DYSLEXIA AND ANORTHOGRAPHY IN AN
ADOLESCENT OF NEARLY SIXTEEN YEARS, WITH MENTAL RETARDATION AND SCHOOL DELAY,
TREATED BY DRUGS: REPORT OF THE FIRST 18 MONTHS OF THERAPY.
Renato Cocchi, neurologist and medical
psychologist.
Summary.
The case history of an adolescent male
aged 15;9 years with light-medium mental retardation, academic delay, dyslexia
and anorthography is reported. An antistress drug therapy lasting seventeen
months probably recovered the anorthography, and decidedly reduced the
dyslexia.
Beyond the improvement in motor skills,
even some behavioural and intellectual aspects of the young are positively
modifying, in spite of the difficulties of an individualised drug therapy.
Key words: Dyslexia, anorthography,
mental retardation, depression, stress, male, adolescent, drug therapy.
Dyslexia (other two articles on this topic)
Drug modulation of stress reactions
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As for me, I think that the dyslexia, and
the anorthography when is following the first, are simply symptoms of
communicative difficulty between the two half-brains. As such, they can be
found in different psychopathological conditions. In the first case I reported
(Cocchi, 1990) there was a contemporary childhood depression. In the second
one, where the dyslexia was intermittent ( Cocchi, 2004 ) there was an atypical
depression in a young adult. In this third case mental retardation is the basic
condition. In a fourth case, now under drug therapy, but not yet reported, a
syndrome of attention deficit disorder with hyperactivity is the first
diagnosis.
A therapy with drugs of the main trouble may
have many difficulties, if it is not possible, as in the case here reported,
for intersecting of several negative variables. However it is worth trying,
because some results can always come out, for lowering of stress answers that the
morbid condition elicits always, as internal stress. This approach is
independent from the treatment of the secondary psychological reactions, which
have often psychotherapy to face them.
The case.
M, of 15;9 years at first consultation,
attends the first year of a professional institute for gardening, as a more
easy school. He is well developed, with over 170cm tall.
January 2003: First visit.
He was adopted when he was six, coming from
a family with burden financial and social-relational troubles. At that time, he
was small for the age and undernourished. Always he had school difficulties,
with annual presence of the support teacher. Foster-parents agreed that he
repeated a school year, with the aim to recover that delay, which instead did
not modify.
Currently he is dyslexic, in the typical
feature, with some semantic substitution, with frequent transpositions of
letters and some confusion among graphically similar letters, but having
different spatial orientation. The anorthography consists in messy use of the
space when he writes, letters of different greatness and many spelling
mistakes. He inclines to write in capital print type letters.
Now, he has evident mental retardation that
seems to border between light and medium ranges, quite surely of deficient
type, with the tendency to the concrete thought. There are many difficulties to
understand the logical connections, which need to be long explained to him, as
a case by a case. He has facility to generalize improperly.
He is usually a little scorbutic and easily
irritable, mainly in his family, for which it is difficult to reproach him.
Memory problems are frequent, and if one insists, he does not go further. In
past he was stammering. When asked on it, he says of not having his head as
voids, but full of thoughts. Often he speaks by himself. The muscular hypertone
usually occurs, and he is more rigid in the evening. In the mornings he
succeeds better in intellectual tasks. Greediness for sweet things is present,
mainly for the chocolate, and he does not show preference for the meat broth,
with normal pleasure for milk and diaries. He takes early his breakfast. He
inclines to eat much, even among meals. Perhaps he suffers more from the heat.
He refrains himself to urinate. Being much
slowed even from a motor point of view, he is a little clumsy. In the evenings,
he would not go to bed, and needs much time to fall asleep but then he sleeps
well, without any somnambulism, neither pavor nocturnus. Talking during his
sleep, or bruxism did not have been reported but he is sucking his tongue. He
is much scary, embarrassed in interpersonal relations, and he chooses less age
companions to play.
No news known on possible gestation
complications, or on his birth, even if some abnormal occurrence appears probable.
Starting therapy (daily doses, by the oral
via): Glutamine 250mg; pyridoxine 150mg; carbamazepine 50mg; amitriptyline 6mg;
oxazepam 5mg.
February 2003: The first checkup one-month
later.
No side effects from drugs, neither initial
drowsiness reported. Now he is little more calm, less irritable, more willing
to listen to the reasons of the other. Motor skills seem improved. At home, he
takes the book in his hands and now studies. At school there is a refusal.
He is writing better, with an appropriate use
of the space of the sheet, with less discordant height of letters. Reading
improved too.
Perhaps he remembers in different way. He
says that his head has always plenty of thoughts. Still hesitant, he goes on to
talk to himself. Less muscular hypertone in the evening reported. He still
postpones falling asleep. Pronunciation is now more clear.
Now he is the less rigid as for
interpersonal relations, even at home, but he chooses always more little
playmates. In this time in his family a little sister arrived, adopted even
her. The appetite is more controlled, and he looks for fewer sweet things.
Therapeutic variation (daily doses, by the
oral via): Carbamazepine 200mg; amitriptyline 10mg.
April 2003, after three months of drug
therapy.
The amitriptyline returned to 6mg, because a
daze to the mornings. The carbamazepine stopped since it occurred of a skin
allergy of eczematous type with small furuncles. Unfortunately the stop of the
carbamazepine at once worsened the young man's behaviour.
Currently he is much aggressive and uses the
hands against the parents. He regained difficulties to fall asleep and he
doesn't attend the prescribed hours of his professional school. Now, he is more
watching for sweets and cheeses. His motor skills seem even improved, and now
he is biking. No difference was noted in choosing more little playmates. If
there are some guests in family, he has the habit of going in his room and
rests there.
These followings discouraged the parents.
Therapeutic variation (daily doses, by the
oral via): Oxazepam stopped; Nimodipine 30mg; Niaprazine 30mg; Diazepam 2mg.
September 2003, after eight months of drug
therapy.
He is studying better. Now he is much less
insecure, but it happens in an irresponsible way. In summer he did not do
anything of his holiday's homework, if not forced to do it. He is better
falling asleep. Usually he has more the contrary Mary character, and still
aggressive. He had an all-destroying episode outdoors, for which he came home
accompanied by the street police. This fact frightened him a lot. An EEG showed
moderate theta activity, mainly in the right temporal areas.
Therapeutic variation (daily doses, by the
oral via): Nimodipine 60mg.
April 2004, after fifteen months of drug
therapy.
Now, he is reading better, even if
transposes some letters, when he wants a hurry. Anorthography currently limits
to spelling mistakes, but diminished. He writes in capital printed type, but
with well-shaped letters in aligned lines. He is always attending his
professional school, where he has limited attention.
Now he has well falling asleep, even if
never he would go to bed. The parents have noticed that if he doesn't take the
prescribed pills, the worsening appears at once because his behaviour changes.
Therapeutic variation (daily doses, by the
oral via): Clonidine 0.075mg; amantadine 50mg.
June 2004, after seventeen months of drug
therapy.
The new therapeutic variation was a disaster
probably due to a hypersensitivity to the amantadine, which stopped after
fifteen days. I added other 2mg diazepam in the evening. He became aggressive,
annoying, with continuous opposition, much more the contrary Mary, without any
rest, and impulsive. The parents were frankly frightened because they did not succeed
more to manage it.
This disastrous period passed, now he is
more calm, less irritable, less annoying, less impulsive and more reflexive. He
is reading better, more easily. Sometimes, by not controlling himself, he
anticipates still a letter for an other. Now he writes more correctly, by doing
fewer spelling mistakes. If more tired, he does more errors. In the mornings,
just he woke up, he speaks more. In certain moments he becomes iterating, doing
again the same question to which he had the answer shortly before.
Therapeutic variation (daily doses, by the
oral via ): Amitriptyline 10mg; Oxcarbamazepine 150mg.
October 2004, after 22 months of drug
therapy.
Globally, he is doing a little better. Now,
he has fewer anger fits, he is lesser jealous of his sister, and in the first
shot, he would postpone everything that it is not an autonomous choice. He more
agrees to accept arguing some possible deficits or inadequate behaviour of him.
The last summer has done the assistant in the CREST (a summer camp) with good
results and he has done the baby-sitter of his little sister, as well. He asked
to go with the scouts.
He inclines to be repetitive, when under
stress. Habitually he doesn't like reading, even if now he is less dyslexic. A
little more anorthography occurs ( he skips the double letters, not always he
pays attention to up and low case letters).
With the psychologist that follows him, he
tries to speak more and to maintain the conversation going. He has some
fetishistic behaviour. Now he is less the Contrary Mary and he accepts more to
pull up. He does not like to do his the homework. To read the clock is an
always difficult task as it is to handle the money. Usually he is eating more.
Current therapy (daily doses, by the oral
via): Oxcarbamazepin 300mg; Glutamine 125mg; Pyridoxine 75mg; Amitriptyline
10mg; Diazepam 5mg.
Discussion.
It is sure that trying to prescribe a drug
therapy in a subject with mental retardation, with dyslexia, and after the sexual
development, is not a simple task. We may go to meet surprises, as in fact
happened here.
Two the unexpected moments, the allergic
intolerance to the carbamazepine, first substituted with the nimodipine, and
now even with oxcarbamazepine. Then the surprise of the amantadine, a
dopaminergic drug prescribed to act on the attention deficit. The following
phase of great psychomotor excitement may be only related with an individual
hypersensitivity to this drug, since the dosing was intentionally low.
However, it seems that something is
improving, the motor awkwardness, as for an example. It will be certainly the
share of the false mental retardation adherent to the mental insufficiency, is
what is going down.
An other discourse concerns instead the
dyslexia and the anorthography. For this last it is difficult to affirm that it
is still present, since the residual element, the spelling mistakes, is
reducing. It seems now what rests of the recuperation of not previously
learning.
For the dyslexia, not completely cut out,
now it remains the error of anticipating a letter for an other, but lesser than
in past. The increasing of this error in tiredness conditions or when the young
man wants to read in a hurry, confirms a possible link with the stress. This would
explain the presence of the dyslexia in different neuropsychiatric troubles.
Does pure dyslexia exist? I cannot answer to
this question, even if I would not exclude it beforehand. At least an other
case, already in drug therapy, will help to understand better what, as for me,
is only a symptom, and not a particular syndrome.
References.
Cocchi R. Pseudo-insufficienza
mentale nell' insufficienza mentale: una cornice di riferimento. Riv. It. Disturbo Intellet. 1992, 5: 175-179.
Cocchi R. Cocchi R. Un caso di dislessia in eta`
scolare trattato con farmaci per 44 mesi. Riv. It. Disturbo Intellet. 1990, 3:
159-165. English translation on <www.stress-cocchi.net/Other3.htm>
Cocchi R. Intermittent dyslexia in an young adult
with initial insomnia, dyslalias and headache. results of a four-months
treatment with antistress and antidepressants drugs. February 2004
<www.stress-cocchi.net/index-it.htm/Other9.htm>
Posted
on Internet on June 2004. Copyright by Renato Cocchi, 2004.
Author's address: dr Renato COCCHI, via Rabbeno,3
42100 Reggio Emilia (Italy)
renatococchi@libero.it
Dyslexia (other two articles on this topic)
Drug modulation of stress reactions
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