HYPERKINESIS IN DOWN CHILDREN
AGED UP TO 12 YEARS:
A SURVEY ON 442 CASES
Renato COCCHI MD, and Marco FAVUTO MD
Summary
From
the same unselected consecutive series of Down Ss already surveyed in a
previous paper ( Cocchi R., Favuto M.: It. J. Intellect. Impair. 1997, 10:19-23) we extracted the clinical
reports of those aged up to 144 months at first consultation. These reports
pertained to 442 children, whose 251 males and 191 females, with M/F ratio =
131.41/100.
The distribution of chromosomal
anomalies divided by gender was as usual, and average age at 1st consultation
was about 51 months. Hyperkinetic Down girls were 34.03% and hyperkinetic Down
boys were 35.86%. Epidemiological features of these hyperkinetic subgroups do
not differ, like the age at 1st consultation. At least for Italian Down
children, we suggest that gender do not influence the presence of hyperkinesis.
Key words: Down’s Syndrome; hyperkinesis;
gender; children.
* Down's syndrome
* Mental retardation
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In our previous paper on hyperkinesis in
Down Ss (Cocchi
and Favuto, 1997) we reached
some interesting results. Hyperkinesis referred to about one third of a
representative sample of 510 Ss. Hyperkinetic Down Ss did not differ from non
hyperkinetic Down Ss as for M/F ratio, chromosomal anomalies' distribution, and
age at 1st consultation. Being the age group up to 12 years the more stable and
indicative, in this respect, we aimed to survey if in it hyperkinesis was a
gender independent feature.
Materials
and method
We used for this survey the clinical
cards referring to an unselected consecutive series of home reared and home
living Down Ss. One of the authors saw all them in outpatients' between January
1979 and April 1997, when the Ss were aged up to 144 months (12 years).
The record of hyperkinesis during 1st
visits followed
- direct observation;
- reports of the parents, or in-home relatives,
or teachers;
- presence of motor behaviours that the
DSM pointed out as symptoms of motor hyperactivity.
From this amount we avoid using the
records of PDD Down children, because we thought that a so heavy superimposed
pathology could have modified also motor behaviours. Of course we did not
consider the records where hyperkinesis did not have any negative or positive
mention.
From so selected records we collected:
- sex;
- age at 1st consultation;
- chromosomal diagnosis;
- presence or absence of hyperkinesis.
Data collected had plain statistics and
we evaluate them, when it possible, with Chi Square Test.
Results
Only 442 Ss out of 548 fitted the limits
for this survey. The analysis of this sample stands in Tables 1-4.
Tab. 1: Epidemiological data of the
sample of Down children aged up to 144 months (12 years)
|
No. of Ss |
442 |
100.00% |
|
(% of the whole series of 548 Ss) |
|
80.66%) |
|
Males |
251 |
56.79% |
|
Females |
191 |
43.21% |
|
M/F ratio |
131.41/100 |
|
|
|
|
|
|
Chromosomal diagnosis |
|
|
|
pure trisomy 21 |
407 |
92.08% |
|
mosaicisms |
14 |
3.16% |
|
translocations |
15 |
3.39% |
|
only clinical diagnosis |
6 |
1.37% |
|
|
|
|
|
Age at 1st visit (months) |
|
|
|
range |
4-144 |
|
|
average +/- SD |
52.55 +/- 36.76 |
|
We have to note M/F ratio and chromosomal
anomalies' distribution.
According to Camera e Mastroiacovo, 1984,
we can consider this sample as representative at least of the Italian Down
children aged up to 144 months.
Tab 2: Epidemiological data of the
sample, divided by gender.
|
|
females |
% |
males |
% |
|
|
|
|
|
|
|
No. of Ss |
191 |
100.00 |
251 |
100.00 |
|
|
|
|
|
|
|
Chromosomal diagnosis |
|
|
|
|
|
pure trisomy 21 |
172 |
90.15 |
235 |
93.61 |
|
mosaicsms |
5 |
2.62 |
2 |
0.79 |
|
translocations |
10 |
5.24 |
5 |
1.99 |
|
only clinical diagnosis |
4 |
2.09 |
2 |
0.79 |
|
|
|
|
|
|
|
Age at 1st visit (months) |
|
|
|
|
|
range |
6-144 |
|
6-144 |
|
|
average +/- SD |
51.42 +/-40.59 |
|
51.21 +/-39.09 |
|
|
|
|
|
|
|
Chi Square for
chromosomal diagnoses = 4.739 with 3 df and p = 0.256 NS
The gender sharing originated two subsamples
not significantly different for chromosomal anomalies' distribution, and, by
evidence, for average age at 1st visit.
Tab. 3: Presence or not of hyperkinesis,
according to gender.
|
Hyperkinesis |
females |
% |
males |
% |
|
|
|
|
|
|
|
not present |
126 |
65.97 |
161 |
64.14 |
|
|
|
|
|
|
|
present |
65 |
34.03 |
90 |
35.86 |
|
|
|
|
|
|
|
|
|
|
|
|
|
totals |
191 |
100.00 |
251 |
100.00 |
Chi Square = 0.089 with
1 df and p = 0.766 NS
The percent presence of hyperkinesis in
both males and females does not clearly differ, being about 35%.
Tab. 4: Analysis of the epidemiological
data of hyperkinetic children divided by gender.
|
|
females |
% |
males |
% |
|
|
|
|
|
|
|
No. of Ss |
65 |
100.00 |
90 |
100.00 |
|
|
|
|
|
|
|
Chromosomal diagnosis |
|
|
|
|
|
pure trisomy 21 |
62 |
95.38 |
84 |
93.33 |
|
mosaicisms |
0 |
0.00 |
5 |
5.56 |
|
translocations |
3 |
4.62 |
0 |
0.00 |
|
only clinical diagnosis |
0 |
0.00 |
1 |
1.11 |
|
|
|
|
|
|
|
Age at 1st visit (months) |
|
|
|
|
|
range |
6-144 |
|
6-144 |
|
|
average |
48.48 |
|
56.85 |
|
|
SD |
40.69 |
|
41.41 |
|
|
|
|
|
|
|
(Chromosomal diagnoses: Chi Square = 0.504 with 3 df
and p = 0.047)
Age at 1st visit: Chi
Square = 0.111 with 1 df and p = 0.739 NS
As we can observe in Table 4, both
subgroups of hyperkinetic Down children, divided by gender, seem ignificantly
differ as for chromosomal anomalies' distribution. They do not differ as for
average age at 1st visit.
Discussion
This second survey on hyperkinesis in
Down children was easier to do, because we used data already computed in the
previous one (Cocchi and Favuto, 1997). We could have previewed the results, as far as an essential element was
accounted, such as the presence of hyperkinesis in about one third of the
original sample.
Now we can confirm hyperkinesis in about
35% of this new sample, without gender difference. We cannot deserve particular
attention to a significant gender difference in chromosomal anomalies'
distribution that we found in this second survey. It is enough to watch at the
figures of either distribution. There is evidence of no differences as for pure
trisomy 21, the percentage of which is as usual.
To have not found hyperkinetic girls with
mosaicisms or the sole clinical diagnosis, and hyperkinetic boys with
translocations, led to nearly sure wrong statistic significance. The percent
rates of mosaicisms and translocations are very low as per se (normally 2-4%).
It is not difficult to find samples of less than 100 Ss, without any one who
carries mosaicism or translocation. The same we can say for the contingent
category of "only clinical diagnosis" the rate of which was already
1.36% in the initial gender mixed sample.
Already in the larger sample previously
surveyed, we did not find any difference between hyperkinetic and non
hyperkinetic children, as for chromosomal anomalies' distribution (Cocchi and
Favuto, 1997).
So we suggest as a highly possible
hypothesis that hyperkinesis is not related to gender. Even if Down males and
females had significantly different chromosomal anomalies' distributions - a
fact that we believe hardly to find - this hypothesis should not be damaged.
Conclusion
In this second survey dealing with
hyperkinesis in Down children aged up to 12, we found it in about 35% without
any gender preference.
We can ask where it is coming this
hyperactive behaviour that characterizes one third of the Down children. Surely
pregnancy and delivery risk factors, with their noticeable prevalence in Downs
(Cocchi, 1987; Cocchi and Branchesi, 1987, Cocchi and Branchesi, 1988, Cocchi,
1992) are first liable to suspicion.
This will be our next target.
References
Camera G., Mastroiacovo P.: Epidemiologia
della sindrome di Down. In. Ce.Pi.M. (ed): Aspetti epidemiologici, genetici,
clinici, riabilitativi e sociali della sindrome di Down. Ce.Pi.M., Genova 1984:
225-230
Cocchi R.: Presenza di scavengers e
incidenza di paralisi cerebrali infantili da prematurita' e basso peso alla
nascita in 381 soggetti Down allevati in famiglia. Giorn. Neuropsichiat. Eta'
Evol. 1987, 7: 317-323.
Cocchi R.: Alcuni dati epidemiologici su
una serie consecutiva di 490 soggetti Down. Riv. It. Disturbo Intellet. 1992,
5: 107-112.
Cocchi R., Branchesi R.: Strabismo e
disturbi pre-, peri- e neonatali in soggetti affetti da sindrome di Down.
Indagine epidemiologica su 215 casi. Rass. Studi Psichiat. 1986, 75: 504-512.
Cocchi R., Branchesi R.: Is there a
causal non-connection between squint and cerebral palsy through prematurity
and/or low birthweight in Down syndrome children? It. J. Intellect. Impair.
1988, 1: 141-144.
Cocchi R., Favuto M.: Hyperkinesis in
Down’s syndrome. A survey on 510 persons. It. J. Intellect. Impair.1997, 10:
19-23
Paper printed on It. J. Intellect. Impair
1997, 10: 25-28.
Author’s address: Renato COCCHI MD, via Rabbeno, 3
42100 Reggio Emilia (Italy)
renatococchi@libero.it
Down's syndrome
Mental retardation
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