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Sudnawa KK, Garber A, Cohen R, Calamia S, Kanner CH, Montes J, Bain JM, Fee RJ, Chung WK. Clinical phenotypic spectrum of CTNNB1 neurodevelopmental disorder. Clin Genet 2024; 105:523-532. [PMID: 38247296 DOI: 10.1111/cge.14487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
Pathogenic heterozygous loss of function variants in CTNNB1 are associated with CTNNB1 neurodevelopmental disorder. We report the clinical phenotype of individuals with CTNNB1 neurodevelopmental disorder using both caregiver-reported data (medical history, adaptive function, quality of life, and behavior issues) and in-person clinical assessments (neurological, motor, and cognitive function) in 32 individuals with likely pathogenic or pathogenic CTNNB1 variants. Most individuals had truncal hypotonia, muscle weakness, hypertonia, dystonia, microcephaly, and many had a history of tethered cord. Visual problems included strabismus, hyperopia, and familial exudative vitreoretinopathy. Half of individuals walked without an assistive device. The mean Gross Motor Functional Measure-66 score was 56.6 (SD = 14.8). Average time to complete Nine-Hole Peg Test was slower than norms. Mean general conceptual ability composite scores from Differential Ability Scales Second Edition were very low (M = 58.3, SD = 11.3). Fifty-five percent of individuals had low adaptive functioning based on the Vineland Adaptive Behavioral Scales. Based upon the Child Behavior Checklist total problems score, the majority (65%) of individuals had behavioral challenges. The mean overall Quality of Life Inventory-Disability score was 81.7 (SD = 11.9). These data provide a detailed characterization of clinical features in individuals with CTNNB1 neurodevelopmental disorder.
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Affiliation(s)
- Khemika K Sudnawa
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatrics, Pramongkutklao Hospital and Pramongkutklao College of Medicine, Bangkok, Thailand
| | - Alison Garber
- Department of Pediatrics, Columbia University, New York, New York, USA
| | - Ryan Cohen
- Department of Pediatrics, Columbia University, New York, New York, USA
| | - Sean Calamia
- Department of Pediatrics, Columbia University, New York, New York, USA
| | - Cara H Kanner
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Jacqueline Montes
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Jennifer M Bain
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Robert J Fee
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, New York, USA
| | - Wendy K Chung
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Donoso J, Rattray F, de Bildt A, Tillmann J, Williams P, Absoud M, Totsika V. Association of cognitive and adaptive skills with internalizing and externalizing problems in autistic children and adolescents. Autism Res 2024; 17:596-609. [PMID: 38031634 DOI: 10.1002/aur.3056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
The presence of an intellectual disability (ID) alongside autism is considered to increase the risk for mental health and behavior problems in children and adolescents. Existing evidence is restricted by looking at ID as a categorical classification. The study aimed to examine the association of cognitive and adaptive behavior skills with internalizing and externalizing problems in a large sample of autistic children and adolescents, across a wide range of cognitive skills. Participants were 2759 children and adolescents aged between 4 and 18 years recruited as part of the Simons Simplex Collection (SSC), of whom 709 (approximately 25%) had ID. Multiple regression models examined associations of internalizing and externalizing problems with cognitive and adaptive skills (communication, daily living, and socialization skills). Cognitive skills were not associated with externalizing problems but were associated with more internalizing problems in autistic children without ID (Cog β: 0.126). All adaptive skill domains were inversely associated with externalizing (Communication β: -0.145; Daily-Living β: -0.132; Socialization β: -0.289) and internalizing problems (Communication β: -0.074; Daily-Living β: -0.064; Socialization β: -0.213) in those without ID. Daily living (β: -0.158) and socialization skills (β: -0.104) were inversely correlated with externalizing problems in autistic children with ID, while only socialization problems (β: -0.099) were associated with internalizing problems in this group. Socialization skills were systematically associated with internalizing and externalizing problems across all levels of cognitive functioning. Supporting social skills development may benefit all aspects of child mental health, while recognizing that children with higher cognitive skills are more vulnerable to internalizing problems might assist with earlier identification of these problems.
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Affiliation(s)
- Javiera Donoso
- Division of Psychiatry, University College London, London, UK
| | - Fiona Rattray
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Annelies de Bildt
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Accare Child Study Center, Groningen, The Netherlands
| | - Julian Tillmann
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Penny Williams
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michael Absoud
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Vasiliki Totsika
- Division of Psychiatry, University College London, London, UK
- Centre for Research in Intellectual and Developmental Disabilities, University of Warwick, Coventry, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
- Millenium Institute for Care Research (MICARE), Santiago, Chile
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Bjurulf B, Reilly C, Hallböök T. Caregiver reported behavior, sleep and quality of life in children with Dravet syndrome: A population-based study. Epilepsy Behav 2024; 150:109560. [PMID: 38071826 DOI: 10.1016/j.yebeh.2023.109560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/02/2023] [Accepted: 11/21/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE The aim of this population-based study was to assess behavior, sleep, and quality of life, and explore factors associated with these in children with Dravet syndrome. METHODS The Developmental Behavior Checklist, the Insomnia Severity Index, and a global question regarding quality of life from the Epilepsy and Learning Disabilities Quality of Life scale were completed by primary caregivers of 42/48 Swedish children with Dravet syndrome, born 2000-2018. Factors associated with problems with insomnia, behavior and quality of life were analyzed using multivariable linear regression. RESULTS Scores indicating significant behavioral problems were seen in 29/40 (72 %) children, scores indicating moderate or severe clinical insomnia in 18/42 (43 %) and scores indicating poor or very poor quality of life in 7/41 (17 %). On multivariable analysis, autistic symptoms were significantly associated with behavioral problems (p = 0.013), side-effects of anti-seizure medications (ASMs) were associated with insomnia (p = 0.038), whilst insomnia was significantly associated with poor quality of life (p = 0.016). SIGNIFICANCE Dravet syndrome in children is associated with significant problems with behavior, sleep and quality of life. There is a need to optimize treatment via ASMs and develop and evaluate interventions to treat behavioral and sleep difficulties to optimize outcomes.
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Affiliation(s)
- Björn Bjurulf
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Member of the ERN, EpiCARE, Gothenburg, Sweden.
| | - Colin Reilly
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Member of the ERN, EpiCARE, Gothenburg, Sweden
| | - Tove Hallböök
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Member of the ERN, EpiCARE, Gothenburg, Sweden
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General Measurement Tools for Assessing Mental Health Problems Among Children and Adolescents with an Intellectual Disability: A Systematic Review. J Autism Dev Disord 2023; 53:132-204. [PMID: 35022944 PMCID: PMC9889433 DOI: 10.1007/s10803-021-05419-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 02/04/2023]
Abstract
There is a need for more knowledge of valid and standardized measures of mental health problems among children and adolescents with intellectual disability (ID). In this study, we systematically reviewed and evaluated the psychometric properties of instruments used to assess general mental health problems in this population. Following PRISMA guidelines, we reviewed empirical research published from 1980 through February 2020 with an updated search in March 2021 in Medline, Embase, PsycINFO, Health and Psychological Instruments, CINAHL, ERIC, and Web of Science databases. Forty-nine empirical articles were included in this review. Overall, the review indicated consistently better documentation of the reliability and validity of instruments designed for the ID population compared to instruments developed for the general child population.
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Bar C, Breuillard D, Kuchenbuch M, Jennesson M, Le Guyader G, Isnard H, Rolland A, Doummar D, Fluss J, Afenjar A, Berquin P, De Saint Martin A, Dupont S, Goldenberg A, Lederer D, Lesca G, Maurey H, Meyer P, Mignot C, Nica A, Odent S, Poisson A, Scalais E, Sekhara T, Vrielynck P, Barcia G, Nabbout R. Adaptive behavior and psychiatric comorbidities in KCNB1 encephalopathy. Epilepsy Behav 2022; 126:108471. [PMID: 34915430 DOI: 10.1016/j.yebeh.2021.108471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 12/13/2022]
Abstract
AIM KCNB1 encephalopathy encompasses a broad phenotypic spectrum associating intellectual disability, behavioral disturbances, and epilepsies of various severity. Using standardized parental questionnaires, we aimed to capture the heterogeneity of the adaptive and behavioral features in a series of patients with KCNB1 pathogenic variants. METHODS We included 25 patients with a KCNB1 encephalopathy, aged from 3.2 to 34.1 years (median = 10 years). Adaptive functioning was assessed in all patients using the French version of the Vineland Adaptive Behavior Scales, Second Edition (VABS-II) questionnaire. We screened global behavior with the Childhood Behavioral Check-List (CBCL, Achenbach) and autism spectrum disorder (ASD) with the Social Communication Questionnaire (SCQ). We used a cluster analysis to identify subgroups of adaptive profiles. RESULTS VABS-II questionnaire showed pathological adaptive behavior in all participants with a severity of adaptive deficiency ranging from mild in 8/20 to severe in 7/20. Eight out of 16 were at risk of Attention Problems at the CBCL and 13/18 were at risk of autism spectrum disorder (ASD). The adaptive behavior composite score significantly decreased with age (Spearman's Rho=-0.72, p<0.001) but not the equivalent ages, suggesting stagnation and slowing but no regression over time. The clustering analysis identified two subgroups of patients, one showing more severe adaptive behavior. The severity of the epilepsy phenotype predicted the severity of the behavioral profile with a sensitivity of 70% and a specificity of 90.9%. CONCLUSION This study confirms the deleterious consequences of early-onset epilepsy in addition to the impact of the gene dysfunction in patients with KCNB1 encephalopathy. ASD and attention disorders are frequent. Parental questionnaires should be considered as useful tools for early screening and care adaptation.
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Affiliation(s)
- Claire Bar
- APHP, Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, member of ERN EPICARE, Université de Paris, Paris, France; Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine Institute, Université de Paris, Paris, France
| | - Delphine Breuillard
- APHP, Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, member of ERN EPICARE, Université de Paris, Paris, France; Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine Institute, Université de Paris, Paris, France
| | - Mathieu Kuchenbuch
- APHP, Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, member of ERN EPICARE, Université de Paris, Paris, France; Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine Institute, Université de Paris, Paris, France
| | | | - Gwenaël Le Guyader
- Department of Genetics, CHU de Poitiers, BP 577, 86021 Poitiers Cedex, France; EA3808 - NEUVACOD Unité neurovasculaire et troubles cognitifs, Université de Poitiers, Pôle Biologie Santé, France
| | - Hervé Isnard
- Pediatric Neurologist, Medical Office 28 rue de la république, Lyon 69002, France
| | - Anne Rolland
- Department of Pediatrics, CHU de NANTES, Nantes, France
| | - Diane Doummar
- Department of Pediatric Neurology, AP-HP, Hôpital Armand Trousseau, Sorbonne Université, Paris, France
| | - Joel Fluss
- Pediatric Neurology Unit, Geneva Children's Hospital, 6 rue Willy-Donzé, 1211 Genève 4, Switzerland
| | - Alexandra Afenjar
- Sorbonne Universités, Centre de Référence Malformations et maladies congénitales du cervelet et déficiences intellectuelles de causes rares, département de génétique et embryologie médicale, Hôpital Trousseau, AP-HP, Paris, France
| | - Patrick Berquin
- Department of Pediatric Neurology, CHU Amiens-Picardie, Université de Picardie Jules Verne, Amiens France Pediatric Neurology Unit, France
| | - Anne De Saint Martin
- Department of Pediatric Neurology, Strasbourg University Hospital, Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - Sophie Dupont
- Epileptology Unit and Rehabilitation Unit AP-HP, GH Pitie-Salpêtrière-Charles Foix, F-75013 Paris, France; Sorbonne University, UPMC Univ. Paris 06, F-75005 Paris, France
| | - Alice Goldenberg
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, CHU Rouen, Rouen, France
| | | | - Gaétan Lesca
- Department of Genetics, Hospices Civils de Lyon, 69002 Lyon, France; Institut NeuroMyoGène, CNRS UMR 5310 - INSERM U1217, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Hélène Maurey
- Department of Pediatric Neurology, AP-HP, Hôpital Universitaire Bicêtre, Kremlin Bicêtre, France
| | - Pierre Meyer
- Department of Pediatric Neurology, CHU Montpellier, Montpellier, France; PhyMedExp, U1046 INSERM, UMR9214 CNRS, Université de Montpellier, Montpellier, France
| | - Cyril Mignot
- INSERM, U 1127, CNRS UMR 7225, Sorbonne Université, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France; APHP, Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière, Department of Genetics, Centre de Reference Déficience Intellectuelle de Causes Rares
| | - Anca Nica
- Neurology Department, Center for Clinical Research (CIC 1414), Rennes University Hospital, France; Laboratory Of Signal Processing (LTSI), UMR 1099 INSERM, Rennes F-35000, France
| | - Sylvie Odent
- Service de Génétique clinique, Reference Ccentre for Rare Developmental Abnormalities CLAD-Ouest, member of ERN ITHACA, CHU Rennes, France; CNRS UMR 6290 Institut de Génétique et Développement de Rennes IGDR, Univ Rennes, Rennes, France
| | - Alice Poisson
- GénoPsy, Reference Center for Diagnosis and Management of Genetic Psychiatric Disorders, Centre Hospitalier le Vinatier and EDR-Psy Team (Centre National de la Recherche Scientifique & Lyon 1 Claude Bernard University), France
| | - Emmanuel Scalais
- Pediatric Neurology Unit, Centre Hospitalier de Luxembourg, Luxembourg
| | - Tayeb Sekhara
- Department of Pediatric Neurology, C.H.I.R.E.C, Brussels, Belgium
| | - Pascal Vrielynck
- William Lennox Neurological Hospital, Reference Center for Refractory Epilepsy UCLouvain, Ottignies, Belgium
| | - Giulia Barcia
- Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine Institute, Université de Paris, Paris, France; APHP, Department of Clinical Genetics, Necker-Enfants Malades Hospital, Paris, France
| | - Rima Nabbout
- APHP, Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, member of ERN EPICARE, Université de Paris, Paris, France; Laboratory of Translational Research for Neurological Disorders, INSERM UMR 1163, Imagine Institute, Université de Paris, Paris, France.
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6
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Landlust AM, Visser L, Flapper BCT, Ruiter SAJ, Zwanenburg RJ, van Ravenswaaij-Arts CMA, van Balkom IDC. Understanding Behavior in Phelan-McDermid Syndrome. Front Psychiatry 2022; 13:836807. [PMID: 35693963 PMCID: PMC9178081 DOI: 10.3389/fpsyt.2022.836807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/27/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Phelan-McDermid syndrome (PMS) or 22q13.3 deletion syndrome is a rare genetic disorder characterized by developmental delay, hypotonia and severely delayed speech. Behavioral difficulties are often reported in PMS, although knowledge of behavioral profiles and the interpretation of reported behavior remains limited. Understanding the meaning of behavior requires considering the context as well as other domains of functioning, for example the individual's level of cognitive, social and emotional development. Combining structured direct in-person neurodevelopmental assessments with contextual assessments to enable meaningful interpretations of reported behavior on functional dimensions across multiple units of analysis, as proposed by the RDoc framework, is essential. METHODS In this article we present a structured multidisciplinary method of assessment through direct in-person neurodevelopmental assessments and assessment of contextual factors. Our study sample includes data of 33 children with an average age of 6.2 years (range 1.1 to 15.7) with PMS, obtained through individual in-person assessments in combination with parent informed questionnaires. We assessed developmental age using the Bayley-III, adaptive behavior was assessed with the Vineland screener, social-emotional development with the ESSEON-R and behavior by using the CBCL. RESULTS Our results show a great deal of variability in phenotypic presentation with regard to behavior, symptom expression and symptom severity in individuals with PMS. The data on behavior is interpreted in the context of the individual's level of cognitive, adaptive development and the (genetic) context. Behavioral data showed high levels of withdrawn behavior and attention problems. More than half of the children showed borderline or clinical symptoms related to Autism Spectrum Disorder (ASD). CONCLUSIONS The interpretation of the meaning of certain behavior in PMS is often based on questionnaires and descriptions without taking the specific context of development into account. Combining questionnaires with direct in-person assessments measuring different domains of functioning should be considered a more accurate method to interpret the meaning of findings in order to understand behavior in rare genetic disorders associated with developmental delay such as PMS. Direct in-person assessment provides valuable and specific information relevant to understanding individual behavior and inform treatment as well as increase knowledge of the neurodevelopmental phenotype in individuals with PMS. More specific application of the proposed frameworks on behavior in PMS is desirable in making useful interpretations.
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Affiliation(s)
- Annemiek M Landlust
- Autism Team Northern-Netherlands, Jonx, Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands.,Department of Genetics, University Medical Centre Groningen, Groningen, Netherlands
| | - Linda Visser
- Leibniz Institute for Research and Information in Education (DIPF), Frankfurt am Main, Germany.,Center for Research on Individual Development and Adaptive Education of Children at Risk, Frankfurt am Main, Germany
| | - Boudien C T Flapper
- Autism Team Northern-Netherlands, Jonx, Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands.,Department of Genetics, University Medical Centre Groningen, Groningen, Netherlands.,Department of Paediatrics, University Medical Centre Groningen, Groningen, Netherlands
| | | | - Renée J Zwanenburg
- Department of Genetics, University Medical Centre Groningen, Groningen, Netherlands
| | - Conny M A van Ravenswaaij-Arts
- Autism Team Northern-Netherlands, Jonx, Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands.,Department of Genetics, University Medical Centre Groningen, Groningen, Netherlands
| | - Ingrid D C van Balkom
- Autism Team Northern-Netherlands, Jonx, Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands.,Department of Psychiatry, Rob Giel Research Centre, University Medical Center Groningen, Groningen, Netherlands
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Furlin V, Bara TS, Felden ÉPG, de Farias AC, Cordeiro ML. Neuropsychological and behavioural profiles of students with intellectual development disorder on parents and teachers' perceptions. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:626-637. [PMID: 33830566 DOI: 10.1111/jir.12837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 02/26/2021] [Accepted: 03/18/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Children with intellectual development disorder (IDD) have high rates of comorbid neuropsychological and behavioural problems. However, there are not many studies on this population in middle-income and low-income countries. Therefore, we aimed to investigate the prevalence of neuropsychological and behavioural problems in students with and without IDD and to assess the correlation between the responses from informants (parents and teachers) and the clinical diagnoses in Brazil. METHODS After clinical diagnosis, 78 male and female students (7-15 years old) were divided into two groups: children with IDD (n = 39) and children without IDD (n = 39). The Child Behaviour Checklist (CBCL) and Teacher's Report Form (TRF) scales were used to track neuropsychological and behavioural problems. Calculations of prevalence ratios were performed using Poisson regression with Wald tests. The CBCL and TRF results were compared between groups with Mann-Whitney U-tests and receiver operating characteristic (ROC) analyses. The agreement between scales was assessed using the Spearman correlation test. RESULTS Neuropsychological and behavioural problems were significantly more prevalent in students with IDD. The average amount of CBCL problems was significantly higher than that of TRF in the dimensions of thought, attention, somatic, attention deficit/hyperactivity, opposition defiant and total problems. Low-to-moderate correlations between CBCL and TRF dimensions in the IDD group were observed. ROC analyses revealed that the dimensions of internalising problems and total scores reflecting CBCL and TRF problems were the most important factors for identifying neuropsychological and behavioural problems in the IDD group. CONCLUSIONS Students with IDD require early identification of behavioural and emotional symptoms to avoid the underdiagnoses of various mental health problems, especially those with internalising characteristics. The CBCL and TRF may assist in the early screening of these comorbidities.
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Affiliation(s)
- V Furlin
- Pelé Pequeno Príncipe Research Institute, Curitiba, Brazil
- Faculdades Pequeno Príncipe, Curitiba, Brazil
| | - T S Bara
- Pelé Pequeno Príncipe Research Institute, Curitiba, Brazil
- Faculdades Pequeno Príncipe, Curitiba, Brazil
| | - É P G Felden
- Centro de Ciências da Saúde e do Esporte (CEFID), State of Santa Catarina University, Florianópolis, Brazil
| | - A C de Farias
- Pelé Pequeno Príncipe Research Institute, Curitiba, Brazil
- Faculdades Pequeno Príncipe, Curitiba, Brazil
- School of Medicine, University Positivo, Curitiba, Brazil
- Department of Neuropediatrics, Children's Hospital, Pequeno Príncipe, Curitiba, Brazil
| | - M L Cordeiro
- Pelé Pequeno Príncipe Research Institute, Curitiba, Brazil
- Faculdades Pequeno Príncipe, Curitiba, Brazil
- Department of Psychiatry and Biobehavior Sciences, David Geffen School of Medicine, Semel Institute for Neusroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
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8
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Buckley N, Glasson EJ, Chen W, Epstein A, Leonard H, Skoss R, Jacoby P, Blackmore AM, Srinivasjois R, Bourke J, Sanders RJ, Downs J. Prevalence estimates of mental health problems in children and adolescents with intellectual disability: A systematic review and meta-analysis. Aust N Z J Psychiatry 2020; 54:970-984. [PMID: 32475125 DOI: 10.1177/0004867420924101] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Children and adolescents with intellectual disability are at risk of developing psychiatric symptoms and disorders; yet, the estimates reported in the literature have been inconsistent, presenting a potential barrier for service planning and delivery. Sources of variability could arise from differences in measurement instruments as well as subgroup membership by severity of intellectual disability, gender and age. This systematic review aimed to address these gaps. METHOD MEDLINE and PsycINFO databases were searched from inception to 2018 and selected studies were reviewed. Studies were included if they reported point prevalence estimates of mental health symptomology or diagnoses in a general population of 6- to 21-year-old individuals with intellectual disability. The Joanna Briggs Institute Prevalence Critical Appraisal Checklist was applied to eligible papers to appraise their scientific strength. Pooled prevalence for mental health symptomology was determined using a random-effects meta-analysis. RESULTS A total of 19 studies were included, including 6151 children and adolescents. The pooled prevalence estimate captured by the Developmental Behaviour Checklist was 38% (95% confidence interval = [31, 46]), contrasting with 49% (95% confidence interval = [46, 51]) captured by the Child Behaviour Checklist; both rates were higher than a non-intellectual disability population. Severity of intellectual disability did not significantly influence the Developmental Behaviour Checklist risks. Insufficient data were available to conduct statistical analyses on the effects of age, gender and socioeconomic status. Of diagnosed psychiatric disorders, attention deficit/hyperactivity disorder (30%), conduct disorder (3-21%) and anxiety disorders (7-34%) were the most prevalent conditions. CONCLUSION This review consists of the largest sample hitherto evaluated. In the intellectual disability population, mental health comorbidities could be better detected by a symptom phenotype than a psychiatric diagnostic phenotype. Crucially, future research needs to address the effect of measurement validity in the intellectual disability population. Estimated prevalence rates were high compared to the general population, indicating the importance of systematic screening, case detection and appropriate management.
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Affiliation(s)
- Nicholas Buckley
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Emma J Glasson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Wai Chen
- Mental Health Service, Fiona Stanley Hospital, Department of Health, Perth, WA, Australia.,Centre for Child and Adolescent Related Disorders, Graduate School of Education, The University of Western Australia, Perth, WA, Australia.,School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.,Current affiliations: Mental Health Service, Fiona Stanley Hospital, Department of Health, Perth, WA, Australia; School of Medicine, Notre Dame University, Fremantle, Perth, WA, Australia and College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia
| | - Amy Epstein
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Rachel Skoss
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Peter Jacoby
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Amanda Marie Blackmore
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,Therapy and Other Health Services, Ability Centre, Perth, WA, Australia
| | | | - Jenny Bourke
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | | | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
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Morningstar M, Hung A, Mattson WI, Gedela S, Ostendorf AP, Nelson EE. Internalizing symptoms in intractable pediatric epilepsy: Structural and functional brain correlates. Epilepsy Behav 2020; 103:106845. [PMID: 31882324 DOI: 10.1016/j.yebeh.2019.106845] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 01/09/2023]
Abstract
Internalizing disorders (i.e., depression and anxiety) are common comorbidities in people with epilepsy. In adults with epilepsy, comorbid depression or anxiety is associated with worse seizure control and reduced quality of life, and may be linked to specific neural biomarkers. Less is known about brain correlates of internalizing symptoms in pediatric populations. In the current study, we performed a retrospective analysis of 45 youth between the ages of 6 and 18 years old with intractable epilepsy. Individuals were evaluated for internalizing symptoms on the Child Behavior Checklist (CBCL) and underwent magnetic resonance (MR) and fluorodeoxyglucose (FDG)-positron emission tomography (PET) imaging as part of the clinical evaluation for surgical treatment of epilepsy. Forty-two percent of patients experienced clinically significant internalizing symptoms based on parent report. Compared with individuals who scored in the normal range, youth with clinical levels of internalizing problems showed overall reductions in cortex volume, as well as widespread reductions in cortical thickness and functional activation in the bilateral occipital/parietal lobe, left temporal regions, and left inferior frontal cortex on MR and PET scans. There were no group differences in amygdala or hippocampus volumes, nor other patient- or illness-related variables such as age, sex, or the type, lateralization, or duration of epilepsy. Results suggest that high rates of internalizing disorders are present in youth with refractory epilepsy. Multifocal reductions in cortical thickness and function may be nonspecific risk factors for clinically meaningful internalizing symptoms in youth with chronic epilepsy. As such, the presence of broad cortical thinning and reduced glucose uptake upon radiological examination may warrant more focused clinical evaluation of psychological symptoms.
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Affiliation(s)
- Michele Morningstar
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America.
| | - Andy Hung
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Whitney I Mattson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Satyanarayana Gedela
- Department of Pediatrics and Neurology, Emory University College of Medicine, Atlanta, GA, United States of America
| | - Adam P Ostendorf
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America; Department of Neurology, Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Eric E Nelson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States of America
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10
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de Lange IM, Gunning B, Sonsma ACM, van Gemert L, van Kempen M, Verbeek NE, Sinoo C, Nicolai J, Knoers NVAM, Koeleman BPC, Brilstra EH. Outcomes and comorbidities of SCN1A-related seizure disorders. Epilepsy Behav 2019; 90:252-259. [PMID: 30527252 DOI: 10.1016/j.yebeh.2018.09.041] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Differentiating between Dravet syndrome and non-Dravet SCN1A-related phenotypes is important for prognosis regarding epilepsy severity, cognitive development, and comorbidities. When a child is diagnosed with genetic epilepsy with febrile seizures plus (GEFS+) or febrile seizures (FS), accurate prognostic information is essential as well, but detailed information on seizure course, seizure freedom, medication use, and comorbidities is lacking for this milder patient group. In this cross-sectional study, we explore disease characteristics in milder SCN1A-related phenotypes and the nature, occurrence, and relationships of SCN1A-related comorbidities in both patients with Dravet and non-Dravet syndromes. METHODS A cohort of 164 Dutch participants with SCN1A-related seizures was evaluated, consisting of 116 patients with Dravet syndrome and 48 patients with either GEFS+, febrile seizures plus (FS+), or FS. Clinical data were collected from medical records, semi-structured telephone interviews, and three questionnaires: the Functional Mobility Scale (FMS), the Pediatric Quality of Life Inventory (PedsQL) Measurement Model, and the Child or Adult Behavior Checklists (CBCL/ABCL). RESULTS Walking disabilities and severe behavioral problems affect 71% and 43% of patients with Dravet syndrome respectively and are almost never present in patients with non-Dravet syndromes. These comorbidities are strongly correlated to lower quality-of-life (QoL) scores. Less severe comorbidities occur in patients with non-Dravet syndromes: learning problems and psychological/behavioral problems are reported for 27% and 38% respectively. The average QoL score of the non-Dravet group was comparable with that of the general population. The majority of patients with non-Dravet syndromes becomes seizure-free after 10 years of age (85%). CONCLUSIONS Severe behavioral problems and walking disabilities are common in patients with Dravet syndrome and should receive specific attention during clinical management. Although the epilepsy course of patients with non-Dravet syndromes is much more favorable, milder comorbidities frequently occur in this group as well. Our results may be of great value for clinical care and informing newly diagnosed patients and their parents about prognosis.
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Affiliation(s)
- Iris M de Lange
- Department of Genetics, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | | | - Anja C M Sonsma
- Department of Genetics, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Lisette van Gemert
- Academical Center of Epileptology, Maastricht and Heeze, the Netherlands
| | - Marjan van Kempen
- Department of Genetics, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Nienke E Verbeek
- Department of Genetics, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Claudia Sinoo
- Department of Genetics, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Joost Nicolai
- Academical Center of Epileptology, Maastricht and Heeze, the Netherlands
| | - Nine V A M Knoers
- Department of Genetics, University Medical Center Utrecht, Utrecht University, the Netherlands; Department of Genetics, University Medical Center Groningen, Groningen, the Netherlands
| | - Bobby P C Koeleman
- Department of Genetics, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Eva H Brilstra
- Department of Genetics, University Medical Center Utrecht, Utrecht University, the Netherlands
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11
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Dieleman LM, De Pauw SSW, Soenens B, Van Hove G, Prinzie P. Behavioral Problems and Psychosocial Strengths: Unique Factors Contributing to the Behavioral Profile of Youth With Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2018; 123:212-227. [PMID: 29671633 DOI: 10.1352/1944-7558-123.3.212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study aimed to describe problem behaviors and psychosocial strengths, examine the problem-strength interrelations, and evaluate profiles of problems and strengths in youth with Down syndrome (DS). The community-based sample consisted of 67 parents of children with DS aged between 4 and 19 years. Parents reported about the developmental age (Vineland screener), behavioral problems (Child Behavior Checklist), and psychosocial strengths (Behavioral and Emotional Rating Scale) of their child. Results indicate that attention, social, and thought problems were most prevalent, whereas family involvement and receiving/expressing affection were identified as strengths. A confirmatory factor analysis identified problems and strengths as distinct, yet related, variables. Moreover, a cluster analysis of problems and strengths identified four different profiles. Implications for interventions are discussed.
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Affiliation(s)
- Lisa M Dieleman
- Lisa M. Dieleman, Sarah S.W. De Pauw, Bart Soenens, and Geert Van Hove, Ghent University, Belgium; and
| | - Sarah S W De Pauw
- Lisa M. Dieleman, Sarah S.W. De Pauw, Bart Soenens, and Geert Van Hove, Ghent University, Belgium; and
| | - Bart Soenens
- Lisa M. Dieleman, Sarah S.W. De Pauw, Bart Soenens, and Geert Van Hove, Ghent University, Belgium; and
| | - Geert Van Hove
- Lisa M. Dieleman, Sarah S.W. De Pauw, Bart Soenens, and Geert Van Hove, Ghent University, Belgium; and
| | - Peter Prinzie
- Peter Prinzie, Erasmus University Rotterdam, The Netherlands
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12
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A structured assessment of motor function, behavior, and communication in patients with Wolf–Hirschhorn syndrome. Eur J Med Genet 2017; 60:610-617. [DOI: 10.1016/j.ejmg.2017.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 03/21/2017] [Accepted: 08/11/2017] [Indexed: 11/23/2022]
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13
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Reis O, Wetzel B, Häßler F. Mild or borderline intellectual disability as a risk for alcohol consumption in adolescents - A matched-pair study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 63:132-141. [PMID: 26691011 DOI: 10.1016/j.ridd.2015.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/24/2015] [Accepted: 11/12/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Studies that investigate the association between mild or borderline intellectual disability (MBID) and alcohol use in adolescents have not examined whether MBID is an independent risk factor for drinking. AIM It is important to examine whether MBID is a risk factor for alcohol consumption by controlling concomitant factors in a matched-pair design. METHOD Overall, 329 students from two schools for children with MBID self-reported their drinking behavior via questionnaires, and 329 students from regular schools were matched to this group by gender, age, family composition, and parental drinking behavior. Matched pairs were compared based on alcohol consumption and motivation to drink. RESULTS MBID is a protective factor, as disabled adolescents drink less on average. This effect is mainly due to larger proportions of youth with MBID who are abstinent. When male adolescents with MBID begin to drink, they are at an increased risk for intoxication and subsequent at-risk behaviors. Motivations to drink were explained by an interaction between MBID and consumption patterns. CONCLUSIONS For male adolescents with MBID, there appears to be an "all-or-nothing" principle that guides alcohol consumption, which suggests a need for special interventions for this group.
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Affiliation(s)
- Olaf Reis
- Clinic for Child and Adolescent Psychiatry, University of Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany.
| | - Britta Wetzel
- Clinic for Child and Adolescent Psychiatry, University of Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany.
| | - Frank Häßler
- Clinic for Child and Adolescent Psychiatry, University of Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany.
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14
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Niemczyk J, von Gontard A, Equit M, Bauer K, Naumann T, Wagner C, Curfs L. Detailed assessment of incontinence in boys with fragile-X-syndrome in a home setting. Eur J Pediatr 2016; 175:1325-34. [PMID: 27567619 DOI: 10.1007/s00431-016-2767-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 08/15/2016] [Accepted: 08/19/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED Fragile-X-syndrome (FXS) is caused by a mutation on the X chromosome (Xq27.3). Males with a full mutation have typical dysmorphic signs, moderate intellectual disability and psychological disorders. Twenty-five to fifty percent are affected by incontinence. The aim of the study was to assess subtypes of incontinence and psychological problems in children with FXS in their home environments. Twenty-two boys with FXS (mean age 11.0 years) and 22 healthy controls (mean age 11.1 years) were examined with sonography, uroflowmetry, 48-h bladder diary, physical examination, IQ test, parental psychiatric interview and questionnaires regarding incontinence and psychological symptoms in a home setting. Boys with FXS had higher rates of incontinence than controls (59.1 vs. 4.8 %). The most common subtypes in FXS boys were primary non-monosymptomatic nocturnal enuresis, urge incontinence and nonretentive faecal incontinence. 90.9 % boys with FXS had a psychological comorbidity. Incontinence and behavioural symptoms were not associated. CONCLUSION Boys with FXS have a higher risk for physical disabilities, psychological disorders and incontinence than healthy boys. Constipation is not a major problem in FXS. As effective treatment is available for children with ID, we recommend offering assessment and therapy to all children with FXS and incontinence. WHAT IS KNOWN • Boys with fragile-X-syndrome (FXS) have higher rates of incontinence, psychological disorders and somatic conditions than typically developing boys. What is New: • Constipation is a rare condition in FXS in contrast to other genetic syndromes. • Although incontinence rates are higher, urological findings (uroflowmetry, sonography) are not more pathological per se in FXS.
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Affiliation(s)
- Justine Niemczyk
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany.
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany
| | - Monika Equit
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany
| | - Katharina Bauer
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany
| | - Teresa Naumann
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany
| | - C Wagner
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany
| | - Leopold Curfs
- Department of Clinical Genetics, Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
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15
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Freeman NC, Gray KM, Taffe JR, Cornish KM. A cross-syndrome evaluation of a new attention rating scale: The Scale of Attention in Intellectual Disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 57:18-28. [PMID: 27348856 DOI: 10.1016/j.ridd.2016.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 05/23/2016] [Accepted: 06/07/2016] [Indexed: 06/06/2023]
Abstract
Whilst neuropsychological research has enhanced our understanding of inattentive and hyperactive behaviours among children with intellectual disability (ID), the absence of rating scales developed for this group continues to be a gap in knowledge. This study examined these behaviours in 176 children with autism spectrum disorder (ASD), Down Syndrome (DS), or idiopathic ID using a newly developed teacher rating scale, the Scale of Attention in Intellectual Disability. Findings suggested that children with ASD had a significantly greater breadth of hyperactive/impulsive behaviours than those with DS or idiopathic ID. These findings support existing research suggesting differing profiles of attention and activity across groups. Understanding disorder-specific profiles has implications for developing strategies to support students with ID in the classroom.
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Affiliation(s)
- Nerelie C Freeman
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Victoria, 3168, Australia
| | - Kylie M Gray
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Victoria, 3168, Australia.
| | - John R Taffe
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Victoria, 3168, Australia
| | - Kim M Cornish
- Monash University, School of Psychological Sciences, Faculty of Medicine, Nursing & Health Sciences, Building 17, Clayton campus, Wellington Road, Victoria, 3800, Australia
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16
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Pierpont EI, Wolford M. Behavioral functioning in cardiofaciocutaneous syndrome: Risk factors and impact on parenting experience. Am J Med Genet A 2016; 170:1974-88. [PMID: 27149079 DOI: 10.1002/ajmg.a.37725] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/24/2016] [Indexed: 11/10/2022]
Abstract
The present study is an investigation of behavioral functioning in children with cardiofaciocutaneous syndrome (CFC). CFC is a rare single-gene disorder associated with cardiac disease, characteristic skin and facial features, intellectual disability, and neurological complications such as seizures and structural brain anomalies. Emotional and behavioral features of CFC have not been systematically investigated. We aimed to identify key variables that contribute to psychopathology during childhood and adolescence, and to examine the impact of challenging behaviors on the caregiving experience. Parents of 34 children and adolescents with CFC completed standardized broadband measures of child emotional and behavioral functioning, as well as measures of sensory modulation, functional communication, and caregiver stress. Results indicate that children with CFC syndrome are at heightened risk for psychopathology, with attention problems, social difficulties, and unusual behaviors (e.g., obsessive thoughts, strange behaviors, repetitive acts) found to be especially prevalent. Behavioral challenges in children with CFC syndrome were significantly associated with a history of obstetric complications and with problems modulating sensory information. With regard to the impact of child neurocognitive and behavioral issues on the caregiving experience, parent self-reported stress was significantly higher among parents of children who engaged in more problem behaviors, and lower among parents whose children could communicate effectively with others. Results of this study suggest avenues to help families cope with CFC-related stressors and enhance overall functioning. In particular, this study highlights the need for educational and treatment interventions aimed at addressing sensory needs, increasing functional communication, and identifying and managing challenging behaviors. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Elizabeth I Pierpont
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Melinda Wolford
- Department of Counseling, Special Education and School Psychology, Youngstown State University, Youngstown, Ohio
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17
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Fevang SKE, Hysing M, Markestad T, Sommerfelt K. Mental Health in Children Born Extremely Preterm Without Severe Neurodevelopmental Disabilities. Pediatrics 2016; 137:peds.2015-3002. [PMID: 26944946 DOI: 10.1542/peds.2015-3002] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the prevalence and gender characteristics of mental health problems in extremely preterm/extremely low birth weight (EP/ELBW) children without intellectual disabilities, blindness, deafness, or severe cerebral palsy compared with a reference group at 11 years of age. METHODS In a national cohort of EP/ELBW children, mental health was assessed by parental and teacher report by using the Autism Spectrum Screening Questionnaire, the Swanson, Noland, and Pelham Questionnaire IV (attention-deficit/hyperactivity disorder), the Screen for Child Anxiety Related Emotional Disorders, symptoms of obsessive-compulsive disorder (OCD), and a total difficulties score from the Strength and Difficulties Questionnaire. Pervasive rating was defined as both parent and teacher scoring the child ≥95th percentile (≥90th percentile for total difficulties score) of the reference group, which was the population-based Bergen Child Study. RESULTS Of eligible children, 216 (64%) EP/ELBW and 1882 (61%) reference children participated. EP/ELBW children were at significantly increased risk of pervasive rated symptoms of autism (odds ratio 4.3, 95% confidence interval 2.0-9.3), inattention (8.3, 4.4-15), anxiety (2.3, 1.4-3.7), OCD (2.6, 1.4-3.7), and ≥90th percentile for total difficulties score (4.9, 2.9-8.2). Reported by either parents or teachers, 54% of the EP/ELBW and 21% of the reference children had ≥1 mental health problem (odds ratio 4.5, 95% confidence interval 3.3-6.1). There were no significant interactions between EP/ELBW and gender in mental health outcomes. CONCLUSIONS EP/ELBW children without severe disabilities had increased risk of symptoms of autism, inattention, anxiety, and OCD. Gender differences were comparable to the reference group.
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Affiliation(s)
- Silje Katrine Elgen Fevang
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway; Department of Pediatrics, Haukeland University Hospital, Bergen, Norway; and
| | - Mari Hysing
- Uni Research Health, Regional Centre for Child and Youth Mental Health and Child Welfare, Bergen, Norway
| | - Trond Markestad
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway; Department of Pediatrics, Haukeland University Hospital, Bergen, Norway; and
| | - Kristian Sommerfelt
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway; Department of Pediatrics, Haukeland University Hospital, Bergen, Norway; and
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18
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Schmidt S, Nag HE, Hunn BS, Houge G, Hoxmark LB. A structured assessment of motor function and behavior in patients with Kleefstra syndrome. Eur J Med Genet 2016; 59:240-8. [PMID: 26808425 DOI: 10.1016/j.ejmg.2016.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 01/18/2016] [Accepted: 01/21/2016] [Indexed: 12/12/2022]
Abstract
The present study aimed to further our understanding of Kleefstra syndrome, especially regarding motor function and behavioral characteristics. In total, four males and four females between two and 27 years of age with a genetically confirmed diagnosis of Kleefstra syndrome and their parents participated in this study. Four patients had 9q34.3 deletions that caused Euchromatin Histone Methyl Transferase 1 (EHMT1) haplo-insufficiency, and four patients harbored EHMT1 mutations. The motor function was evaluated via systematic observation. Standardized assessments such as the Vineland Adapted Behavior Scales II (VABS II), the Social Communication Questionnaire (SCQ) and the Child or Adult Behavior Checklist (CBCL, ABCL) were used for the behavioral assessment. All patients showed a delayed developmental status. Muscular hypotonia and its manifestations were present in all patients, regardless of their age. The mean values for all VABS II domains (communication, socialization, daily living skills, and motor skills) were significantly lower than the mean of the reference population (p < 0.001), but similar to other rare intellectual disabilities such as Smith-Magenis syndrome and Angelman syndrome. The results from the SCQ indicated that all patient values exceeded the cut-off value, suggesting the possibility of autism spectrum disorder. The behavioral and emotional problems assessed by CBCL and ABCL were less frequent. In conclusion, patients with Kleefstra syndrome present with a broad range of clinical problems in all age groups and are therefore in need of a multidisciplinary follow-up also after their transition into adulthood.
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Affiliation(s)
| | - Heidi E Nag
- Frambu Resource Centre for Rare Disorders, Siggerud, Norway
| | - Bente S Hunn
- Frambu Resource Centre for Rare Disorders, Siggerud, Norway
| | - Gunnar Houge
- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - Lise B Hoxmark
- Frambu Resource Centre for Rare Disorders, Siggerud, Norway.
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19
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Soltau B, Biedermann J, Hennicke K, Fydrich T. Mental health needs and availability of mental health care for children and adolescents with intellectual disability in Berlin. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:983-994. [PMID: 25716574 DOI: 10.1111/jir.12185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 09/12/2014] [Accepted: 12/07/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND The increased risk of mental health problems in children and adolescents with intellectual disability (ID) has been reported in several studies. However, almost no research has been conducted on parents' experiences with the general mental health system. We have investigated the prevalence of emotional and behavioural problems in children with ID as well as the availability and quality of mental health care from the parents' point of view. METHODS Teachers of specialised schools for ID in Berlin were asked to complete the Teacher's Report Form (TRF) of the Child Behavior Checklist. Information was collected for 1226 children and adolescents aged 6-18 years with mild to profound ID (response 70.5%). The availability and quality of mental health care was assessed by a questionnaire given to parents who had already been seeking help for their children. A total of 330 parents completed the questionnaires (response 62.0%). In addition to univariate analysis, we conducted multiple logistic regressions regarding the psychopathology reported by teachers (TRF-syndrome scales) and difficulties concerning mental health care reported by parents for a paired sample of 308 children. RESULTS Overall, 52.4% of the children and adolescents with ID had a total problem score on the TRF in the deviant range (47.1% when eliminating four items reflecting cognitive deficits). Compared with the general population normative sample of children, this is a three-time higher prevalence. The most striking problems were thought problems (schizoid and obsessive-compulsive), aggressive behaviour, attention problems and social problems. Parents whose children had more severe behavioural or emotional dysfunction reported more difficulties with the mental health system. From the parents' point of view, mental health professionals frequently did not feel responsible or were not sufficiently skilled for the treatment of children with ID. As a consequence, 96% of all parents were longing for specialised in- and outpatient services. CONCLUSIONS This study confirms the findings from other studies regarding the high rate of co-occurrence of ID and mental health problems in youths. Results indicate that both are strongly requested by parents: specialised in- and outpatient services, as well as more professional general services and equitable treatment for all children, with and without ID.
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Affiliation(s)
- B Soltau
- Institute of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - J Biedermann
- Institute of Forensic Psychiatry, Charité - University of Medicine Berlin, Berlin, Germany
| | - K Hennicke
- Institute of Curative Education and Social Therapy, Evangelische Fachhochschule Rheinland-Westfalen-Lippe, Bochum, Germany
| | - T Fydrich
- Institute of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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20
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Marquis WA, Baker BL. An examination of Anglo and Latino parenting practices: relation to behavior problems in children with or without developmental delay. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:383-392. [PMID: 24334227 DOI: 10.1016/j.ridd.2013.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 11/13/2013] [Indexed: 06/03/2023]
Abstract
The transactional model of development has received empirical support in research on at-risk children. However, little is known about the role of ethnicity or child delay status (i.e., developmental delay [DD] or typical cognitive development [TD]) in the process of parents adapting to their child's behavior problems and special needs. We examined whether Latina (N=44) and Anglo (N=147) mothers of 3-year-old children with or without DD differed in their use of two parenting practices, maternal scaffolding and sensitivity. We also examined how the status and ethnic groups differed in child behavior problems at ages 3 and 5 and whether parenting predicted change in behavior problems over time in the ethnic and status groups. Analyses generally supported previous research on status group differences in behavior problems (DD higher) and parenting practices (TD higher). Parenting practices predicted a decrease in externalizing problems from child age 3 to 5 years among Latino families only. Child developmental status was not associated with change in behavior problems. Cultural perspectives on the transactional model of development and implications for intervention are discussed.
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Affiliation(s)
- Willa A Marquis
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA.
| | - Bruce L Baker
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA
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21
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Socio-emotional Problems in Children with CDG. JIMD Rep 2013; 11:139-48. [PMID: 23733602 DOI: 10.1007/8904_2013_233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/05/2013] [Accepted: 04/12/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Congenital disorders of glycosylation (CDG) form a group of inherited metabolic diseases. Although the clinical presentation shows extreme variability, the nervous system is frequently affected. Several parents of our patients diagnosed with CDG reported behavioral problems, including mood swings, depressive behavior, and anxiety. This raised the question whether patients with CDG have an increased risk for socio-emotional problems. METHODS We evaluated 18 children with confirmed CDG. The Child Behavior Checklist (CBCL) was used to screen for socio-emotional problems. To determine the disease progression and severity in CDG, the Nijmegen Paediatric CDG Rating Scale (NPCRS) was used. RESULTS were compared to "norm scores" and to children with mitochondrial disorders and children with other chronic metabolic disorders with multisystem involvement. RESULTS RESULTS showed a high prevalence of socio-emotional problems in children with CDG. Mean total scores, scores on withdrawn/depressed behavior, social problems, and somatic complaints were significantly increased. More than two thirds of our CDG patients have abnormal scores on CBCL. The mean score on social problems was significantly higher compared to our two control groups of patients with other chronic metabolic disorders. CONCLUSIONS Patients with CDG have an increased risk of developing socio-emotional problems. A standard screening for psychological problems is recommended for the early detection of psychological problems in CDG patients.
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Mammen P, Russell PSS, Nair MKC, Russell S, Kishore C, Shankar S. Development and psychometric validation of the Brief Intellectual Disability Scale for use in low-health resource, high-burden countries. J Clin Epidemiol 2013. [PMID: 23177892 DOI: 10.1016/j.jclinepi.2012.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To develop and validate a concise, parent-completed Brief Intellectual Disability Scale (BIDS) for children in low-disability resource and high-disability care burden countries. STUDY DESIGN AND SETTING In this prospective cross-sectional study of 124 children recruited from a facility for intellectual disability (ID), the newly developed BIDS as the measure for validation as well as for the gold standard and convergent and divergent validities was administered by independent raters. Tests for diagnostic accuracy, reproducibility, and validity were conducted at the item and scale levels. RESULTS The BIDS scores of ≥5 (sensitivity [Sn] = 71.43%, specificity [Sp] = 80.95%) and ≥11 (Sn = 4.29%, Sp = 100%), with area under the curve of 0.79, are suggested, respectively, for screening and diagnostic use in Indian populations. The inter-rater reliability (intra-class correlation coefficient [ICC] = 0.96) and test-retest reliability at 4 weeks (ICC = 0.95) for BIDS are strong. Besides the adequate face and content validities, BIDS demonstrates good internal consistency (Cronbach α = 0.80) and item-total correlation. There is moderate convergent validity with Binet-Kamat Test of Intelligence or Gesell's Developmental Schedule (r = -0.66, P = 0.001) as well as with adaptive behavior measure of Vineland Social Maturity Scale (r =-0.52, P = 0.001) and low divergent validity with the subscales of Attention Deficit Disorder with Hyperactivity: Comprehensive Teacher Rating Scale ( r = -0.11, P = 0.7; r = 0.18, P = 0.5; r = 0.13, P = 0.6; r = 0.08, P = 0.7). An exploratory factor analysis demonstrated a three-factor structure, explaining 60% of variance. CONCLUSION The BIDS shows promise as a psychometrically adequate, yet brief measure for identifying ID in countries with low disability care resources and high disability-related burden.
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Affiliation(s)
- Priya Mammen
- Facility for Children with Intellectual Disability, Child and Adolescent Psychiatry Unit, Department of Psychiatry, Christian Medical College, Vellore 632 002, India.
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Vrijmoeth C, Monbaliu E, Lagast E, Prinzie P. Behavioral problems in children with motor and intellectual disabilities: prevalence and associations with maladaptive personality and marital relationship. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1027-1038. [PMID: 22502827 DOI: 10.1016/j.ridd.2012.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 01/24/2012] [Accepted: 01/24/2012] [Indexed: 05/31/2023]
Abstract
Prevalence rates of behavioral problems in children with motor disabilities are commonly based on questionnaires developed for a general population (e.g., Child Behavior CheckList). These questionnaires do not take into account lower levels of intellectual functioning. The first aim of this study was to examine the prevalence of parent-reported and daily caretaker-reported behavioral problems in children with motor and intellectual disabilities (MID) using the Developmental Behavior Checklist. Second, we investigated whether behavioral problems were related to sex and age. Our third and fourth aim were to determine whether behavioral problems are related to maladaptive personality traits and to marital stress and conflict. Participants were 101 Flemish children with MID (mean age=14 years 6 months). For total behavioral problems, we found prevalence rates of 18% and 8% based on parent and daily caretaker reports, respectively. Based on parent reports, twenty seven percent of the children with MID exhibited anxiety problems. Behavioral problems were not related to sex. Older children showed fewer behavioral problems than younger children. Multiple hierarchical regression analyses revealed that lower scores on Compulsivity and higher scores on Emotional Instability and Disagreeableness were related to behavioral problems. In addition to personality traits, stress and conflict in the marital relationship was also positively associated with behavioral problems. Given the importance of behavioral problems in children with MID, this study is of theoretical and clinical interest and has the potential to inform targeted clinical interventions.
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Affiliation(s)
- Cis Vrijmoeth
- Department of Child and Adolescent Studies, Utrecht University, The Netherlands
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Abstract
Children and adolescents with intellectual disabilities (IDs), often diagnosed with comorbid psychiatric disorders, are a vulnerable population who may be at risk for developing suicidal thoughts and behaviors. Previous research has demonstrated that direct suicide screening can rapidly and effectively detect suicide risk and facilitate further clinical evaluation and management. Currently, there are no measures that screen for suicide risk designed specifically for individuals with ID. A review of the literature was conducted to (1) estimate the prevalence of suicidal thoughts, behaviors, and deaths by suicide in children and adolescents with ID; (2) describe associations between youth with ID and suicide risk; and (3) identify the limitations of commonly used suicide screening measures developed for non-ID youth. The literature review confirms that suicide risk exists in this population; youth with ID think about, attempt, and die by suicide. Standardized suicide risk screening is challenged by the lack of measures developed for this population. A summary of the findings is followed by a discussion of the practical clinical considerations surrounding the assessment of suicide risk in youth with ID.
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Zachi EC, Taub A, Ventura DF. Perfil comportamental e competência social de crianças e adolescentes com distrofia muscular de Duchenne. ESTUDOS DE PSICOLOGIA (NATAL) 2012. [DOI: 10.1590/s1413-294x2012000100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A distrofia muscular de Duchenne é uma doença genética caracterizada por enfraquecimento muscular progressivo e degeneração irreversível, acompanhados por danos sensoriais e neuropsicológicos. Os objetivos do estudo consistiram em avaliar o perfil comportamental de crianças/adolescentes com DMD e a influência do prejuízo motor, da idade no início do uso de cadeira de rodas e da idade no diagnóstico. Participaram 34 pacientes e 20 controles. Os pacientes formaram dois grupos conforme o quociente de inteligência (QI). Os pais responderam ao Inventário de Comportamentos da Infância e da Adolescência. Pacientes com DMD obtiveram escores mais baixos em Atividades e Sociabilidade (p < 0,01; ANCOVA). Os pacientes com QI < 80 apresentaram menores índices de Escolaridade. O prejuízo motor e as idades referentes à cadeira e ao diagnóstico correlacionaram-se com sintomas psiquiátricos/somáticos e problemas escolares. Os achados enfatizam a necessidade de programas educacionais acerca da doença como base para o desenvolvimento de estratégias de inclusão social.
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Skokauskas N, Gallagher L. Mental health aspects of autistic spectrum disorders in children. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:248-257. [PMID: 21554467 DOI: 10.1111/j.1365-2788.2011.01423.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Previous studies have reported variable and at times opposite findings on comorbid psychiatric problems in children with autistic spectrum disorders (ASD). AIMS This study aimed to examine patterns of comorbid psychiatric problems in children with ASD and their parents compared with IQ matched controls and their parents. METHODS Behavioural/emotional problems were evaluated in a sample of children with ASD [a diagnosis of ASD was given if they met criteria for ASD on both of the ADI-R (Autism Diagnostic Interview-Revised) and ADOS (Autism Diagnostic Observational Schedule)] and an age and IQ matched control group using the Child Behavior Checklist (CBCL/6-18). Parental psychological distress for both groups was evaluated with the Brief Symptom Inventory (BSI). RESULTS There were 59 (88%) boys and 8 (12%) girls in the ASD group. Similarly, 57 (85%) of the control group were male and 10 (15%) were female. The groups did not differ significantly on mean age, mean IQ scores, gender and parents mean age. Results of the CBCL/6-18 revealed that the majority of parents reported their child with ASD as having either internalising (clinical range: 47.8%; borderline range: 16.4%) or externalising problems (clinical range: 10.4%; borderline range: 20.9%). In the control group more parents reported their children having externalising (clinical range: 46.3%; borderline range: 16.4%) than internalising problems (clinical range: 35.8%; borderline range: 11.9%). Almost a half of the ASD group met CBCL DSM criteria for clinically significant attention deficit hyperactivity disorder (44.78%) and anxiety (46.2%) problems. Based on the Brief Symptom Inventory Global Severity Index 22.4% of fathers and 23.8% of mothers of ASD children produced scores that were indicative of possible psychopathology. CONCLUSIONS High rates of clinically significant psychiatric problems were detected in ASD children, with anxiety and attention deficit hyperactivity disorder being the most frequently detected syndromes.
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Affiliation(s)
- N Skokauskas
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland.
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Matson JL, Belva BC, Hattier MA, Matson ML. Scaling methods to measure psychopathology in persons with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:549-562. [PMID: 22119704 DOI: 10.1016/j.ridd.2011.10.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 09/15/2011] [Indexed: 05/31/2023]
Abstract
Psychopathology prior to the last four decades was generally viewed as a set of problems and disorders that did not occur in persons with intellectual disabilities (ID). That notion now seems very antiquated. In no small part, a revolutionary development of scales worldwide has occurred for the assessment of emotional problems in persons with ID. The first standardized test to emerge was the Psychopathology Instrument for Mentally Retarded Adults (PIMRA) in 1984. Since that time, an impressive number of measures of general psychopathology have emerged for adults and children as well as for persons across the full range of levels of ID. The purpose of this review was to provide a description of available measures, to review papers published on these measures, and to discuss emerging trends in test development. The trends in this body of information for enhancing differential diagnosis of psychopathology in persons with ID are discussed.
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Affiliation(s)
- Johnny L Matson
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, USA.
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Özer D, Baran F, Aktop A, Nalbant S, Ağlamış E, Hutzler Y. Effects of a Special Olympics Unified Sports soccer program on psycho-social attributes of youth with and without intellectual disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:229-39. [PMID: 22093669 DOI: 10.1016/j.ridd.2011.09.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 09/09/2011] [Accepted: 09/09/2011] [Indexed: 05/25/2023]
Abstract
The purpose of the study was to investigate the effects of a Special Olympics (SO) Unified Sports (UNS) soccer program on psycho-social attributes of youth with and without intellectual disabilities (ID). Participants were 76 male youth with (n=38) and without (n=38) ID. Participants with ID were randomly allocated into a SO athletes group (n=23, mean age=14.5; SD=1.2 years) and a control group (CG) (n=15, mean age=14.5; SD=.8 years). Twenty-three randomly selected youth without ID formed the partner group (mean age=14.1; SD=.9 years) and 15 youth without ID (mean age=13.8; SD=.5 years) formed the CG. Instruments included the Friendship Activity Scale (FAS) (Siperstein, 1980), the Adjective Checklist (Siperstein, 1980), and the Children Behavior Checklist (Achenbach, 1991). The soccer training program lasted eight weeks, 1.5h per session, three times per week, in addition to school physical education (PE). The CG did not participate in any sports in addition to PE. The findings showed that the UNS program was effective in decreasing the problem behaviors of youth with ID and increasing their social competence and FAS scores. In addition, the program was found to be effective in improving the attitude of youth without disabilities toward participants with disabilities. In conclusion, the present findings demonstrate the utility of a UNS program for both youth with and without disabilities.
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Affiliation(s)
- D Özer
- Çanakkale Onsekiz Mart University School of Physical Education and Sport, Turkey
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Fagerlund A, Autti-Rämö I, Hoyme HE, Mattson SN, Korkman M. Risk factors for behavioural problems in foetal alcohol spectrum disorders. Acta Paediatr 2011; 100:1481-8. [PMID: 21575054 DOI: 10.1111/j.1651-2227.2011.02354.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To examine risk and protective factors associated with behavioural problems of children and adolescents following prenatal alcohol exposure. METHODS A total of 73 children and adolescents with foetal alcohol spectrum disorders (FASD) were assessed for internalizing, externalizing and total behavioural problems using the Child Behavior Checklist. Linear regression models were used to determine the effects of diagnostic and environmental risk and protective factors on behaviour, while controlling for age, sex and IQ. RESULTS Length of time spent in residential care was the most pervasive risk factor associated with internalizing, externalizing and total behavioural problems. A low dysmorphology score was related to more internalizing and total problems. CONCLUSIONS Children and adolescents prenatally exposed to alcohol faced greater risk of substantive behavioural problems (i) if they were less visibly alcohol affected and (ii) the longer time they had spent in residential care. The results underscore the clinical importance of appropriate services and care for less visibly affected children with FASD and highlight the need to attend to children with FASD being raised in institutions.
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[Psychopathology in youths with intellectual disabilities--prevalence and prevention]. Prax Kinderpsychol Kinderpsychiatr 2011; 60:510-26. [PMID: 21991670 DOI: 10.13109/prkk.2011.60.7.intro] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A survey of epidemiological findings suggests a significantly increased level of emotional and behavioural problems in children and youth with intellectual disabilities. Some biological and social factors are presented which contribute to this elevated risk for psychopathology. Assessment and intervention planning needs to acknowledge genetic dispositions, and limitations of the capacity of information processing which characterise children with intellectual disabilities. Early intervention may help to prevent emotional and behavioural problems by supporting a positive parent-child relationship, increasing the parents' educational competence and assisting preschool teachers in supporting positive relationships with peers, and promoting social competence.
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van Balkom IDC, Shaw A, Vuijk PJ, Franssens M, Hoek HW, Hennekam RCM. Development and behaviour in Marshall-Smith syndrome: an exploratory study of cognition, phenotype and autism. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2011; 55:973-987. [PMID: 21790824 DOI: 10.1111/j.1365-2788.2011.01451.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Marshall-Smith syndrome (MSS) is an infrequently described entity characterised by failure to thrive, developmental delay, abnormal bone maturation and a characteristic face. In studying the physical features of a group of patients, we noticed unusual behavioural traits. This urged us to study cognition, behavioural phenotype and autism in six patients. METHODS Information on development, behavioural characteristics, autism symptoms, and adaptive and psychological functioning of six MSS children was collected through in-person examinations, questionnaires, semi-structured interviews of parents and neuropsychological assessments. RESULTS Participants showed moderate to severe delays in mental age, motor development and adaptive functioning, with several similarities in communication, social interactions and behaviour. There was severe delay of speech and motor milestones, a friendly or happy demeanour and enjoyment of social interactions with familiar others. They exhibited minimal maladaptive behaviours. Deficits in communication and social interactions, lack of reciprocal social communication skills, limited imaginary play and the occurrence of stereotyped, repetitive behaviours were noted during assessments. CONCLUSIONS Systematic collection of developmental and behavioural data in very rare entities such as MSS allows recognition of specific patterns in these qualities. Clinical recognition of physical,developmental and behavioural features is important not only for diagnosis, prognosis and counselling of families, but also increases our understanding of the biological basis of the human physical and behavioural phenotype.
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Affiliation(s)
- I D C van Balkom
- Jonx Department of Youth Mental Health, Lentis Psychiatric Institute, Zuidlaren, The Netherlands.
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Huisman M, Araya R, Lawlor DA, Ormel J, Verhulst FC, Oldehinkel AJ. Cognitive ability, parental socioeconomic position and internalising and externalising problems in adolescence: findings from two European cohort studies. Eur J Epidemiol 2010; 25:569-80. [PMID: 20535529 PMCID: PMC2921071 DOI: 10.1007/s10654-010-9473-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 05/27/2010] [Indexed: 11/28/2022]
Abstract
We investigated whether cognitive ability (CA) may be a moderator of the relationship of parental socioeconomic position (SEP) with internalising and externalising problems in adolescents. We used data from two longitudinal cohort studies; the Avon Longitudinal Study of Parents and Children (ALSPAC) and the Tracking Adolescents' Individual Lives Survey (TRAILS). Indicators of SEP were mother's education and household income. CA was estimated with IQ scores, derived from the Wechsler Intelligence Scale for Children. Internalising and externalising problems were measured with the Strengths and Difficulties Questionnaire in ALSPAC and with the Child Behavior Checklist in TRAILS. Logistic regression analyses were used to estimate the relative index of inequality (RII) for each outcome; the RII provides the odds ratio comparing the most to least deprived for each measure of SEP. In fully adjusted models an association of mother's education with externalising problems was observed [ALSPAC RII 1.42 (95%CI: 1.01-1.99); TRAILS RII 2.21 (95%CI: 1.37-3.54)], and of household income with internalising and externalising problems [pooled ALSPAC & TRAILS internalising RII 1.30 (95%CI: 0.99-1.71); pooled ALSPAC & TRAILS externalising RII 1.38 (95%CI: 1.03-1.84)]. No consistent associations were observed between mother's education and internalising problems. Results of stratified analyses and interaction-terms showed no evidence that CA moderated the association of SEP with internalising or externalising problems.
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Affiliation(s)
- Martijn Huisman
- Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, Groningen, The Netherlands.
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Ozer D, Nalbant S, Aktop A, Duman O, Keleş I, Toraman NF. Swimming training program for children with cerebral palsy: body perceptions, problem behaviour, and competence. Percept Mot Skills 2008; 105:777-87. [PMID: 18229533 DOI: 10.2466/pms.105.3.777-787] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to assess the effects of a 14-week swimming training program on the competence, problem behaviour, and body awareness in 13 children with cerebral palsy aged 5 to 10 years, compared with 10 subjects in a comparison group. Both of the groups continued a traditional rehabilitation program. The outcome measures were Child Behaviour Check List (CBCL) and Body Awareness. The parent forms were evaluated before and after training and also at 6 months followup. Teacher forms and body awareness were evaluated before and after training. The results showed that swimming training produced significant gain on body awareness in the Swimming Group, whereas no significant group differences were evident in competence and problem behaviours on parent or teacher forms of the CBCL.
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Affiliation(s)
- Dilara Ozer
- School of Physical Education and Sports, Akdeniz University.
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Kaptein S, Jansen DEMC, Vogels AGC, Reijneveld SA. Mental health problems in children with intellectual disability: use of the Strengths and Difficulties Questionnaire. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2008; 52:125-131. [PMID: 18197951 DOI: 10.1111/j.1365-2788.2007.00978.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND The assessment of mental health problems in children with intellectual disability (ID) mostly occurs by filling out long questionnaires that are not always validated for children without ID. The aim of this study is to assess the differences in mental health problems between children with ID and without ID, using a short questionnaire, the Strengths and Difficulties Questionnaire (SDQ). METHODS We studied 260 children (6-12 years) selected from special education schools for trainable children (response: 57%). Parents completed the extended Dutch version of the SDQ, questions on background characteristics and on the care provided. A non-ID control group of 707 children (response: 87%) was included to compare mental health problems. RESULTS In total, 60.9% of children with ID had an elevated score on the SDQ, compared with 9.8% of children without ID. Only 45% of the children with ID and an elevated SDQ score had visited a healthcare professional for these problems in the last 6 months. DISCUSSION The SDQ or an adapted version could contribute to the early identification of mental health problems in children with ID. Further research is needed to confirm the validity of the SDQ when used in a sample of children with ID.
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Affiliation(s)
- S Kaptein
- University Medical Center Groningen, University of Groningen, Department of Health Sciences, Groningen, The Netherlands
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Tenneij NH, Koot HM. A Preliminary Investigation into the Utility of the Adult Behavior Checklist in the Assessment of Psychopathology in People with Low IQ. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2007. [DOI: 10.1111/j.1468-3148.2007.00383.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Antshel KM, Faraone SV, Fremont W, Monuteaux MC, Kates WR, Doyle A, Mick E, Biederman J. Comparing ADHD in velocardiofacial syndrome to idiopathic ADHD: a preliminary study. J Atten Disord 2007; 11:64-73. [PMID: 17606773 DOI: 10.1177/1087054707299397] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Children with velocardiofacial syndrome (VCFS), a contiguous deletion syndrome, have an increased prevalence of attention deficit/hyperactivity disorder (ADHD). METHOD The authors compared youth with VCFS+ADHD (from the SUNY Upstate VCFS Research Program) to those with ADHD but not VCFS (from the Massachusetts General Hospital Longitudinal Family Studies of ADHD). RESULTS Children with VCFS+ADHD were more likely to be diagnosed with the inattentive subtype and differed from idiopathic ADHD in the frequency of several inattentive symptoms that appear linked to general cognitive functioning. After controlling for IQ differences, parents of children with VCFS+ADHD endorsed more thought and social problems on a rating checklist. Patterns of comorbidity also differed between the two groups of children with ADHD: Children with idiopathic ADHD had higher rates of comorbid major depression and disruptive behavior disorders. CONCLUSION Children with VCFS+ADHD may have a different profile of ADHD symptoms and comorbidity when compared to children with idiopathic ADHD.
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de Ruiter KP, Dekker MC, Verhulst FC, Koot HM. Developmental course of psychopathology in youths with and without intellectual disabilities. J Child Psychol Psychiatry 2007; 48:498-507. [PMID: 17501731 DOI: 10.1111/j.1469-7610.2006.01712.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to describe similarities and differences in the developmental course of psychopathology between children with and without intellectual disabilities (ID). METHODS Multilevel growth curve analysis was used to analyse the developmental course of psychopathology, using the Child Behavior Checklist (CBCL), in two longitudinal multiple-birth-cohort samples of 6- to 18-year-old children with ID (N = 978) and without ID (N = 2,047) using three repeated measurements across a 6-year period. RESULTS Children with ID showed a higher level of problem behaviours across all ages compared to children without ID. A significant difference between the samples in the developmental courses was found for Aggressive Behaviour and Attention Problems, where children with ID showed a significantly larger decrease. Gender differences in the development of psychopathology were similar in both samples, except for Social Problems where males with ID showed a larger decrease in problem behaviour across time than females with ID and males and females without ID. CONCLUSIONS Results indicate that children with ID continue to show a greater risk for psychopathology compared to typically developing children, although this higher risk is less pronounced at age 18 than it is at age 6 for Aggressive Behaviour. Contrary to our expectations, the developmental course of psychopathology in children with ID was quite similar from age 6 to 18 compared to children without ID. The normative developmental trajectories of psychopathology in children with ID, presented here, can serve as a yardstick against which development of childhood psychopathology can be detected as deviant.
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Affiliation(s)
- Karen P de Ruiter
- Department of Child and Adolescent Psychiatry, Erasmus MC-Sophia, Rotterdam, The Netherlands
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OZER DILARA. SWIMMING TRAINING PROGRAM FOR CHILDREN WITH CEREBRAL PALSY: BODY PERCEPTIONS, PROBLEM BEHAVIOUR, AND COMPETENCE. Percept Mot Skills 2007. [DOI: 10.2466/pms.105.7.777-787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sarimski K. Psychische Störungen bei behinderten Kindern und Jugendlichen - Übersicht und Schlussfolgerungen für die Psychodiagnostik. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2007; 35:19-29; quiz 30-1. [PMID: 17230426 DOI: 10.1024/1422-4917.35.1.19] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Es wird eine Übersicht über die Studien zur Prävalenz psychischer Störungen bei Hörschädigung, Blindheit, körperlicher oder intellektueller Behinderung gegeben. Neben Entwicklungseinschränkungen in Folge von organischen oder genetischen Bedingungen tragen Belastungen der Eltern-Kind-Beziehung und der Entwicklung sozialer Kompetenzen sowie der sozialen Partizipation zu einem deutlich erhöhten Risiko für die Ausbildung emotionaler oder sozialer Störungen bei. Probleme der psychopathologischen Beurteilung sowie der Differenzierung zwischen Auswirkungen der Behinderung und psychischer Störung werden diskutiert und Schlussfolgerungen für die Praxis gezogen.
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Einfeld SL, Piccinin AM, Mackinnon A, Hofer SM, Taffe J, Gray KM, Bontempo DE, Hoffman LR, Parmenter T, Tonge BJ. Psychopathology in young people with intellectual disability. JAMA 2006; 296:1981-9. [PMID: 17062861 PMCID: PMC2422867 DOI: 10.1001/jama.296.16.1981] [Citation(s) in RCA: 172] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
CONTEXT Comorbid severe mental health problems complicating intellectual disability are a common and costly public health problem. Although these problems are known to begin in early childhood, little is known of how they evolve over time or whether they continue into adulthood. OBJECTIVE To study the course of psychopathology in a representative population of children and adolescents with intellectual disability. DESIGN, SETTING, AND PARTICIPANTS The participants of the Australian Child to Adult Development Study, an epidemiological cohort of 578 children and adolescents recruited in 1991 from health, education, and family agencies that provided services to children with intellectual disability aged 5 to 19.5 years in 6 rural and urban census regions in Australia, were followed up for 14 years with 4 time waves of data collection. Data were obtained from 507 participants, with 84% of wave 1 (1991-1992) participants being followed up at wave 4 (2002-2003). MAIN OUTCOME MEASURES The Developmental Behaviour Checklist (DBC), a validated measure of psychopathology in young people with intellectual disability, completed by parents or other caregivers. Changes over time in the Total Behaviour Problem Score and 5 subscale scores of the DBC scores were modeled using growth curve analysis. RESULTS High initial levels of behavioral and emotional disturbance decreased only slowly over time, remaining high into young adulthood, declining by 1.05 per year on the DBC Total Behaviour Problem Score. Overall severity of psychopathology was similar across mild to severe ranges of intellectual disability (with mean Total Behaviour Problem Scores of approximately 44). Psychopathology decreased more in boys than girls over time (boys starting with scores 2.61 points higher at baseline and ending with scores 2.57 points lower at wave 4), and more so in participants with mild intellectual disability compared with those with severe or profound intellectual disability who diverged from having scores 0.53 points lower at study commencement increasing to a difference of 6.98 points below severely affected children by wave 4. This trend was observed in each of the subscales, except the social-relating disturbance subscale, which increased over time. Prevalence of participants meeting criteria for major psychopathology or definite psychiatric disorder decreased from 41% at wave 1 to 31% at wave 4. Few of the participants (10%) with psychopathology received mental health interventions during the study period. CONCLUSION These results provide evidence that the problem of psychopathology comorbid with intellectual disability is both substantial and persistent and suggest the need for effective mental health interventions.
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Affiliation(s)
- Stewart L Einfeld
- School of Psychiatry, University of New South Wales, 190 Russell Ave, Dolls Point, NSW 2219, Australia. [corrected]
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Galéra C, Delrue MA, Goizet C, Etchegoyhen K, Taupiac E, Sigaudy S, Arveiler B, Philip N, Bouvard M, Lacombe D. Behavioral and temperamental features of children with Costello syndrome. Am J Med Genet A 2006; 140:968-74. [PMID: 16575889 DOI: 10.1002/ajmg.a.31169] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Costello syndrome (CS) is a rare genetic condition due to germline mutations in HRAS proto-oncogene and characterized by increased birth weight, postnatal growth retardation, distinctive facial appearance, typical medical problems (including feeding problems in the neonatal period), cutaneous anomalies, and developmental delay. Outgoing personality has often been noted in case reports, but few studies have focused specifically on the behavioral aspects of CS. A preliminary survey described irritability in younger patients with improvement between age 2 and 4, but a standardized psychometric tool was not used. A second study using the Child Behavior Checklist (CBCL) showed relatively high (albeit subclinical) levels of internalizing problems. These descriptive investigations lacked a control group. We describe a comparative survey to evaluate the behavioral and temperamental features of children with CS. We conducted a cross-sectional assessment using the CBCL and the Emotionality, Activity, Shyness, Sociability (EAS) temperament questionnaire to evaluate behavior and temperament in 11 CS children (2 years 5 months to 9 years) comparing them to 33 gender- and age-matched children without disability. The results suggest that the high levels of internalizing problems found before age 4 in CS patients might decrease with age. They also point to possible "hyperemotionality." Further studies using a larger sample size and IQ-matched control groups are needed to more accurately characterize individuals with this rare syndrome.
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Affiliation(s)
- Cédric Galéra
- Child Psychiatry Department, Centre Hospitalier Charles-Perrens, Bordeaux2 University, Bordeaux, France.
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Abstract
PURPOSE OF REVIEW This review examines an eclectic selection of publications from the past 12 months under the broad heading of 'assessment in intellectual disability'. Being unable to cover all possible publications the authors have concentrated on the assessment of pain (in those with severe intellectual disability), psychopathology, risk assessment and offending, autism, preference and choice, and dementia. RECENT FINDINGS Research into assessment has generally taken the form of developing new instruments, or adapting existing ones, or comparing the performance of a range of scales in a certain area. Researchers are using increasingly sophisticated psychometric analyses and refining the nature and purpose of tools for a range of clinical purposes. SUMMARY The result of recent effort in this area is better instruments, often developed by experienced researchers who have been working in their chosen area of speciality for some years. It has been a very worthwhile period of extension and consolidation.
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Affiliation(s)
- Caroline Mohr
- Monash University Centre for Developmental Psychiatry and Psychology, Capital and Coast District Health Board, Porirua, Wellington, New Zealand.
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