2 |
1 / 2 |
1 / 0 |
0 / 2 |
4 / 0 |
5 / 0 |
0 / 0 |
|
Fingers stereot. |
0 - 1 |
0 / 2 |
0 / 2 |
3 / 1 |
2 / 2 |
2 / 1 |
6 / 1 |
3 / 0 |
4 / 0 |
1 / 1 |
5 / 0 |
2 / 0 |
|
Toe walking |
0 - 0 |
1 / 1 |
0 / 2 |
1 / 1 |
1 / 0 |
1 / 0 |
1 / 0 |
0 / 0 |
2 / 0 |
1 / 0 |
2 / 0 |
0 / 0 |
|
Skill stereotypies |
0 - 0 |
0 / 0 |
0 / 0 |
0 / 0 |
0 / 3 |
2 / 0 |
1 / 0 |
1 / 0 |
1 / 0 |
1 / 0 |
0 / 0 |
0 / 0 |
|
Voice stereot. |
0 / 1 |
2 / 1 |
0 / 3 |
2 / 2 |
2 / 2 |
1 / 1 |
2 / 1 |
1 / 0 |
1 / 2 |
2 / 2 |
7 / 2 |
1 / 0 |
|
% of + results |
.67 |
.38 |
.29 |
.71 |
.53 |
.67 |
.59 |
1.00 |
.65 |
.82 |
.94 |
1.00 |
Table 6: comparison of the
improvements, according to the length of therapy.
|
Group |
Rocking |
Head banging |
Flapping tremor |
Fingers stereot. |
Toe walking |
Skill stereotyp. |
Voice stereotyp. |
|
Months of therapy |
|
||||||
|
6. PDG (2-0 Ss) |
2 |
1 |
1 |
0 |
|
|
|
|
6. PnDG (3-0 Ss) |
2 |
0 |
1 |
0 |
0 |
|
2 |
|
12. PDG (4-0 Ss) |
2 |
0 |
1 |
0 |
0 |
|
2 |
|
12.PnDG (4-0 Ss) |
2 |
0 |
4 |
3 |
1 |
|
2 |
|
24.PDG (10-1 Ss) |
6 |
1 |
3 |
1 |
1 |
0 |
2 |
|
24.PnDG (3-1 Ss) |
2 |
1 |
1 |
2 |
1 |
2 |
1 |
|
36. PDG (6-0 Ss) |
4 |
2 |
1 |
5 |
1 |
1 |
2 |
|
36.PnDG (3-0 Ss) |
1 |
1 |
2 |
3 |
|
1 |
1 |
|
60. PDG (5-0 Ss) |
2 |
2 |
1 |
3 |
2 |
|
0 |
|
60.PnDG (5-1 Ss) |
1 |
4 |
5 |
2 |
1 |
0 |
2 |
|
+60 PDG (8-0 Ss) |
6 |
5 |
5 |
5 |
2 |
|
6 |
|
+60PnDG (2-0 Ss) |
1 |
|
2 |
1 |
1 |
|
1 |
|
% of + results |
.78 |
.46 |
.63 |
.61 |
.75 |
.20 |
.55 |
|
.73 |
.78 |
.79 |
..69 |
.71 |
.75 |
.60 |
Discussion
As therapies are all individualised,
as reported in previous papers (Cocchi, 1990b, Cocchi, 1991a and 1991b) and as
can be seen in the case extensively reported (Cocchi 1990d), the statistical
analysis is mainly descriptive, so much so that for each case the clinical
evaluation of the results has been reported here (Tables 2-3). It should also
be noted that 3 cases of the PNDG and 1 of the PDG have been cited in other
papers, and so 3 have also been evaluated by external observers (Bondanini,
1990; Grasso Rossetti, 1990; Cocchi, 1990 d) and one by means of laboratory
parameters (Cocchi, 1990a).
As far as the length of the
therapy is concerned, regarding the many cases where it was interrupted, I must
confirm here what has already stated in the previous research (Cocchi, 1990b); the
lack of some results was the reason for it only in very few cases.
The length of therapy for
the two groups does not significantly differs (Table 1). The effect that drug
therapy has on stereotypies in both groups seems to be dependent on the length
of the therapy itself (Tables 4-5). It is as well to make this statement
cautiously in the case of the PDG because the numerous interruptions which
occurred in the therapy may possibly have singled out the better subjects whose
parents felt more motivated to continue the treatment being undertaken.
This caution is not so
necessary when considering the PNDG as there were fewer overall interruptions
in treatment.
The results of drug therapy
on Down subjects has proven to be statistically significant in the areas of
rocking, head banging, flapping tremor and fingers movements (table 2). In the
non-Down group significance was only achieved in the case of stereotypies such
as flapping tremor and fingers movements. The overall percentage of positive
results in tables 5-6 have been calculated on the basis of the number of
subjects in which that particular stereotypy was evident, according to tables
2-3.
Even though the therapy,
when maintained, produced results in all the subjects treated (table 4), the
total erasure of stereotypies was not always achieved. It should be born in
mind that, in themselves, stereotypies are not symptomatic of psychosis, but
are also found in children presenting other disorders where such behaviour
cannot be defined as anything more than neurotic aspects. There seems to be
some evidence that as far as stereotypies are concerned, psychotic down
subjects show less overall improvement than non-Downs, or if they improve, they
do so at slower rate (Table 4).
The presence of
stereotypies in 13.32 % of Down subjects, in absence of psychosis (Cocchi,
1989), leads to the supposition that these are the symptom of a primitive
neurochemical imbalance, perhaps involving a brain dopaminergic structure and
dependent on the same causes which lead to an excess of childhood psychoses
within the Down Syndrome.
On the basis of information
supplied by this research it is not possible, as yet, to establish which kinds
of stereotypies can be treated more effectively despite the fact that in both
groups significant results were achieved in flap-ping tremor and fingers
stereotypies.
At present no definite
relationship between less frequent stereotypies and lower sensitivity to
therapy can be hypothesised.
Conclusion
The comparative study of the
effects of individualised drug therapy on motor and voice stereotypies between
one group of psychotic Down children and another group of psychotic non-Down
children has brought to light common factors which merit interest and further
research.
The results tends to run
parallel to the length of therapy, and the decrease in the various kinds of
stereotypies follows a very similar trend in both groups. The improvement rate,
which is slower in the PDG, could be attributable to the persistence of the
biological disorder representing the basis of the enormous prevalence of
childhood psychosis in these subjects.
Acknowledgement
This research was supported
by a grant no. PSS */0201/00 of the Commission of the European Communities,
Bruxelles.
References
American Psychiatric
Association: Diagnostic and Statistic Manual of Mental Disorders (3rd
edition revised, DSM-III, R). APA, Washington D.C., 1987.
Bondanini M.: Storia di
Nicola, che cerca il sole. Riv. It. Disturbo Intellet. 1990, 3: 95-101.
Cocchi R.: Psychosis in
Down children: An epidemiological and clinical survey on 413 subjects. It. J.
Intellect. Impair. 1989, 2: 131-136.
Cocchi R.: Aminoacidi
plasmatici in una bambina autistica prima e dopo 7 anni di farmacoterapia. Riv.
It. Disturbo Intellet. 1990a, 3: 127-130.
Cocchi R.: The
pharmacological approach to treating childhood psychoses: Theoretical basis.
It. J. Intellect. Impair. 1990b, 3: 185-193.
Cocchi R.: Childhood
psychoses: Results of drug treatment with Down and non-Down subjects. Ital. J.
Intellect. Impair. 1990c, 3: 195-202.
Cocchi R.: Autismo
infantile e sordita' di trasmissione. Si puo' supporre una relazione temporale
diversa? Riv. It. Disturbo Intellet. 1990d, 3: 313-320.
Cocchi R.: Childhood
psychoses: Results of drug treatment on the social behaviour of Down and
non-Down subjects. It. J. Intellect. Impair. 1991a, 4: 15-22.
Cocchi R.: Childhood
psychoses: Results of drug treatment on the school achievement of Down and
non-Down subjects. It. J. Intellect. Impair. 1991b, 4: 23-30.
Cocchi R.: Childhood
psychoses: Results of drug treatment on the language development of Down and
non-Down subjects. It. J. Intellect. Impair. 1991c, 4: 167-174.
Grasso Rossetti A.: Il
disegno della casa e della figura umana in due soggetti psicotici trattati con
farmacoterapia. Riv. It. Disturbo Intellet. 1990, 3: 119-126.
Printed on It. J.
Intellect. Impair. 1991, 4: 159-166.
Author's address: dr Renato COCCHI, via Mercalli 10
42100 Reggio Emilia (Italy)
renatococchi@aliceposta.it
Down's
syndrome
Drug therapy
Mental retardation