SCHOOL LEARNING
IN 8 YEAR OLD DOWN
CHILDREN
TREATED OR NOT
WITH DRUGS
Renato COCCHI , a neurologist and a medical
psychologis
Italian
translation / traduzione italiana
Summary.
School
learning in 8 years old children of two group (Experimental Group:
40 Ss, 23 F and 17 M; 36 pure trisomy 21, 3
translocations and 1 mosaicism;
at least 5 years of individualised drug therapy. Control Group: 24 Ss,
13 F and 11 M; 21 pure trisomy 21, 2
translocations and 1 mosaicism; no drug treatment) was compared. Classroom behaviour, reading (syllables, plain
words, sentences), writing (copy,
dictation, invention from a visual model, free invention) and
arithmetic (digit sequence, addiction and subtraction up to 20
were evaluated according to a 5 point
scale.
Drug
treated Ss presented significant
improvements in all the
investigated fields but classroom behaviour showed only a very
strong trend (.053) towards amelioration.
Since
both groups differ
from the general population as
for gender and chromosomal anomalies distribution, the generalisation of these very promising results warrants some caution.
Key words: Down syndrome: school
learning; drug therapy.
Drug modulation of stress reactions
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Since
1979 I have been occupied with the use of the drug therapy in Downs Syndrome. Among the various areas this therapy has demonstrated to
have effect there are a definite improvement in attention,
concentration, long-term memory
and speech. This means an improvement
in the pre-requisites
indispensable for school learning.
Owing the difficulty to make an investigation
in this field, a valuation of the capacity of school
learning has never been done before.
In this study, from 502 cases personally visited
and checked (seen between January 1979
and September 1992) a survey was
carried out to compare
school learning in 8 years Down children coming for a first visit at
that age (control group) with school learning of same age children
treated with drugs for at least 5 years (experimental group).
Materials and methods
The records pertaining to an unselected
consecutive series of 502 Down’s children visited between January 1979 and the
end of September 1992 were re-examined, and those who had had a diagnosis of childhood psychosis were first
excluded.
From the remaining were extracted the records of those who came
for their first visit between the ages of 7 years 7 months and 8 years 6
months and also the records of the children who had a check
at the same age period, after undergoing an individualised drug treatment for
at least 5 years.
Data
were gathered from all of these regarding sex, chromosomal
diagnosis and the age (year and months)
at the first visit (Control Group) or
at check visit in the same age period
(Experimental Group).
Also
data were gathered regarding
classroom behaviour and reading (isolated syllables, plain words, sentences)
writing (copying, dictation, invention on sight models, real
or picture or photo, free invention)
and elementary arithmetic (sequence of numbers more than 20, addition and
subtraction up to at least 20, with 1
or 2 digits).
These
data were reported by parents
and often controlled in exercise
books shown during the visit of control or by school reports at the end
of the year.
All
of these fields were investigated and evaluated by using a 5 points scale
from 0 (negative behaviour or zero learning) to 4 (behaviour and
learning normal).
The
statistic comparison between the
2 groups was done by the test of Mann-Whitney.
It
was possible to collect the charts of two groups of
Down subjects, an Experimental Group (EDG) with 40
children and a Control Group (CDG) with
24 children.
|
Group |
Nr. of Ss |
% |
|
Experimental
Group (EDG) |
40 |
100.00 |
|
Sex: M |
17 |
42.50 |
|
F |
23 |
57.50 |
|
M/F ratio |
73.90 /100 |
|
|
Average age at 1st
visit (years) |
7; 11 +/- 2 months |
|
|
Distribution of
chromosomal anomalies: |
||
|
Standard trisomy
21 |
36 |
90.00 |
|
Mosaicisms |
1 |
2.50 |
|
Translocations |
3 |
7.50 |
|
|
||
|
Control Group
(CDG) |
24 |
100.00 |
|
Sex: M |
11 |
45.83 |
|
F |
13 |
54.17 |
|
M/F ratio |
84.6/100 |
|
|
Average age at 1st visit (years) |
8;1 +/- 2 months |
|
|
Distribution of
chromosomal anomalies: |
||
|
Standard trisomy
21 |
21 |
87.50 |
|
Mosaicisms |
2 |
8.33 |
|
Translocations |
1 |
4.17 |
Table 1: EDG: results rated as (0) zero
learning; (1) poor learning; (2) mild
learning; (3) marked learning and (4) normal learning The same for
classroom behaviour.
|
S. |
Classr Behav |
Reading |
Writing |
Arithmetic |
|||||||
|
|
Syllab. |
Words |
Sentenc. |
Copy |
Dictat. |
Mod. inv. |
Free
inv. |
Seq. |
Additt. |
Subtract |
|
|
1 |
3 |
4 |
3 |
1 |
4 |
2 |
0 |
0 |
2 |
2 |
2 |
|
2 |
4 |
4 |
4 |
3 |
4 |
3 |
1 |
0 |
2 |
2 |
0 |
|
3 |
3 |
4 |
4 |
3 |
4 |
4 |
3 |
2 |
4 |
3 |
2 |
|
4 |
3 |
4 |
3 |
2 |
4 |
3 |
2 |
0 |
4 |
3 |
2 |
|
5 |
4 |
4 |
4 |
2 |
4 |
3 |
1 |
0 |
4 |
2 |
2 |
|
6 |
4 |
4 |
4 |
4 |
4 |
4 |
4 |
3 |
4 |
4 |
4 |
|
7 |
4 |
4 |
3 |
2 |
4 |
3 |
0 |
0 |
4 |
2 |
1 |
|
8 (*) |
3 |
4 |
3 |
2 |
4 |
2 |
0 |
0 |
3 |
0 |
0 |
|
9 |
3 |
4 |
3 |
2 |
4 |
4 |
3 |
2 |
4 |
2 |
2 |
|
10 |
3 |
4 |
4 |
3 |
4 |
4 |
1 |
0 |
2 |
1 |
1 |
|
11 |
4 |
4 |
2 |
1 |
4 |
2 |
0 |
0 |
1 |
0 |
0 |
|
12 |
4 |
4 |
4 |
3 |
4 |
4 |
4 |
3 |
4 |
2 |
0 |
|
13 |
3 |
4 |
3 |
2 |
4 |
2 |
0 |
0 |
2 |
0 |
0 |
|
14 |
4 |
4 |
4 |
4 |
4 |
4 |
2 |
0 |
2 |
0 |
0 |
|
15 |
4 |
4 |
3 |
2 |
4.. |
3 |
1 |
9 |
4 |
1 |
1 |
|
16 |
4 |
4 |
4 |
4 |
4 |
4 |
3 |
2 |
4 |
4 |
4 |
|
17 |
4 |
4 |
4 |
3 |
4 |
4 |
3 |
2 |
4 |
4 |
4 |
|
18 |
3 |
2 |
1 |
0 |
3 |
1 |
0 |
0 |
2 |
0 |
0 |
|
19 |
3 |
2 |
1 |
0 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
|
20 |
3 |
4 |
2 |
0 |
3 |
1 |
0 |
0 |
2 |
0 |
0 |
|
21 |
3 |
4 |
3 |
2 |
4 |
3 |
1 |
0 |
2 |
0 |
0 |
|
22 |
4 |
4 |
4 |
4 |
4 |
4 |
3 |
2 |
4 |
4 |
2 |
|
23 |
4 |
4 |
4 |
4 |
4 |
3 |
1 |
0 |
4 |
4 |
4 |
|
24 |
3 |
4 |
3 |
2 |
3 |
3 |
0 |
0 |
2 |
0 |
0 |
|
25 |
4 |
4 |
4 |
4 |
4 |
4 |
4 |
4 |
4 |
4 |
4 |
|
26 |
4 |
4 |
3 |
1 |
4 |
3 |
0 |
0 |
2 |
1 |
0 |
|
27 |
4 |
4 |
4 |
3 |
4. |
4 |
3 |
2 |
4 |
4 |
4 |
|
28 (*) |
3 |
3 |
1 |
0 |
3 |
1 |
0 |
0 |
0 |
0 |
0 |
|
29 |
2 |
2 |
0 |
0 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
|
30 |
4 |
4 |
4 |
3 |
4 |
4 |
3 |
2 |
4 |
4 |
3 |
|
31 |
4 |
4 |
3 |
2 |
4 |
4 |
1 |
0 |
4 |
2 |
2 |
|
32 (*) |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
|
33 |
3 |
2 |
0 |
0 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
|
34 |
4 |
4 |
3 |
1 |
4 |
2 |
1 |
0 |
2 |
1 |
0 |
|
35 |
4 |
4 |
4 |
3 |
4 |
3 |
3 |
2 |
4 |
4 |
4 |
|
36 |
3 |
4 |
4 |
4 |
4 |
4 |
4 |
4 |
4 |
3 |
3 |
|
37 |
3 |
4 |
4 |
4 |
4 |
4 |
3 |
1 |
4 |
4 |
4 |
|
38 |
3 |
4 |
3 |
2 |
4 |
3 |
3 |
2 |
3 |
3 |
2 |
|
39 |
4 |
4 |
2 |
0 |
4 |
2 |
0 |
0 |
2 |
2 |
0 |
|
40 |
4 |
4 |
4 |
4 |
4 |
4 |
4 |
4 |
4 |
4 |
4 |
(*) irregular therapy compliance.
Table 2: CDG: Results rated as (0) zero
learning; (1) poor learning; (2) mild
learning; (3) marked learing. and (4) normal learning. The same for
classroom behaviour.
|
S. |
Classr Behav |
Reading |
Writing |
Arithmetic |
|||||||
|
|
Syllab. |
Words |
Sentenc. |
Copy |
Dictat. |
Mod. inv. |
Free
inv. |
Seq. |
Additt. |
Subtract |
|
|
1 |
1 |
0 |
0 |
0 |
2 |
0 |
0 |
0 |
1 |
0 |
0 |
|
2 |
4 |
3 |
2 |
0 |
3 |
2 |
0 |
0 |
2 |
1 |
0 |
|
3 |
4 |
3 |
1 |
0 |
2 |
1 |
0 |
0 |
1 |
0 |
0 |
|
4 |
3 |
4 |
4 |
3 |
4 |
2 |
1 |
0 |
3 |
1 |
0 |
|
5 |
2 |
2 |
0 |
0 |
2 |
1 |
0 |
0 |
1 |
0 |
0 |
|
6 |
2 |
1 |
0 |
0 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
|
7 |
2 |
3 |
1 |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
|
8 |
2 |
1 |
0 |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
|
9 |
3 |
3 |
1 |
0 |
3 |
1 |
0 |
0 |
1 |
0 |
0 |
|
10 |
3 |
3 |
1 |
0 |
3 |
2 |
0 |
0 |
2 |
1 |
0 |
|
11 |
1 |
0 |
0 |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
|
12 |
3 |
3 |
2 |
1 |
4 |
3 |
1 |
0 |
2 |
1 |
0 |
|
13 |
4 |
3 |
1 |
0 |
2 |
1 |
0 |
0 |
1 |
0 |
0 |
|
14 |
3 |
4 |
3 |
1 |
4 |
3 |
1 |
0 |
2 |
1 |
0 |
|
15 |
3 |
3 |
1 |
0 |
3 |
0 |
0 |
0 |
1 |
0 |
0 |
|
16 |
4 |
4 |
4 |
4 |
4 |
4 |
3 |
1 |
4 |
3 |
1 |
|
17 |
4 |
4 |
3 |
3 |
4 |
3 |
1 |
0 |
2 |
1 |
1 |
|
18 |
4 |
4 |
4 |
4 |
4 |
4 |
3 |
2 |
4 |
4 |
4 |
|
19 |
3 |
3 |
1 |
0 |
3 |
1 |
0 |
0 |
1 |
0 |
0 |
|
20 |
3 |
4 |
2 |
1 |
4 |
2 |
0 |
0 |
1 |
0 |
0 |
|
21 |
3 |
4 |
2 |
0 |
4 |
3 |
0 |
0 |
0 |
0 |
0 |
|
22 |
3 |
4 |
3 |
1 |
3 |
3 |
0 |
0 |
2 |
0 |
0 |
|
23 |
3 |
4 |
3 |
2 |
4 |
3 |
1 |
0 |
4 |
2 |
1 |
|
24 |
2 |
3 |
1 |
0 |
2 |
1 |
0 |
0 |
1 |
0 |
0 |
Table 3: statistics (EDG
vs. CDG)
|
Investigated field |
p |
|
Classroom behaviour |
.056 NS |
|
Reading: Syllables |
.007 |
|
Plain words |
.001 |
|
Sentences |
.003 |
|
Writing: Copy |
.005 |
|
Dictation |
.005 |
|
Invention from a model |
.0009 |
|
Free invention |
.01 |
|
Arithmetic: Digit sequence |
.0009 |
|
Addition |
.0009 |
|
Subtraction |
.002 |
Comparing the results of the two groups,
according to the field investigated, the
results obtained from the
experimental group reached a significant statistic level, sometimes a very high
level, in all the learning fields of this
study.
Although the experimental group obtained higher rates,
the difference in classroom behaviour has only a high
tendency to a major suitability, without attaining for a while the minimum
conventional
significant level.
With view to the 2 groups, I have to say that the
ratio M/F is reversed, as compared
to the general population of
Down subjects where boys are about one third
more than girls. The distribution of chromosomal anomalies,
although not very different from the Italian and international
rates, cannot be assumed as representative, especially as for CDG, because the exiguity of the samples has probably not expressed true
rates for mosaicisms or translocations.
Though important as for
the generalisation of the results,
these differences have less
importance as for our research, the aim of which was, for
now, to discover, if any, an
improvement in school learning between the 2 casual groups, one of them
treated by drug for a long
period. The two samples are very similar
in their distribution of the sexes, of the chromosomal anomalies
and the age in which they were taken.
The result of the drug therapy on school learning at the age of 8
was certainly different in the two groups, being definitely better in the
experimental group, in which the
components had at least 5 years drug treatment. Regarding the actual treatment, the therapy is individualised,
that means that it could be different
from child to child.
The therapies were not reported
here case by case, but the rationale and a large idea of
it could be deduced from other
papers (Cocchi, 1987a; Cocchi,
1987b; Cocchi, 1988; Lamma and
Cocchi, 1988; Cocchi, 1989; Cocchi, 1990; Cocchi, 1991; Cocchi,
1992).
The classroom behaviour is
much more adequate in the experimental group,
where in the control
group there are more
hyperkinetic children, with a
marked attention deficit.
With regards to school
learning it is evident that drug therapy is not able to resolve every situation of poor learning, but in the
group of children treated there was only one case of zero learning, and
those with little learning were definitely few.
The
sequence by which the various abilities were drawn up presents decreasing scores attained by each child of
both groups.
The
best results were in reading syllables, in copy writing and in memorising number sequences. Being that learning occurs first also in normal
children, it is probable
that the process of promotion or stimulation in the
capacity of learning becomes developed in the same way, a fact
that in Down children, was
already noted in England by Buckley et al., in 1986.
It is not possible for me
to make a comparison with other research as
I have not found
anything similar in literature,
either in treatment or standard valuation in school learning. I
retain that an tailored drug therapy
that tends to favour learning should be valued in long
term and based on
precise indicators, clear and comprehensible.
The
presentation of this research during a refreshment
course for school
teachers (San Costanzo,
September 1992) confirmed
that the choice of the parameters investigated in this
study was the same the school teachers
use in evaluating learning.
The comparative examination of the results
of a drug therapy individualised for school learning for a group of Downs aged
8 (elementary level 2-3) with a group
of Downs subjects aged 8 and not treated (same school level) has shown
that the group treated
with drugs for at least 5 years have attained average higher scores.
In 10 out of 11 investigated fields significant differences were reached.
The results again
confirmed the intuition that a
therapy prevalently anti-stress
in Down’s Syndrome (Cocchi, 1987a) is a wide spectrum therapy which can gain improvements also in intellectual
performances.
Nevertheless different characteristics between the two samples and
the general population of Downs subjects, with regard to gender
and chromosomal anomalies distribution suggest
that caution must be taken as for the generalisation of these results.
References
Buckley S., Emslie
M., Haslegrave G.,
LePrevost P.: The development of language
and reading skills
in children with Down’s
syndrome. Portsmouth Polytechnic,
Portsmouth 1986 (trad. ital.: Lo sviluppo del linguaggio e
delle abilita‘ di lettura nei
bambini con sindrome di Down. 1° ristampa.
GISSTIMMAI, San Costanzo 1991).
Cocchi R. Terapia
farmacologia nella sindrome di Down: Inquadramento teorico. IN: Cocchi R.,
Belacchi C., Cocchi Cercolani P. (a cura di): Risultati di 8 anni di terapia
farmacologia nella sindrome di Down. Gisstimmai, Pesaro, 1987a: 19-41.
Cocchi R. Reduction
of susceptibility to upper respiratory tract infections in Down's sindrome
children following treatment with GABAergic drugs: Report of 70 cases. Int.
J. Psychosom (Philadelphia) 1987b, 34/2: 3-7.
Cocchi R. Esperienze di terapia farmacologica nell'adulto Down.
Riv. It. Disturbo. Intellet. 1988, 1: 57-69.
Cocchi
R. The anticipation of walking in drug treated Down
infants : A controlled trial. It. J. Intellect. Impair 1989, 2: 15-19.
Cocchi R.: The use of drugs to
modulate stress responses reduces the time of intensive care needed by Down
children to recover after open-heart surgery. It. J. Intellect. Impair
1990, 3: 11-16.
Cocchi R.: Drug therapy of
squint in Down syndrome subjetcts. Results according to the length of drug taking:
Report on 125 cases. It. J. Intellect. Impair.1991, 4: 9-14.
Cocchi R.: Pseudo-debility in
mental retardation: A frame of reference. It. J. Intellect. Impair. 1992,
5: 137-142.
Lamma A., Cocchi R.: Drug therapy
of bruxism in Down children. It. J. Intellect. Impair. 1988, 1: 19-24
Presented during the 6th World Down Sindrome Congress,
Madrid October 1997
Presented in
Italian during the IV Convegno Il disturbo cognitivo in eta' scolare: Il
ritardo mentale, S. Costanzo, September
1992.
First printed on It. J. Intellect. Impair.
1992, 5: 143-148.
Author's address: Dr Renato COCCHI, via Rabbeno, 3
42100 Reggio Emilia (Italy)
renatococchi@libero.it
Drug modulation of stress reactions
World Congresses on Stress and other
congresses