CHILDHOOD PSYCHOSES:
RESULTS OF DRUG TREATMENT
ON LANGUAGE DEVELOPMENT
IN DOWN AND NON-DOWN SUBJECTS
Renato COCCHI, a neurologist and a medical
psychologist
Summary
After 3-106 months of individualised drug
therapies, the results on language development of 37 psychotic Down children
and 30 psychotic non-Down children were compared. The Down group (PDG)
comprised 24 M and 13 F; average age at first consultation: 6 +/- 3;2 years;
chromosomal diagnoses: 35 pure trisomy 21, 1 mosaicism and 1 not known;
DSM-III, R diagnosis: 34 early onset and 3 late onset Pervasive Developmental
Disorder.
The non-Down group (PnDG) comprised 17 M
and 13 F; average age at first consultation 6;11 +/- 3;2 years; DSM-II,R
diagnoses: 21 early onset and 4 late onset Pervasive Developmental Disorder, 5
Atypical Pervasive Developmental Disorder.
Results on echolalia, understanding
simple and double commands, the use of new words, the correct use of pronouns
and the ability to say "yes", the use of verbal language to ask and
to tell. Significant results (p < .001) in the understanding of simple and
double commands in both groups, but also in the use of new words in the PDG.
All the remaining investigated fields of verbal language showed a trend to
improve in direct proportion to the duration of the drug therapy.
Key words: Childhood psychoses; Down children; non-Down children; drug
therapy; individualised regimen; language development; results.
One of the most severe symptoms in the
psychotic child's behaviour is the inability to use verbal language for normal
communication. This disorder can manifest itself in various forms: language may
not yet have been acquired or may have regressed after beginning to develop
precociously.
It may remain at a rudimentary stage showing
particular characteristics (immediate and delayed echolalia, inability to say
"yes", pronoun reversal, etc.). Then again it may be structurally
correct but inadequate for communication, as in Asperger's Autistic
Psychopathy.
Verbal language impairment is constantly
present and the fact that gestual language is a poor substitute strongly
suggests that the impairment is active in the areas of both comprehension and
production.
Any therapeutical approach towards curing
childhood psychoses cannot afford to ignore verification of the results in this
area. The detailed evaluation of the results obtained following drug treatment
of a group of psychotic Down children (PDG) and a group of psychotic non-Down
children (PNDG) treated for various periods of time continues.
After a global comparative evaluation
(Cocchi, 1990), specific comparative evaluation of social behaviour (Cocchi,
1991a), the outcome on school achievement (Cocchi, 1991b) and on motory and
vocal stereotypies (Cocchi, 1991c), in this research the therapy's effect on
"abnormal language" symptoms was examined.
As the therapies were individualised, as
reported in previous articles (Cocchi, 1990b, Cocchi 1991a and 1991b), the
statistical comparison is prevalently descriptive, and for this reason the
clinical evaluations of the investigated behaviour or symptom in each single
case are shown here (Tables 3 and 4).
The children making up the survey groups are
those whose the parents accepted drug treatment administered along the
guidelines already described (Cocchi, 1990d). The two groups involved comprise
only subjects who undervent at least one check up of the therapy effects after
a minimum of 3 months' treatment.
Materials and method
All the clinical records of psychotic Down
and non-Down subjects who had been the object of previous research (Cocchi,
1991a & 1991b), were re-examined. To the PnDG were added the records of one
subject escaped the previous survey.
The clinical records selected were those
cases where a diagnosis of childhood psychosis conforming to DSM-III, R (1987)
had been made during the first consultation.
The following symptoms or behaviours were
evaluated:
- echolalia;
- performs simple verbal commands;
- performs double verbal commands;
- pronoun reversal;
- says "yes", when he/she agrees;
- uses language for asking;
- uses language for telling.
The presence of the verbal symptoms or
behaviours was scored, before and after a therapy period by means of a five
steps scale of intensity as follows:
0 = symptom or behaviour not present;
1 = rarely present;
2 = moderately present;
3 = very present;
4 = always present.
This scale works from 4 to 0 as for
echolalia and from 0 to 4 for the other verbal symptoms.
For each child were also noted:
- sex;
- age at first consultation;
- chromosomal diagnosis (for the PDG).
For the statistical analysis the tests of
Wilcoxon and the Chi Square were chosen.
Results
The results, up to the end of August 1991,
were reported on tables 1-6.
Two groups of children were identified on
the basis of diagnosis made at first consultation, and the length of time of
drugs were taken:
1. Psychotic Down children Group (PDG): 37
Ss = 100.00% .
Characteristics of PDG are:
Sex: M = 24 e F = 13; M/F ratio = 184.62/100
.
Distribution of chromosomal anomalies:
Pure trisomy 21: 35 Ss = 94.59% ;
Mosaicisms: 1 S = 2.70% ;
Not known: 1 S = 2.70% .
Average age at first consultation: 6 years
with SD = 3; 2 years.
Diagnosis, according to DSM-III,R:
Early onset Pervasive Developmental
Disorder: 34 Ss = 91.89% ;
Late onset Pervasive Developmental Disorder:
3 Ss = 8.11% .
2. Psychotic non-Down group (PNDG): 30 Ss =
100.00% ;
Characteristics of PnDG are:
Sex: M = 17 e F = 13; M/F ratio = 130.77/100
;
Average age at first consultation: 6; 11
years, with SD = 3; 2 years;
Diagnoses, according to DSM-III, R:
Early onset Pervasive Developmental
Disorder: 21 Ss = 70.00% ;
Late onset Pervasive Developmental Disorder:
4 Ss = 13.33% ;
Atypical Pervasive Developmental Disorder: 5
Ss = 16.67% .
Table 1: Comparison of the length of the
therapies.
|
Group /length |
PDG Ss |
% |
PnDG Ss |
% |
<>% |
|
1. from 3 to 6 months |
2 |
5.41 |
4 |
13.33 |
+7.92 |
|
2. from 7 to 12 months |
4 |
10.81 |
7 |
23.33 |
+12.52 |
|
3. from 13 to 24 months |
10 |
27.03 |
5 |
16.67 |
-10.36 |
|
4. from 25 to 36 months |
8 |
21.62 |
3 |
10.00 |
-11.62 |
|
5. from 37 to 60 months |
5 |
13.51 |
7 |
23.34 |
+9.83 |
|
6. from + 60 months |
8 |
21.62 |
4 |
13.33 |
-8.29 |
|
Totals |
37 |
100.00 |
30 |
100.00 |
0.00 |
Chi Square = 6.43 with 5
dfl.; .30 > p > .20; N.S.
Table 2: PDG, risults on verbal language,
before (bef.) and after (aft.) therapy.
.
|
|
Echolaly |
Performs commands |
Uses new words. |
Pronoun reversal |
Says "yes" |
Spontaneous speech |
||||||||||
|
Group |
|
simple |
double |
|
For asking |
For telling |
||||||||||
|
S. nr. |
Bef. |
Aft. |
Bef. |
Aft. |
Bef. |
Aft. |
Bef. |
Aft |
Bef. |
Aft. |
Bef. |
Aft. |
Bef. |
Aft |
Bef. |
Aft |
|
Gr. 1. (3-6 months therapy) |
|
|||||||||||||||
|
182 |
4 |
4 |
1 |
2 |
0 |
0 |
0 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
353 |
3 |
3 |
1 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
Gr. 2 (7-12 months therapy) |
||||||||||||||||
|
32 |
0 |
0 |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
34 |
3 |
2 |
1 |
3 |
0 |
1 |
0 |
2 |
0 |
0 |
0 |
0 |
1 |
2 |
0 |
1 (*) |
|
316 |
2 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
332 |
2 |
1 |
1 |
3 |
0 |
2 |
0 |
1 |
0 |
1 |
0 |
1 |
0 |
3 |
0 |
0 (*) |
|
Gr. 3 (13-24 months therapy) |
||||||||||||||||
|
124 |
1 |
3 |
2 |
4 |
0 |
1 |
1 |
2 |
0 |
0 |
0 |
0 |
0 |
1 |
0 |
0 (*) |
|
173 |
3 |
2 |
2 |
3 |
0 |
0 |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
1 |
0 |
0 (*) |
|
186 |
3 |
3 |
2 |
3 |
0 |
0 |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
289 |
0 |
0 |
1 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
325 |
0 |
0 |
2 |
3 |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
330 |
2 |
2 |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
333 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
345 |
3 |
1 |
2 |
3 |
1 |
2 |
1 |
3 |
1 |
4 |
0 |
1 |
1 |
2 |
0 |
0 (*) |
|
430 |
2 |
3 |
1 |
3 |
0 |
2 |
1 |
3 |
0 |
1 |
0 |
0 |
1 |
2 |
0 |
0 |
|
455 |
0 |
0 |
1 |
2 |
0 |
1 |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
|
Gr. 4 (25-36 months therapy) |
||||||||||||||||
|
93 |
0 |
0 |
3 |
4 |
2 |
3 |
1 |
3 |
0 |
0 |
0 |
0 |
0 |
2 |
0 |
0 (*) |
|
101 |
3 |
0 |
2 |
4 |
1 |
3 |
1 |
3 |
0 |
2 |
0 |
2 |
0 |
3 |
0 |
2 (*) |
|
120 |
0 |
0 |
1 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
191 |
3 |
4 |
2 |
2 |
1 |
1 |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
225 |
0 |
0 |
1 |
2 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
281 |
0 |
0 |
1 |
3 |
0 |
1 |
0 |
2 |
0 |
0 |
0 |
0 |
1 |
2 |
0 |
0 (* |
|
319 |
0 |
0 |
0 |
2 |
0 |
0 |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
433 |
3 |
1 |
2 |
4 |
1 |
3 |
1 |
3 |
0 |
2 |
1 |
3 |
1 |
3 |
0 |
2 @ |
|
Gr. 5. (37-60 months therapy) |
||||||||||||||||
|
85 |
2 |
3 |
2 |
2 |
2 |
1 |
2 |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
268 |
3 |
1 |
1 |
4 |
0 |
1 |
0 |
2 |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
|
308 |
0 |
0 |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 (*) |
|
372 |
3 |
1 |
1 |
4 |
0 |
3 |
1 |
3 |
0 |
2 |
0 |
3 |
0 |
2 |
0 |
1 |
|
400 |
4 |
2 |
1 |
3 |
0 |
1 |
1 |
3 |
0 |
1 |
0 |
2 |
0 |
1 |
0 |
0 |
|
Gr. 6. (61-100 months therapy) |
||||||||||||||||
|
7 |
4 |
1 |
1 |
4 |
1 |
4 |
2 |
4 |
0 |
3 |
0 |
4 |
0 |
4 |
0 |
2 @ |
|
49 |
3 |
1 |
1 |
3 |
0 |
2 |
1 |
3 |
0 |
2 |
0 |
2 |
0 |
3 |
0 |
3 |
|
206 |
0 |
0 |
0 |
4 |
0 |
3 |
1 |
4 |
0 |
3 |
0 |
4 |
0 |
4 |
0 |
3 @ |
|
217 |
4 |
1 |
0 |
3 |
0 |
2 |
1 |
3 |
0 |
|||||||