BRUXISM AND OTHER STRESS
SYMPTOMS IN CHILDREN
OR YOUNG ADULTS WITH AUTISM OR OTHER PDDs,
WITH OR WITHOUT DOWN SYNDROME
By Renato COCCHI, MD, a neurologist and a medical psychologist
Summary
Two groups of autistic or other Pervasive
Developmental Disordered (PDD) Ss (Group 1: 13 F + 20 M, all with Down's
syndrome; Average age at 1st consultation 89.91 +/- 40.14 months; Group 2: 18 F
+ 39 M; Average age at 1st consultation: 108.25 +/- 59.60 months) were
evaluated for the bruxism's prevalence, or the co-presence of bruxism, upper
respiratory tract infections' easiness, and spastic constipation and/or
diarrhoea as reactions to an internal stress or stresses.
As suggested, i. Down Ss who own two
factors of internal stress (the chromosomal anomaly and autism or other PDD)
presented more bruxism than non-Downs (.033); ii. Down Ss showed a larger
co-presence of these three symptoms than non-Downs (.02).
Stress can also arise from internal
factors, as it happens for genetic and chromosomal anomalies. The amount of
internal stress could be a variable leading to multiple stress reactions.
Key words: Stress; Bruxism; URTI easiness
Constipation; Down syndrome; Autism; PDDs.
Down's Syndrome
Mental retardation
Autism and other PDDs
Symptoms of stress
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The link between stress and bruxism has a
quite long and controversial history. The psychological stress was asserted as
the main causal factor, according to experimental data, but it cannot fully explain
the night bruxism. (Morse, 1982).
This investigation aims to evaluate if there
are any difference of bruxism's prevalence (or bruxism and other stress
symptoms) as a function of internal stress linked to the illness. On other
terms I expected to found more bruxism in Down Ss, with autism or PDD than in
autistic or PDD Ss without Down syndrome or other illnesses.
Materials
and method
We checked out clinical records of all
autistic or PDD children or young adults' one of us had in consultation since 1980.
From these records we collected: sex, age at 1st consultation, chromosomal or
genetic diagnosis, type of autism or PDD according to DSM-IV, presence and type
of bruxism.
Results
All autistic or other PDD Down Ss fitted the
above-mentioned criteria and formed Group 1 (33 Ss).
Among autistic or other PDD non-Down Ss
three were suffering from Tuberous Sclerosis and two others from Rett's
syndrome. Since these five had a second illness, they did not fit our inclusion
criteria, being more similar to autistic or other PDD Down syndrome Ss. For
that reason they did not have inclusion into the Group 2 (57 Ss).
Table 1: Epidemiological data.
|
|
Down Ss |
Non-Down Ss |
|
Ss no. |
33 (100.00%) |
57 (100.00%) |
|
F |
13 ( 39.40%) |
18 ( 31.58%) |
|
M |
20 ( 60.60%) |
39 ( 68.42%) |
|
M/F |
153.85 |
216.67 |
|
Age at 1st consult. (months) |
89.91 +/- 40.14 |
108.25 +/- 59.60 |
|
Age range’ |
15-160 |
25-351 |
As we can see there are moderate differences
as for M/F ratio and age at 1st consultation, but we think that it does not
invalidate our investigation. Several Group 2 Ss came at 1st consultation as
young adults because parents hoped to find some help for current troubles,
namely sleep troubles and self-injuring.
Table 2: Chromosomal diagnosis of 21
trisomy Ss Group 1 (Down's syndrome
Ss): Chromosomal diagnoses
|
Diagnoses |
Ss no |
% |
|
Standard trisomy 21 |
31 |
93.94 |
|
Mosaicisms |
1 |
3.03 |
|
Unknown |
1 |
3.03 |
The lack of Down Ss with translation is
probably due to the reduced extent of the sample. Remaining chromosomal
diagnoses fitted the international ranges.
Table 3:Diagnoses according to DSM-IV
(autism or other PDD).
|
|
Down Ss |
Non-Down Ss |
||
|
|
Ss no. |
% |
Ss no |
% |
|
Autism |
30 |
90.91 |
53 |
92.98 |
|
Other PDDs |
3 |
9.09 |
4 |
7.02 |
Our two samples did not differ as for DSM-IV
diagnoses.
Research 1: results on bruxism's
prevalence.
Table 4: Prevalence of bruxism.
|
|
Down Ss |
Non-Down Ss |
|||
|
Bruxism |
Ss no.. |
% |
Ss no.. |
% |
|
|
Not present |
13 |
39.39 |
32 |
56.15 |
|
|
Only in past |
0 |
0.00 |
7 |
12.28 |
|
|
Daily rare |
1 |
3.03 |
3 |
5.26 |
|
|
Day only |
15 |
45.45 |
10 |
17.54 |
|
|
Day and night |
4 |
12.12 |
3 |
5.26 |
|
|
Night only |
0 |
0.00 |
2 |
3.51 |
|
|
Totals |
33 |
100.00 |
57 |
100.00 |
|
Chi Square = 12.252 with 5 df and p =
.033
Research 2: Results on bruxism and
other stress symptoms prevalence
Table 5: Co-presence of the three symptoms in Down and
non-Down Ss. Key:
1 = present and 0 = not present; 1st digit = URTI easiness; 2nd
digit = spastic constipoation etc.; 3rd digit = bruxism
|
|
Down Ss |
Non-Down Ss |
||
|
Codie |
Ss no. |
% |
Ss no. |
% |
|
0-0-0 |
2 |
6.06 |
13 |
22.81 |
|
0-1-0 |
1 |
3.03 |
11 |
19.31 |
|
0-0-1 |
2 |
6.06 |
9 |
15.78 |
|
1-0-0 |
4 |
12.12 |
6 |
10.52 |
|
0-1-1 |
5 |
15.15 |
7 |
12.28 |
|
1-1-0 |
6 |
18.18 |
2 |
3.51 |
|
1-0-1 |
6 |
18.18 |
5 |
8.77 |
|
1-1-1 |
7 |
21.23 |
4 |
7.02 |
|
Totali |
33 |
100.00 |
57 |
100.00 |
Chi Square = 22.846 with 7 df and p .002
The distribution of the three-symptoms
coding is significantly different in our two groups, with a larger presence of
two or three symptoms in the Down group.
Graphic 1: Trend of the three-symptoms
co-presence within the two groups.
The graphic 1 shows a rather opposite trend as
for the three-symptoms co-presence Their absence is at minimum in Down Ss and
at maximum in non-Down Ss and vice-versa.
Discussion
It is not the first time that one of us uses comparison between autistic or other PDD Down or non-Down subjects (Cocchi, 1988; Cocchi and Bonaduce 1988a, 1988b; Cocchi 1990, 1991a, 1991b, 1991c; 1991d).
As for the epidemiology, autistic of other
PDD Down Ss presented an increased prevalence of prematurity, low birthweight
and squint.
Autistic or other PDD non-Down Ss showed
increased EEG anomalies. Autistic or PDD non-Down Ss had increased sudden
anxiety, sameness, hypersensitivity, rituals and aggression (Cocchi, 1988).
Same non-Down Ss had lesser easiness to
upper respiratory tract infections, as compared to similar Down Ss (Cocchi and
Bonaduce, 1988a).
The self-injuring behaviour prevails in
autistic or other PDD non-Down Ss when compared with similar Down Ss, but the
observed difference did not reach a significant level. (Cocchi and Bonaduce
1988b).
In the current investigation we do not think
that different M/F ratio and different average age at 1st consultation could
negatively influence the results.
As for research 1, according to our
hypothesis, autism and other PDD non-Down Ss presented lesser bruxism than
similar Down Ss. In this way we found confirmation that the amount of stress is
a variable to count on, when the internal stress factor is genetic as it
happens in Downs.
Since the bruxism without any occlusional
cause is a stress reaction, we can understand its prevalence by evaluating the
extent of stress factors, in a virtual manner.
As for research 2, symptoms like URTI
easiness, and spastic constipation and/or diarrhoeas were selected as stress
symptoms according to our previous research (Cocchi, 1998; Cocchi 1996; Cocchi
1997a, 1997b). On URTI easiness as a symptom of stress there exists concordant
literature recently elsewhere reported by one of us. (Cocchi 1999 )
Spastic constipation with little balls'
faeces and/or diarrhoeas were considered a symptom of excess vagal stimulation
of the bowel following stress. We found evidence that stress can elicit not
only vagal symptoms like that, but can also increase peripheral acetylcholine.
(Hata et al., 1986; Kita et al., 1986).
As we said, non-Down Ss presented lesser
co-presence of URTI easiness, spastic constipation and/or diarrhoeas and
bruxism than Down Ss. So we can confirm that the stress amount is a variable to
consider, when an internal stress factor is genetic as it happens in Down's
syndrome.
Why these symptoms have different
prevalence, with a significant difference as for URTI easiness, and non
significant for spastic constipation and/or diarrhoeas, and bruxism (at least
how here summarized)? That is something too hard to explain at the moment.
Conclusion
Our research aimed to find some different
prevalence of bruxism (or bruxisms and other stress symptoms) according to the
amount of internal stress produced by one or more illnesses.
We expected more bruxism (or more bruxism
and other stress symptoms) in autistic or other PDD Down Ss than in similar
non-Down ones.
Referring to our two groups of probands, we
exactly found it. Of course, this fact does not give any information about the
individual resistance to stress, which surely needs a different type of
investigation.
References
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bambino Down e nel bambino normale: Analogie e differenze. Riv. It. Disturbo
Intellet. 1988, 1: 89-95
Cocchi R. Childhood
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Cocchi R. Childhood
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Presented at the 3rd World Congress on Stress, Dublin 24-27 September 2000.
Author’s address: dr Renato Cocchi, via Rabbeno, 3
42100 Reggio Emilia (Italy)
renatococchi@libero.it
Italian translation
Down's Syndrome
Mental retardation
Autism and other PDDs
Symptoms of stress
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