CHILDHOOD PSYCHOSES: RESULTS OF DRUG TREATMENT
ON SOCIAL BEHAVIOUR IN DOWN AND NON-DOWN SUBJECTS

Renato COCCHI, neurologist and medical psychologist

(Italian translation)

Summary

After 3-94 months of individualized drug therapies, the results on social behaviour of 36 psychotic Down children and 29 psychotic non-Down children were compared.

The Down group (PDG) comprised 24 M and 12 F; average age at first consultation, 5;10 +/- 3;1 years; chromosomal diagnoses, 34 pure trisomy 21, 1 mosaicism and 1 not known; DSM-III,R diagnosis, 33 early onset and 3 late onset Pervasive Developmental Disorder. The non-Down group (PNDG) comprised 16 M and 13 F; average age at first consultation, 6;1 +/- 3;1 years; DSM-III,R diagnosis, 20 early onset and 4 late onset Pervasive Developmental Disorder and 5 Atypical Pervasive Developmental Disorders.

Social isolation, the relationship with people around and social play, have all been evaluated.

A reduction in isolation and the appearance of more complex forms of relationship and social play are in direct proportion to the duration of the drug therapy.

The psychotic Down subjects' learning of social skills is, however, a little slower than that of the psychotic non-Down group and this fact could reflect a stronger presence of cognitive deficit.

Key words: Childhood psychoses; Down children; non-Down children; drug therapy; individualized regimen; social behaviour; results.

Autism

Down's syndrome

Drug therapy

Mental retardation

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A lessening of social isolation together with the learning of relational skills is one of the basic objectives of any therapy to do with childhood psychoses.

Having treated with drug therapy, for various periods of time, a group of psychotic Down children (PDG) and a group of psychotic non-Down children (PNDG), the results, concerning this, have already been globally evaluted in the previous research (Cocchi, 1990c).

In order to evaluate more precisely the benefit obtained, I thought it would be interesting to compare the results more extesively.

The fields of investigation chosen for evaluation are that of social isolation, as a chief symptom of childhood psychoses, and the appearance or reappearance of social relationships with the various figures around the child.

Along with this areas, social play, one of the behaviours typical of childhood socialisation, has also been assessed.

The children making up the survey groups are those whose parents accepted drug treatment administered along the guidelines already described (Cocchi, 1990b).

The two groups involved comprise only subjects who undervent at least one check up of the therapy effects after a minimum of 3 months' treatment.

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 psychotic non-Down group were added the records of some new subjects whose progress had been checked after at least 3 months of drug therapy.

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 were evaluated:

- social isolation;

- social relationships: with parents,

with siblings, family relations,

with peers,

with teachers and therapists,

with strangers;

- social play: observation,

partecipation (if involved in the game),

requests to play.

For each child were also noted:

- sex;

- age at first consultation;

- cromosomal diagnosis (for the Down subjects).

Results

Results were reported on tables 1-6.

Two groups of subjects were identified on the basis of diagnosis at first consultation, and the length of time the drugs were taken:

1. Psychotic Down children group (PDG): 36 Ss = 100.00%.

Characteristics of PDG are:

Sex: M = 24 and F = 12; M/F ratio = 200/100.

Average age at 1st consultation: 5;10 years, with SD = 3;2 years.

Distribution of chromosomal anomalies: Pure trisomy 21: 34 Ss = 94.44% ;

Mosaicisms: 1 S = 2.78% ;

Unknown (only clinical diagnosis): 1 S = 2.78 %.

Diagnoses, according with DSM-III, R: Early onset Pervasive Developmental Disorder: 33 Ss = 91.67 % ; Late onset Pervasive Developmental Disorder: 3 Ss = 8.33% .

Table 1: PDG results; keys: (=) = no relationship or behaviour improvemennt; (=) = slight improvement; (++) = mild improvement; (+++) = marked improvement; (++++) normal behaviour.

	Social relationship with people around							Play
S. nr.	Isolation		parents	brothers	peers	teachers	strangers	observation	partecipat		request
				relatives		therapists					to play
Gr. 1
182	=	+		=	=	=	=	=	=		= (*)
353	+	+		=	+	+	=	=	=		= (*)
Gr.2
32	=	+		=	=	=	=	=	=		= (*)
34	+	++		+	=	+	=	+	+		= (*)
316	+	+		+	=	+	=	=	=		= (*)
332	+	+		=	=	=	=	=	=		= (*)
430	++	++		=	++	=	=	++	+		=
455	++	++		=	=	+	=	=	=		=
Gr.3
124	+	++		+	No nursery school nor rehabilitation						(*)
173	+	++		+	+	+	=	+		=	= (*)
186	+	+		+	+	+	=	+		+	= (*)
289	+	+		=	+	=	=	+		=	= (*)
325	+	++		+	+	+	=	+		+	= (*)
330	=	+		+	=	=	=	=		=	= (*)
333	+	+		=	=	=	=	=		=	= (*)
345	++	+++		++	++	+	=	++		+	+ (*)
400	+++	++		=	++	++	=	+++		++	+
433	++	+++		+++	+	++	+	No play, because he was too old
Gr.4
93	++	+++		++	++	+	+	++		+	= (*)
101	++	+++		++	++	+	=	++		++	++ (*)
120	+	++		+	=	=	=	+		=	= (*)
191	+	++		=	=	=	=	+		=	= (*)
225	+	+		=	+	=	=	=		=	= (*)
281	+++	+++		+++	++	+	+	++		++	+ (*)
319	+	++		=	=	+	=	+		=	= (*)
372	+++	+++		+++	++	++	+	++		+	=
Gr.5
85	+	++		=	=	=	=	+		=	= (*)
268	++	++		+	++	+	=	++		+	=
308	+	++		+	=	=	=	No nursery school			(*)
Gr.6
7	+++	+++		=	++	++	=	+++		+++	++
49	+++	++		+	++	+	=	+		=	=
206	++++	++++		++++	+++	+++	++	+++		+++	++
217	++	++		+	++	+	=	=		=	=
226	++	++++		+++	+++	+++	++	+++		+++	++
242	++	+++		++	=	=	=	+		=	=
284	+++	+++		+++	++	++	+	++		++	+

(*) therapy interrupted by the parents.

2. Psychotic non-Down group (PNDG): 29 Ss = 100.00%.

Characteristics of PNDG are:

Sex: M = 16 e F = 13; M/F ratio M/F = 123/100;

Age at first consultation: 6;10 years with SD = 3;1 years;

Diagnoses, according to DSM-III,R:

Early onset Pervasive Developmental Disorder: 20 Ss = 68.97 %;

Late onset Pervasive Developmental Disorder: 4 Ss = 13.79 %;

Atypical Pervasive Developmental Disorder: 5 Ss = 17.24 %.

Table 2: PNDG results; keys: (=) = no relationship or behaviour improvement; (+) = slight improvement; (++) = mild improvement; (+++) = marked improvement; (++++) normal behaviour.

	Social relationship with people around						Play
S. nr.	Isolation	parents	brothers	peers	teachers	strangers	observation	partecipat	request
			relatives		therapists				to play
Gr.1
F	+	++	+	=	=	=	+	=	= (*)
M	+	++	+	+	+	=	+	=	=
M	+	++	+	+	+	=	+	=	=
M	+	++	+	+	+	=	+	+	+
Gr.2
M	++	++	=	++	=	=	+	=	= (*)
M	+++	++	+	++	+	+	++	+	=
M	+	++	+	+	+	=	=	=	=
M	++	++	++	=	+	=	No nursery school
F	+	++	=	=	=	=	=	=	=
F	++	+++	+	++	++	=	++	+	=
Gr.3
F (#)	+	+	=	Since motor worsening, she stopped the nursery school attendance
F	++	++	+	+	+	=	+	=	+ (*)
M	+	++	+	=	+	=	=	=	=
F	+++	+++	++	++	+	=	++	+	= (*)
M	+++	+++	+	+	+	=	+	=	=
Gr.4
M	+++	+++	+++	+++	++	++	+++	++	++
M	+++	+++	+++	++	++	+	++