CHILDHOOD PSYCHOSES: RESULTS

ON SCHOOL ACHIEVEMENT

OF DOWN AND NON-DOWN SUBJECTS

TREATED BY DRUGS

Renato COCCHI, a neurologist and a medical psychologist

(Traduzione italiana)

Summary.

After 3-94 months of individualized drug therapies, the results on school learning of 36 psychotic Down children and 29 psychotic non-Down children were compared.

The Down group (PDG) comprised 24 M and 12 F; average age at first consultation, 5;10 + 3;1 years; chromosomal diagnoses, 34 pure trisomy 21, 1 mosaicism and 1 not known; DSM-III,R diagnosis, 33 early onset and 3 late onset Pervasive Developmental Disorder.
The non-Down group (PNDG) comprised 16 M and 13 F; average age at first consultation, 6;1 + 3;1 years; DSM-III,R diagnosis, 20 early onset and 4 late onset Pervasive Developmental Disorder and 5 Atypical Pervasive Developmental Disorders.
Reading and writing performance and ability in elementary arithmetic have all been evaluated. Improvement in classroom behaviour and the increase in learning capacity are in direct proportion to the duration of drug therapy and follow the same sequence as a normal child on entry to elementary school.

School achievement tends to be slower and less frequent in the psychotic Down subjects compared to the psychotic non Down group.

Key words: Childhood psychoses; Down children; non-Down children; drug therapy; individualized regimen; school learning; results.

Autism and other psychoses

Down's syndrome

Drug modulation of stress reactions

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The possibility of comparing directly a group of psychotic Down children (PDG) with a group of psychotic non-Down children (PNDG), both tretaed by the same child psychiatrist, has already allowed comparisons of notable interest in epidemilogy and clinical features (Cocchi, 1988), in the area of self-injurious behaviour (Cocchi & Bonaduce, 1988b), in susceptibility towards upper tract respiratory diseases (Cocchi & Bonaduce, 1988a), in global results on psychotic symptoms (Cocchi, 1990c) and detailed results on social behaviours (Cocchi, 1991) following drug treatment.

In order to evaluate more precisely the therapeutic benefit obtained in the subjects who undervent drug treatment for at least 3 months, I thought it would be interesting to compare the scholastic achievements of Down and non-Down psychotic children whose parents had accepted this type of treatment, administered along the guidelines already described (Cocchi, 1990b).

The two groups therefore comprise only subjects assessible under these criteria.

Materials and method.

All the clinical records of psychotic Down and non-Down subjects who had been the object of the previous research (Cocchi, 1990c), were re-examined.

To the psychotic non-Down group were added the records of some new subjects whose progress had been checked after at least 3 months of drug terapy.

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. Information regarding classroom behaviour, reading, writing and elementary arithmetic ability was estracted. For each child sex, age at first consultation, chromosomal anomalies (for the Down subjects) were also collected.

Results

Results were reported on tables 1-6.

According to the diagnoses made during first consultation and the length of drug taking, 2 groups of children records were assembled:

1. Psychotic Down children group (PDG): 36 Ss = 100.00 % .

Characteristics of PDG are:

Sex: M = 24 and F = 12; M/F ratio = 200/100.

Distribution of chromosomal anomalies:

Pure trisomy 21: 34 Ss = 94.44 % ;

Mosaicisms: 1 " = 2.78 % ;

Unknown (only clinical diagnosis): 1 " = 2.78 % .

Average age at 1st consultation: 5;10 years, with SD = 3;2 years.

Diagnoses, according with DSM-III,R:

Early onset Pervasive Developmental Disorder: 33 Ss = 91.67 % ;

Late onset Pervasive Developmental Disorder: 3 " = 8.33 % .

Table 1: Results; keys: (=) inadequate or no learning; (+) slight improvement; (++) mild improvement; (+++) marked improvement; (++++) normalized behaviour.

S	classroom behaviour	reading		writing			elementary arithmetic
		syllabl.	words	Copy	dictatat.	invention	digits sequence	addition	subtraction
Group 1
182	++	=	=	=	=	=	=	=	= (*)
353	=	=	=	=	=	=	=	=	= (*)
Group 2
32	=	=	=	=	=	=	=	=	= (*)
34	=	=	=	=	=	=	=	=	= (*)
316	++	=	=	=	=	=	=	=	= (*)
332	+	=	=	=	=	=	=	=	= (*)
430	++	=	=	=	=	=	=	=	=
455	++	(pre-elementary school attendance)
Group 3
124	(no attendance to any kind of pre-elementary school, because very young)								(*)
173	++	=	=	=	=	=	=	=	= (*)
186	++	=	=	=	=	=	=	=	= (*)
289	=	=	=	=	=	=	=	=	= (*)
325	++	=	=	=	=	=	=	=	= (*)
330	+	=	=	=	=	=	=	=	= (*)
333	++	(pre-elementary school attendance)							(*)
345	+++	++	+	+++	++	+	++	+	+ (*)
400	++	+++	++	++	=	=	=	=	= (*)
433	+++	(attendance on a daily protected workshop)
Group 4
93	++	=	=	=	=	=	=	=	= (*)
101	++	=	=	=	=	=	=	=	= (*)
120	+	=	=	=	=	=	=	=	= (*)
191	++	=	=	=	=	=	=	=	= (*)
225	+	=	=	=	=	=	=	=	= (*)
281	++