PSYCHOSIS IN DOWN CHILDREN AND IN
By Renato COCCHI, a neurologist
and a medical psychologist.
Summary.
A
group of 40 psychotic Down children (
Key
words: Childhood psychoses, Down syndrome, stress, epidemiology, prematurity, low biryhweigh, squint,
EEG, symptoms, anxiety, sameness, sensibility, rituals, aggression.
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Scoggin and Patterson (1982) affirmed that the presence of
relatively many Down individuals could help in
understanding of illnesses that affect both these subjects and normal ones.
This fact
could be true even for childhood psychoses, whose incidence, about 10% of Down children, has been found similar in two investigations
carried out in two different countries (Gath and Gumley, 1986; Cocchi, 1988).
With this
short work I want to start comparisons, between them, a group of psychotic Down children and a group of psychotic non-Down children.
Materials and methods.
The group
of 40 psychotic Down children (39 standard trisomy 21
and one mosaicism), came out from a consecutive, non
selected series of 389 Down subjects with no more than 15 years, all living in
their family and all personally visited by the author. This group was already
described elsewhere (Cocchi, 1988).
The group
of 20 non-Down psychotic children represented the whole series of the psychotic
children, all living in their family, and visited by the author between 1982
and end April
For them
too, I select 15 years as the maximum age to the first visit, as the age considered
as the conventional limit of paediatric and child neuropsychiatric
competence.
For both
groups' clinical cards I transcribed the following data:
- gender;
- age to the first visit;
- prematurity (less than 38 weeks of
fetal life), or low birthweigh
(less of
- history of convulsions, epilepsy, and/or the altered EEG;
- observed squint;
-
reported or observed bruxism;
-
presence of following symptoms: social isolation, language troubles; motor stereotypies; echolalia; groundless anxiety; disturbed
affectivity; the sameness; troubles of the sensory perception; self-aggression;
gaze aversion; rituals; other.
Hallucinations, delusions, loss of the association ability or incoherence
doesn't ever found, during the first visit, and the following checkups.
Both
groups had the diagnosis, as for what possible, according with the DSM-III.
The same
ones were compared between them, for what concerns every investigated
characteristic and the statistical analysis used the the
Results.
The
results vere summarized in the table 1
(epidemiological and aspecific clinical features), in
the table 2 (diagnosis) and in the table 3 ( psychotic
symptoms).
Table 1:
Epidemiological and aspecific clinical features.
|
Parameter |
Down Group Ss |
% |
Non-Down Group Ss |
% |
|
No. of Ss |
40 |
100.00 |
20 |
100.00 |
|
Males |
26 |
65.00 |
11 |
55.00 |
|
Females |
14 |
35.00 |
9 |
45.00 |
|
M/F Ratio |
185.71 |
|
122.22 |
|
|
Average
age at 1st consult. |
7 + 3.5 |
|
7 + 3.7 |
|
|
Prematurity |
6 |
15.00 |
2 |
10.00 |
|
Low birthweigh |
1 |
2.5 |
2 |
10.00 |
|
Prematurity + low birthwigh |
4 |
10.00 |
0 |
0.00 |
|
Squint |
15 |
37.5 |
5 |
20.00 |
|
Bruxism |
29 |
72.50 |
13 |
65.00 |
|
Fits, epilessia and/or altered EEG |
5 |
12.50 |
5 |
25.00 |
Chi Square
= 9.7842 NS
Table 2: Comparison among the diagnosess
according with the DSM-III.
|
Diagnosis |
Down Group Ss |
% |
Non-Down Group Ss |
% |
|
Autism |
12 |
30.00 |
7 |
35.00 |
|
Pervasive Develop. Disorder |
5 |
12.50 |
6 |
30.00 |
|
Atypical Pervasive Develop. Disorder |
2 |
5.00 |
7 |
35.00 |
|
Cannot be decided (*) |
21 |
52.00 |
0 |
0.00 |
(*) see discussion.
Table 3: Psychotic symptoms detected.
|
Symptom |
Down Group Ss |
% |
Non-Down Group Ss |
% |
|
Social isolation |
40 |
100.00 |
20 |
100.00 |
|
Speech troubles: but echolalia (*) |
40 |
100.00 |
20 |
100.00 |
|
Motori stereotypies |
40 |
100.00 |
20 |
100.00 |
|
Self-aggression |
21 |
52.50 |
11 |
55.00 |
|
Disturbed affect |
18 |
45.00 |
9 |
45.00 |
|
Gaze aversion |
18 |
45.00 |
12 |
60.00 |
|
Echolalia |
17 |
42.50 |
8 |
40.00 |
|
Groundless anxiety |
16 |
40.00 |
12 |
60.00 |
|
Need of rthe sameness |
14 |
35.00 |
9 |
45.00 |
|
Sensory sensibility troubles |
11 |
27.50 |
14 |
70 |
|
Rituals |
2 |
5.00 |
4 |
20.00 |
|
Aggression |
0 |
0.00 |
7 |
35.00 |
(*) One child with Asperger
language.
Chi Square = 19.7432 with 11 df
and p < 0.05.
Discussion.
Several
points of this comparison, deserve deepening.
While I
am enough sure about the representativeness of the
sample of the psychotic Down children, as collected from a large survey (Cocchi, 1988 ) I cannot say the
same on the sample of the psychotic non-Down children.
At least
two reasons lead to doubt; the inferior numerical consistence and the M/F ratio
absolutely lead unbalanced in favour of the males, in clear contrast with what
reported in the literature, even recent (Lotter,
1966; Brask, 1967; Lotter,
1967; Burd, Fisher and Kerbeshian,
1987).
So, it is
therefore possible that not statistic significance of the differences of the
epidemiological and aspecific clinical features, is a not to be generalized datum.
No
results however about gender differences in psychotic symptoms, for which, as
for it, I should deny the risk of drawing wrong conclusions, because a wrong
selection of the sample.
By still
referring to epidemiological data, it is to point up the different prevalence
of prematurity and/or low birthweigh,
larger in
There is
a growing interest towards the investigation of these risk factors, to try to
explain a possible biological cause, as exact and identifiable, in childhood
psychoses (DeMyer, Hingtgen
and Jackson, 1981; Ritvo and Freeman, 1984; Lelord and coll., 1986; Mason-Brothers and coll., 1987).
We may
think that the larger prevalence these risk factors in
The
squint presence, as a sign of brain suffering, was found again as larger in
psychotic
For what
concerns the diagnosis, according to the DSM-III, here too happened what Burd, Fisher and Kerbeshian
(1987) debated.
The
diagnosis of Atypical Pervasive Developmental Disorder, as made because the
beginning of the symptoms before 30 months prevents to use that of Child
Pervasive Developmental Disorder, that otherwise should be the right one, is a
shift unsatisfactory at all.
The large
number of diagnoses "not to be chosen', in the group of psychotic Down
children, is creditable to the fact that the parents of these latter ones,
differently from the parents of psychotic non-Down children, were unable to
specify the time when psychotic symptoms appeared.
It is
probable that their reduced expectations about their Down child have induced to
believe, for a time, that some particular symptoms were characteristic of the
Down syndrome, and not symptoms of psychotic development.
All this
cases could have been included in the diagnosis of Atypical Pervasive
Developmental Disorder, but a such choice would have
been even more debatable.
Finally, about the psychotic symptoms, if, in part, they are
superimposed. The different prevalence of the groundless anxiety,
of the need of the sameness, of the troubles of the sensory sensibility, of the
rituals, but, above all, of the aggressiveness, is what led to statistical
significance. I have to add that I admitted among stereotypies,
to rip the paper, found in five psychotic non-Down children and, if I am not
wrong, in none of the Down. It could be an other
differential symptom.
Personally
I think that it is a symptom closer to the aggressive behaviors
than to true stereotypies.
On other
hand, the presence of aggressiveness in the non-Down children and its possible
absence in the Down children would require an explanation for it, if confirmed.
To say that is not in the character of the Down child to be aggressive, though
being true, it is at most a verification, but not an
explanation.
Conclusions.
The
comparison between Down and not-Down psychotic children is surely one detective
strategy to understand better the origin and the morbid development of
childhood psychoses.
The
different prevalence of symptoms like the need of the sameness, the troubles of
the sensory sensibility, the rituals and the aggressiveness, if confirmed from
other investigations, could already help, in a neuropsychological perspective
of explaining.
References.
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Psychiatric Association: Dignostic and statistic
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prevalence study of Pervasive Developmental Disorders in
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Printed in italian on Riv.
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Posted
on internet on 9 June 2005. Copyright by Renato Cocchi, 2005.
Author's address: dr Renato COCCHI, via Rabbeno, 3
42100 Reggio Emilia
renatococchi@libero.it
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