THE
DIFFICULTY OF BEING COMBED AS A CURIOUS SYMPTOM IN
AN
EPIDEMIOLOGICAL INVESTIGATION ON 510 SUBJECTS.
Renato Cocchi, neurologist and medical psychologist.
Summary
This study reports a
retrospective epidemiological investigation on 213 Down subjects (M =124 Ss; F
= 89 Ss, average age to the first visit 71.37 +/- 69.71 months; Normal
distribution of the chromosomal diagnosis) in whose clinical records was
annotated, in positive (83 Ss) or in negative (130 Ss), the symptom
"difficulty or refusal to have the hair combed", a symptom even found
in non Down children, suffering from childhood depression.
It doesn't have any
relationship with the chromosomal diagnosis, it is more frequent in females (.
012) and it is disappearing with the age (.0009). The author thinks that such a
symptom is the childhood equivalent of the tension headache.
Key
words: Down syndrome, difficulty or
refusal of being combed, female prevalence, chromosomal diagnosis, age, tension
headache, stress.
Symptoms
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During a 25-years clinical experience with infants and children, mainly
affected by Down syndrome, I happened to find a curious symptom, both in
Being the data of 510 Down subjects stored in a database, already used
for other investigations ( Cocchi, 1994, 1997a and 1997b ), it was easier to
examine them to this aim.
Unfortunately this symptom, as not essential to evaluate the current
stress and the possible brain biochemical balance, did not have punctual
attention and investigation in all subjects, even if this happened in a random
way.
Materials and methods
This investigation used the clinical cards referring to a consecutive,
series of home reared and home living
During their 1st consultation I asked the parents of many subjects, but
not all, if their son or daughter had the difficulties or the
refusal of being combed.
From all the records so pointed out those pertaining to autistic or PDD
DS Ss were discarded because we saw that this second heavier pathology can
modify every sympotm or behaviour.
From the remaining records I collected:
- sex; -
- chromosomal diagnosis; -
- age at 1st consultation;
- positive or negative presence of the symptom "difficulty
or refusal to have the hair combed" .
I processed data by sex, chromosomal anomalies, age bands and I applied
Chi Square Test, when suitable.
Results
I reported the data pertaining to the subjects of the clinical records
in the following tables.
Tab. 1: Epidemiological data.
|
Nr. of Ss |
510 |
100.00% |
|
Malesi |
292 |
57.25% |
|
Females |
218 |
42.57% |
|
M/F ratio |
133.94/100 |
|
|
|
|
|
|
Chromosomal diagnosis |
|
|
|
Standard trisomy 21 |
461 |
90.39% |
|
Mosaicisms |
16 |
3.14% |
|
Translocations |
16 |
3.14% |
|
Unknown, only clinical diagn. |
17 |
3.33% |
|
|
|
|
|
Age at 1st consultation (months) |
|
|
|
Range |
6-510 |
|
|
Mean +/- SD |
71.37 +/- 69.71 |
|
As we can see in Table 1, the M/F ratio overlaps the same known ratio of
Italian live-born Down babies. Even the distribution of chromosomal anomalies
fitted the variance range for Italian and International samples.
For these reasons we ought to maintain the present sample as
representative at least of the Italian Downs population.
Tab. 2. Gender distribution of the prevalence of the symptom
"difficulty or refusal of being combed".
|
Nr. of sample's Ss |
510 |
100.00% |
|
|
||
|
Not investigated |
297 |
58.24% |
|
Males |
182 |
35.69% |
|
Females |
115 |
22.55% |
|
M/F ratio |
158.26% |
|
|
|
||
|
Symptom present |
83 |
16.27% |
|
Males |
39 |
7.65% |
|
Females |
44 |
8.62% |
|
M/F ratio |
88.63% |
|
|
|
||
|
Symptom absent |
130 |
25.49% |
|
Males |
85 |
16.67% |
|
Females |
45 |
8.82% |
|
M/F ratio |
188.88% |
|
Chi Square
between Ss with or without the symptom = 6.312, with 1 df and p = .012
The symptom was investigated in 213 subjects = 41.76% of the whole series.
As the investigated subjects only, I found it in about the 39% of them.
The overthrow of the M/F ratio in carriers, as significantly confirmed
by the statistical test, points up that the symptom has female prevalence.
Tab.3. Chromosomal diagnosis distribution of the prevalence of the
symptom "difficulty or refusal of being combed".
|
Nr. of the sample's Ss |
510 |
100.00% |
|
|
||
|
Not investigated |
288 + 9 |
288 =100.00% |
|
Standard trisomy 21 |
269 |
93.40% |
|
Translocations |
10 |
3.47% |
|
Mosaicisms |
9 |
3.13% |
|
Only clinical diagnosis |
9 |
|
|
|
||
|
Symptom present |
83 |
100.00% |
|
Standard trisomy 21 |
78 |
93.98% |
|
Translocations |
2 |
2.41% |
|
Mosaicisms |
3 |
3.61% |
|
|
||
|
Symptom absent |
122 + 8 |
122 = 100.00% |
|
Standard trisomy 21 |
114 |
93.44% |
|
Translocations |
4 |
3.28% |
|
Mosaicisms |
4 |
2.28% |
|
Only clinical diagnosis |
8 |
|
From the rates counting I have excluded the subjects without any
chromosomal diagnosis.
How we can observe, the distribution of the subgroups is nearly
overlapping and it is within the Italian and International normal ranges. For
which we can easily infer that the different chromosomal anomalies are without
any result on the symptom.
Tab. 4: Distribution of the symptom according to the age, for bands of
two years, with only one band (17+) after 16 years.
|
Age bands In years |
Not indagated Ss |
Symptom present |
Symptom absent |
|||
|
Nr. Ss |
% |
Nr. Ss |
% |
Nr. Ss |
% |
|
|
0-2 |
131 |
44.11 |
9 |
10.84 |
11 |
8.46 |
|
3-4 |
67 |
22.56 |
28 |
33.74 |
12 |
9.23 |
|
5-6 |
44 |
14.83 |
18 |
21.69 |
10 |
7.69 |
|
7-8 |
8 |
2.69 |
13 |
15.67 |
13 |
10.00 |
|
9-10 |
19 |
6.39 |
5 |
6.02 |
22 |
16.92 |
|
11-12 |
11 |
3.71 |
8 |
9.64 |
18 |
13.85 |
|
13-14 |
5 |
1.68 |
2 |
2.40 |
13 |
10.00 |
|
15-16 |
7 |
2.36 |
|
|
15 |
11.54 |
|
17+ |
5 |
1.68 |
|
|
16 |
12.31 |
|
Totals |
297 |
100.00 |
83 |
100.00 |
130 |
100.00 |
Chi Square between Ss with or without the symptom = 30.330,
with 6 df and p = .0009.
The symptom is
significantly more frequent in the first years' life, mainly in the second two
years and it inclines to disappear as the age is growing.
Discussion.
Even if the data collection
did not get the deserved care, to the current goal, 213 investigated subjects
give a rise to however a substantial sample, randomly picked on.
As I know, this symptom was
not previously described non psychotic
It not directly depends on
the chromosomal anomaly, even more because I found it in non Down children with
depression.
Reporting me to the
investigated
Even if being found in both
sexes, this symptom has clear female prevalence, a fact that would already be
an indication of its link with the depression, in broader sense.
Interesting even the datum
that it disappears with the age and it not appears in persons over the 14
years. This fact does not seem casual because its rate is decreasing as the age
grows, and my investigation, as reported, did not omit subjects of 15 and more
years. However, they did always negative answers.
To the first sight, and the
nap location addresses to that, it seems the childhood equivalent of the tension
headache. Much more so since even it disappears in a short time following an
antistress drug therapy, as I will report in further research.
Conclusions.
This study reports a retrospective epidemiological investigation on 213 Down subjects in whose clinical records was annotated, in positive or in negative, the symptom "difficulty or refusal to have the hair combed", a symptom even found in non Down children, suffering from childhood depression.
It doesn't have any link with the chromosomal diagnosis, it is more frequent in females and it is disappearing with the age. The author thinks that such a symptom is the childhood equivalent of the tension headache.
References.
Cocchi R. Depression in Downs: An epidemiological and clinical investigation on 510 subjects. Printed in Italian on Riv. It. Disturbo Intellet. 1994, 7: 93-100.
Cocchi R., Favuto M.:
Cocchi R. Easiness to upper respiratory tract
infections: An investigation on 510 Down's syndrome persons It. J. Intellect. Impair. 1997, 10: 143-149
Author's address: dr Renato Cocchi, via Rabbeno, 3
42100 Reggio Emilia.
renatococchi@libero.it
Symptoms
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