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Carl A, Good M, Haag E, Hutaff-Lee C, Swain D, Tartaglia N, Sakamoto C, Davis S, Thompson T. Anxiety in Turner syndrome: Engaging community to address barriers and facilitators to diagnosis and care. Am J Med Genet A 2024:e63564. [PMID: 38528640 DOI: 10.1002/ajmg.a.63564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 03/27/2024]
Abstract
Turner syndrome (TS), caused by complete or partial loss of the second sex chromosome, is associated with complex medical manifestations. The TS community identifies anxiety as a major contributor to reduced quality of life. The study aimed to improve understanding of anxiety symptomatology, diagnosis, and care in individuals with TS. A mixed methods design integrated community engagement, including community leaders as co-investigators and a community advisory board, an online survey (N = 135), and in-depth interviews (N = 10). The majority of respondents reported that anxiety symptoms occur two or more days per week, with self-advocates reporting more frequent symptoms than caregivers (p = 0.03). Self-advocates reported feeling anxious more often at school/work; both rater groups reported anxiety-related behaviors were most likely to be expressed at home. Insomnia was the most common symptom of anxiety endorsed across age and rater groups (>70%). Anxiety symptoms and triggers changed with age and often were undiagnosed or untreated during childhood. Therapy and medication were reported as helpful by most respondents who had tried these strategies. Qualitative themes included: 'Triggers for anxiety are related to TS', 'Anxiety impacts the whole family', and 'Opportunities for early identification and intervention'.
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Affiliation(s)
- Alexandra Carl
- eXtraOrdinary Kids Turner Syndrome Research and Clinic Team, Children's Hospital of Colorado, Aurora, Colorado, USA
| | | | | | - Christa Hutaff-Lee
- eXtraOrdinary Kids Turner Syndrome Research and Clinic Team, Children's Hospital of Colorado, Aurora, Colorado, USA
- Division of Neurology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Deanna Swain
- Division of Developmental Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicole Tartaglia
- eXtraOrdinary Kids Turner Syndrome Research and Clinic Team, Children's Hospital of Colorado, Aurora, Colorado, USA
- Division of Developmental Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Casey Sakamoto
- Child Health Biostatistics Core, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shanlee Davis
- eXtraOrdinary Kids Turner Syndrome Research and Clinic Team, Children's Hospital of Colorado, Aurora, Colorado, USA
- Division of Endocrinology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Talia Thompson
- eXtraOrdinary Kids Turner Syndrome Research and Clinic Team, Children's Hospital of Colorado, Aurora, Colorado, USA
- Child Health Biostatistics Core, University of Colorado School of Medicine, Aurora, Colorado, USA
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Urbanus E, Swaab H, Tartaglia N, van Rijn S. Social Communication in Young Children With Sex Chromosome Trisomy (XXY, XXX, XYY): A Study With Eye Tracking and Heart Rate Measures. Arch Clin Neuropsychol 2023:acad088. [PMID: 37987192 DOI: 10.1093/arclin/acad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE Children with sex chromosome trisomy (SCT) have an increased risk for suboptimal development. Difficulties with language are frequently reported, start from a very young age, and encompass various domains. This cross-sectional study examined social orientation with eye tracking and physiological arousal responses to gain more knowledge on how children perceive and respond to communicative bids and evaluated the associations between social orientation and language outcomes, concurrently and 1 year later. METHOD In total, 107 children with SCT (33 XXX, 50 XXY, and 24 XYY) and 102 controls (58 girls and 44 boys) aged between 1 and 7 years were included. Assessments took place in the USA and Western Europe. A communicative bids eye tracking paradigm, physiological arousal measures, and receptive and expressive language outcomes were used. RESULTS Compared to controls, children with SCT showed reduced attention to the face and eyes of the on-screen interaction partner and reduced physiological arousal sensitivity in response to direct versus averted gaze. In addition, social orientation to the mouth was related to concurrent receptive and expressive language abilities in 1-year-old children with SCT. CONCLUSIONS Children with SCT may experience difficulties with social communication that extend past the well-recognized risk for early language delays. These difficulties may underlie social-behavioral problems that have been described in the SCT population and are an important target for early monitoring and support.
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Affiliation(s)
- Evelien Urbanus
- Department of Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
- TRIXY Center of Expertise, Leiden University Treatment and Expertise Centre (LUBEC), Leiden, The Netherlands
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hanna Swaab
- Department of Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
- TRIXY Center of Expertise, Leiden University Treatment and Expertise Centre (LUBEC), Leiden, The Netherlands
| | - Nicole Tartaglia
- eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sophie van Rijn
- Department of Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
- TRIXY Center of Expertise, Leiden University Treatment and Expertise Centre (LUBEC), Leiden, The Netherlands
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Bouw N, Swaab H, Tartaglia N, Wilson RL, Van der Velde K, van Rijn S. Early symptoms of autism spectrum disorder (ASD) in 1-8 year old children with sex chromosome trisomies (XXX, XXY, XYY), and the predictive value of joint attention. Eur Child Adolesc Psychiatry 2023; 32:2323-2334. [PMID: 36107256 PMCID: PMC10576671 DOI: 10.1007/s00787-022-02070-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/14/2022] [Indexed: 11/03/2022]
Abstract
The objective of the present study is to investigate the impact of Sex Chromosome Trisomy (SCT; XXX, XXY, XYY) on the early appearance of Autism Spectrum Disorder (ASD) symptoms, and the predictive value of Joint Attention for symptoms of ASD. SCTs are specific genetic conditions that may serve as naturalistic 'at risk' models of neurodevelopment, as they are associated with increased risk for neurobehavioral vulnerabilities. A group of 82 children with SCT (aged 1-8 years) was included at baseline of this longitudinal study. Joint Attention was measured at baseline with structured behavior observations according to the Early Social Communication Scales. ASD symptoms were assessed with the Modified Checklist for Autism in Toddlers questionnaire and Autism Diagnostic Interview-Revised in a 1-year follow-up. Recruitment and assessment took place in the Netherlands and in the United States. The results demonstrate that ASD symptoms were substantially higher in children with SCT compared to the general population, with 22% of our cohort at clinical risk for ASD, especially in the domain of social interaction and communication. Second, a predictive value of Joint Attention was found for ASD symptoms at 1-year follow-up. In this cohort, no differences were found between karyotype-subtypes. In conclusion, from a very early age, SCT can be associated with an increased risk for vulnerabilities in adaptive social functioning. These findings show a neurodevelopmental impact of the extra X or Y chromosome on social adaptive development associated with risk for ASD already from early childhood onward. These findings advocate for close monitoring and early (preventive) support, aimed to optimize social development of young children with SCT.
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Affiliation(s)
- Nienke Bouw
- Clinical Neurodevelopmental Sciences, Faculty of Social and Behavioral Sciences, Leiden University, PO Box 9500, 2300 RA, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Hanna Swaab
- Clinical Neurodevelopmental Sciences, Faculty of Social and Behavioral Sciences, Leiden University, PO Box 9500, 2300 RA, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Nicole Tartaglia
- Developmental Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rebecca L Wilson
- Developmental Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Sophie van Rijn
- Clinical Neurodevelopmental Sciences, Faculty of Social and Behavioral Sciences, Leiden University, PO Box 9500, 2300 RA, Leiden, The Netherlands.
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
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4
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Thompson T, Tisher J, Davis S, Miller C, Kirk J, Tartaglia N, Howell S. The emotional journey of adapting to prenatally identified trisomy X. J Genet Couns 2023:10.1002/jgc4.1778. [PMID: 37691399 PMCID: PMC10924744 DOI: 10.1002/jgc4.1778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/14/2023] [Accepted: 08/19/2023] [Indexed: 09/12/2023]
Abstract
There is a paucity of research on the experiences of parents of children with trisomy X (47,XXX). Increased prenatal diagnoses associated with advances in noninvasive prenatal screening necessitate a better understanding of how trisomy X impacts family systems. This qualitative investigation aimed to describe the lived experience of parents of young daughters with prenatally identified trisomy X to guide genetic counseling. Semi-structured qualitative interviews were conducted via teleconferencing with parents (n = 11) of girls with trisomy X, ages 6-44 months. A descriptive phenomenological approach was used to code transcripts for significant statements and reduce data into themes describing the experience of receiving a diagnosis of trisomy X and the experience of early parenting in this population. Participants described an emotional journey of adapting to prenatally identified trisomy X. Four descriptive themes included two related, yet distinct, life stages: Negative Diagnostic Experience and a Hopeful Early Childhood, as well as two ongoing experiences: Persistent Ambiguity and Coping with and Adapting to Uncertainty. Results suggest providers should carefully consider word choice and timing in delivery of diagnosis, and genetic counseling should provide expectant parents with current research specific to trisomy X, facilitate connections with other parents of young girls with trisomy X, introduce developmental monitoring approaches, and be prepared to support families with a range of emotional responses to the diagnosis and decisions regarding disclosure.
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Affiliation(s)
- Talia Thompson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- eXtraordinarY Kids Program, Children’s Hospital Colorado, Aurora, Colorado
| | - Jessica Tisher
- Genetic Counseling Graduate Program, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
- Avera Health, Sioux Falls, South Dakota
| | - Shanlee Davis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- eXtraordinarY Kids Program, Children’s Hospital Colorado, Aurora, Colorado
| | - Christina Miller
- Genetic Counseling Graduate Program, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Jillian Kirk
- Genetic Counseling Graduate Program, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Nicole Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- eXtraordinarY Kids Program, Children’s Hospital Colorado, Aurora, Colorado
| | - Susan Howell
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- eXtraordinarY Kids Program, Children’s Hospital Colorado, Aurora, Colorado
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Bouw N, Swaab H, Tartaglia N, Cordeiro L, van Rijn S. Early Social Behavior in Young Children with Sex Chromosome Trisomies (XXX, XXY, XYY): Profiles of Observed Social Interactions and Social Impairments Associated with Autism Spectrum Disorder (ASD). J Autism Dev Disord 2023; 53:3194-3207. [PMID: 35551591 PMCID: PMC10313563 DOI: 10.1007/s10803-022-05553-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
Individuals with Sex Chromosome Trisomies (SCT; XXX, XXY, XYY) have an increased vulnerability for developing challenges in social adaptive functioning. The present study investigates social interaction behavior in the context of varying social load, and Autism Spectrum Disorder (ASD) symptomatology in young children aged 1-7.5 years old, with SCT (N = 105) and control children (N = 101). Children with SCT show less interaction behaviors and more social withdrawal, as compared to their control peers, which were most evident in the high social load condition. Second, social impairments related to ASD are more prevalent, as compared to controls (27.1% at clinical level). These findings stress the importance of early monitoring and (preventive) support of early social development in young children with SCT.
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Affiliation(s)
- Nienke Bouw
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Hanna Swaab
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Nicole Tartaglia
- Developmental Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lisa Cordeiro
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sophie van Rijn
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands.
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
- Clinical Neurodevelopmental Sciences, Faculty of Social and Behavioral Sciences, Leiden University, PO Box 9500, 2300 RA, Leiden, The Netherlands.
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6
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Kuiper KC, Swaab H, Tartaglia N, Cordeiro L, van Rijn S. [Formula: see text] Emotional reactivity and expressivity in young children with sex chromosome trisomies: evidence from psychophysiological and observational data. Child Neuropsychol 2023; 29:569-587. [PMID: 35876333 DOI: 10.1080/09297049.2022.2102161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Although sex chromosomal trisomies (SCT) in children are highly prevalent and associated with an increased risk for neurodevelopmental difficulties including socio-emotional problems, little is known about underlying mechanisms that could drive this risk. Studying emotional reactivity and expressivity of young children with SCT in early childhood could identify deviations in early emotional development and potentially serve as risk markers to guide clinical care in developing interventions. Participants in the current study were 90 SCT children and 97 population-based controls, aged 1 to 7 years, who experienced a stress-inducing event in which physiological (heart rate) and observational data (expression of negative emotions) were collected. Results showed early disturbances in the emotion system of young children with SCT, in terms of blunted but prolonged emotional reactivity and a reduced emotional expressivity in response to stress. Further, the concordance between emotional reactivity (arousal response) and expressivity was significantly lower in SCT, compared to controls. Given the significant impact of emotions on adaptive day-to-day functioning, deviations in processing emotions could be an important underlying mechanism in explaining the heterogeneity and variability in developmental outcomes often described in individuals with SCT.
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Affiliation(s)
- Kimberly C Kuiper
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Hanna Swaab
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Nicole Tartaglia
- eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lisa Cordeiro
- eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sophie van Rijn
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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Davis SM, Urban R, D'Alessandro A, Reisz JA, Chan CL, Kelsey M, Howell S, Tartaglia N, Zeitler P, Baker Ii P. Unique plasma metabolite signature for adolescents with Klinefelter syndrome reveals altered fatty acid metabolism. Endocr Connect 2023; 12:EC-22-0523. [PMID: 36884262 PMCID: PMC10160545 DOI: 10.1530/ec-22-0523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 03/07/2023] [Indexed: 03/09/2023]
Abstract
Conditions related to cardiometabolic disease, including metabolic syndrome and type 2 diabetes, are common among men with Klinefelter syndrome (KS). The molecular mechanisms underlying this aberrant metabolism in KS are largely unknown, although there is an assumption that chronic testosterone deficiency plays a role. This cross-sectional study compared plasma metabolites in 31 pubertal adolescent males with KS to 32 controls of similar age (14 ± 2 years), pubertal stage, and body mass index z-score of 0.1 ± 1.2 and then between testosterone-treated (n = 16) and untreated males with KS. The plasma metabolome in males with KS was distinctly different from that in controls, with 22% of measured metabolites having a differential abundance and seven metabolites nearly completely separating KS from controls (area under the curve > 0.9, P < 0.0001). Multiple saturated free fatty acids were higher in KS, while mono- and polyunsaturated fatty acids were lower, and the top significantly enriched pathway was mitochondrial β-oxidation of long-chain saturated fatty acids (enrichment ratio 16, P < 0.0001). In contrast, there were no observed differences in metabolite concentrations between testosterone-treated and untreated individuals with KS. In conclusion, the plasma metabolome profile in adolescent males with KS is distinctly different from that in males without KS independent of age, obesity, pubertal development, or testosterone treatment status and is suggestive of differences in mitochondrial β-oxidation.
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Affiliation(s)
- Shanlee M Davis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- eXtraOrdinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Rhianna Urban
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Julie A Reisz
- Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christine L Chan
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Megan Kelsey
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Susan Howell
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- eXtraOrdinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Nicole Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- eXtraOrdinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Philip Zeitler
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- eXtraOrdinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Peter Baker Ii
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Urbanus E, Swaab H, Tartaglia N, Stumpel C, van Rijn S. Structural and pragmatic language in young children with sex chromosome trisomy (XXX, XXY, XYY): Predictive value for neurobehavioral problems one year later. Clin Neuropsychol 2023; 37:650-675. [PMID: 35477417 PMCID: PMC11033613 DOI: 10.1080/13854046.2022.2067078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 04/13/2022] [Indexed: 11/03/2022]
Abstract
Objective: To investigate pragmatic language abilities in young children with an increased risk for adverse neurobehavioral and neurocognitive outcomes due to an extra X or Y chromosome (sex chromosome trisomy; SCT) and to investigate to what degree early structural and pragmatic language abilities are predictive of neurobehavioral problems one year later. Method: In total, 72 children with SCT and 71 controls aged 3-7 years were included. Language assessments included parent-reported pragmatic language skills and direct assessment of structural language abilities. Parent-reported behavioral outcomes were measured one year after the initial language assessment. Results: Children with SCT demonstrated weaker pragmatic language skills compared to controls. These differences were not driven by karyotype, time of diagnosis, or ascertainment bias and irrespective of the presence of structural language impairment. Odds of having pragmatic difficulties was 23 times higher in the SCT group, with 25% of the children not meeting age-expectations. In addition, language, in particular pragmatic language, was an important predictor for later affective, oppositional defiant, pervasive developmental, attention deficit, and social-emotional problems in young children with SCT. Conclusions: This study is one of the first studies that directly illustrates the relationship between language and behavioral outcomes in children with SCT. Our results stress the importance to closely monitor pragmatic language in addition to structural language in clinical care of children with SCT, as pragmatic language abilities could serve as an early marker for children at risk for developing behavioral problems.
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Affiliation(s)
- Evelien Urbanus
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Hanna Swaab
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Nicole Tartaglia
- Extraordinary Kids Clinic, Developmental Pediatrics, Children’s Hospital Colorado, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Constance Stumpel
- Department of Clinical Genetics and GRoW-School for oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sophie van Rijn
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, the Netherlands
- Leiden Institute for Brain and Cognition, Leiden, the Netherlands
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Gravholt CH, Ferlin A, Gromoll J, Juul A, Raznahan A, van Rijn S, Rogol AD, Skakkebæk A, Tartaglia N, Swaab H. New developments and future trajectories in supernumerary sex chromosome abnormalities: a summary of the 2022 3rd International Workshop on Klinefelter Syndrome, Trisomy X, and XYY. Endocr Connect 2023; 12:e220500. [PMID: 36598290 PMCID: PMC9986408 DOI: 10.1530/ec-22-0500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 01/05/2023]
Abstract
The 3rd International Workshop on Klinefelter Syndrome, Trisomy X, and 47,XYY syndrome was held in Leiden, the Netherlands, on September 12-14, 2022. Here, we review new data presented at the workshop and discuss scientific and clinical trajectories. We focus on shortcomings in knowledge and therefore point out future areas for research. We focus on the genetics and genomics of supernumerary sex chromosome syndromes with new data being presented. Most knowledge centre specifically on Klinefelter syndrome, where aspects on testosterone deficiency and the relation to bone, muscle and fat were discussed, as was infertility and the treatment thereof. Both trisomy X and 47,XYY syndrome are frequently affected by infertility. Transitioning of males with Klinefelter syndrome was addressed, as this seemingly simple process in practise is often difficult. It is now realized that neurocognitive changes are pervasive in all supernumerary sex chromosome syndromes, which were extensively discussed. New intervention projects were also described, and exciting new data concerning these were presented. Advocacy organizations were present, describing the enormous burden carried by parents when having to explain their child's specific syndrome to most professionals whenever in contact with health care and education systems. It was also pointed out that most countries do not have health care systems that diagnose patients with supernumerary sex chromosome syndromes, thus pinpointing a clear deficiency in the current genetic testing and care models. At the end of the workshop, a roadmap towards the development of new international clinical care guidelines for Klinefelter syndrome was decided.
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Affiliation(s)
- Claus H Gravholt
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Alberto Ferlin
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - Joerg Gromoll
- Centre of Reproductive Medicine and Andrology, Münster, Germany
| | - Anders Juul
- Department of Growth and Reproduction Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Armin Raznahan
- Section on Developmental Neurogenomics, National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, Maryland, USA
| | - Sophie van Rijn
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands and TRIXY Center of Expertise, Leiden University Treatment and Expertise Centre (LUBEC), Leiden, The Netherlands
| | - Alan D Rogol
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
| | - Anne Skakkebæk
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Nicole Tartaglia
- Department of Pediatrics, Developmental Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Hanna Swaab
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands and TRIXY Center of Expertise, Leiden University Treatment and Expertise Centre (LUBEC), Leiden, The Netherlands
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10
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Kuiper K, Swaab H, Tartaglia N, van Rijn S. (Not) getting what you want: frustration and emotion regulation in children with sex chromosome trisomies. Endocr Connect 2023; 12:e220442. [PMID: 37183811 DOI: 10.1530/ec-22-0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/27/2023] [Indexed: 03/29/2023]
Abstract
The presence of an additional X or Y chromosome (sex chromosome trisomies, SCT) is associated with an increased risk for neurodevelopmental difficulties, including socio-emotional problems, across the life-span. Studying emotion regulation in young children with SCT could signal deviations in emotional development that serve as risk markers to guide clinical care. This study explored the presence and variety of emotion regulation strategies in 75 SCT children and 81 population-based controls, aged 1 to 7 years, during a frustration-inducing event in which physiological (heart rate) and observational data (behavioral responses) were collected. Children with SCT were equally physiologically aroused by the event as compared to controls. However, they showed more emotion regulation difficulties in terms of behavior compared to controls that was not explicable in terms of differences in general intellectual functioning. Specifically, they had a more limited range of behavioral alternatives and tended to rely longer on inefficient strategies with increasing age. The field of practice should be made aware of these early risk findings regarding emotion regulation in SCT, which may potentially lay at the foundation of later socio-emotional problems, given the significant impact of emotion regulation on child and adult mental health outcomes. The current results may help to design tailored interventions to reduce the impact of the additional sex chromosome on adaptive functioning, psychopathology, and quality of life.
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Berry-Kravis E, Hagerman R, Budimirovic D, Erickson C, Heussler H, Tartaglia N, Cohen J, Tassone F, Dobbins T, Merikle E, Sebree T, Tich N, Palumbo JM, O’Quinn S. A randomized, controlled trial of ZYN002 cannabidiol transdermal gel in children and adolescents with fragile X syndrome (CONNECT-FX). J Neurodev Disord 2022; 14:56. [PMID: 36434514 PMCID: PMC9700889 DOI: 10.1186/s11689-022-09466-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 11/03/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Fragile X syndrome (FXS) is associated with dysregulated endocannabinoid signaling and may therefore respond to cannabidiol therapy. DESIGN CONNECT-FX was a double-blind, randomized phase 3 trial assessing efficacy and safety of ZYN002, transdermal cannabidiol gel, for the treatment of behavioral symptoms in children and adolescents with FXS. METHODS Patients were randomized to 12 weeks of ZYN002 (250 mg or 500 mg daily [weight-based]) or placebo, as add-on to standard of care. The primary endpoint assessed change in social avoidance (SA) measured by the Aberrant Behavior Checklist-Community Edition FXS (ABC-CFXS) SA subscale in a full cohort of patients with a FXS full mutation, regardless of the FMR1 methylation status. Ad hoc analyses assessed efficacy in patients with ≥ 90% and 100% methylation of the promoter region of the FMR1 gene, in whom FMR1 gene silencing is most likely. RESULTS A total of 212 patients, mean age 9.7 years, 75% males, were enrolled. A total of 169 (79.7%) patients presented with ≥ 90% methylation of the FMR1 promoter and full mutation of FMR1. Although statistical significance for the primary endpoint was not achieved in the full cohort, significant improvement was demonstrated in patients with ≥ 90% methylation of FMR1 (nominal P = 0.020). This group also achieved statistically significant improvements in Caregiver Global Impression-Change in SA and isolation, irritable and disruptive behaviors, and social interactions (nominal P-values: P = 0.038, P = 0.028, and P = 0.002). Similar results were seen in patients with 100% methylation of FMR1. ZYN002 was safe and well tolerated. All treatment-emergent adverse events (TEAEs) were mild or moderate. The most common treatment-related TEAE was application site pain (ZYN002: 6.4%; placebo: 1.0%). CONCLUSIONS In CONNECT-FX, ZYN002 was well tolerated in patients with FXS and demonstrated evidence of efficacy with a favorable benefit risk relationship in patients with ≥ 90% methylation of the FMR1 gene, in whom gene silencing is most likely, and the impact of FXS is typically most severe. TRIAL REGISTRATION The CONNECT-FX trial is registered on Clinicaltrials.gov (NCT03614663).
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Affiliation(s)
- Elizabeth Berry-Kravis
- grid.240684.c0000 0001 0705 3621Departments of Pediatrics and Neurological Sciences, Rush University Medical Center, Chicago, IL USA
| | - Randi Hagerman
- grid.413079.80000 0000 9752 8549Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California-Davis Medical Center, Sacramento, CA USA ,grid.27860.3b0000 0004 1936 9684Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA USA
| | - Dejan Budimirovic
- grid.21107.350000 0001 2171 9311Departments of Psychiatry and Child Psychiatry, Fragile X Clinic, Kennedy Krieger Institute/the Johns Hopkins Medical Institutions, Baltimore, MD USA ,grid.21107.350000 0001 2171 9311Department of Psychiatry & Behavioral Sciences-Child Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Craig Erickson
- grid.24827.3b0000 0001 2179 9593Department of Psychiatry and Behavioral Neuroscience, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Helen Heussler
- grid.512914.a0000 0004 0642 3960Centre for Clinical Trials in Rare Neurodevelopmental Disorders, Children’s Health Queensland, Brisbane, Australia ,grid.1003.20000 0000 9320 7537Centre for Child Health Research, University of Queensland, Brisbane, Australia
| | - Nicole Tartaglia
- Department of Pediatrics, Developmental Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO USA
| | - Jonathan Cohen
- Fragile X Alliance Inc, North Caulfield, VIC, Australia ,grid.1002.30000 0004 1936 7857Centre for Developmental Disability Health Victoria, Monash University, Clayton, VIC Australia
| | - Flora Tassone
- grid.413079.80000 0000 9752 8549Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California-Davis Medical Center, Sacramento, CA USA ,grid.413079.80000 0000 9752 8549Department of Biochemistry and Molecular Medicine, School of Medicine, University of California-Davis, Sacramento, CA USA
| | | | | | - Terri Sebree
- grid.422480.80000 0004 8307 0679Zynerba Pharmaceuticals Inc., Devon, PA USA
| | - Nancy Tich
- grid.422480.80000 0004 8307 0679Zynerba Pharmaceuticals Inc., Devon, PA USA
| | - Joseph M. Palumbo
- grid.422480.80000 0004 8307 0679Zynerba Pharmaceuticals Inc., Devon, PA USA
| | - Stephen O’Quinn
- grid.422480.80000 0004 8307 0679Zynerba Pharmaceuticals Inc., Devon, PA USA
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12
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Bouw N, Swaab H, Tartaglia N, Cordeiro L, van Rijn S. The impact of sex chromosome trisomies (XXX, XXY, XYY) on gaze towards faces and affect recognition: a cross-sectional eye tracking study. J Neurodev Disord 2022; 14:44. [PMID: 35918661 PMCID: PMC9347080 DOI: 10.1186/s11689-022-09453-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/19/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND About 1:650-1000 children are born with an extra X or Y chromosome (47,XXX; 47,XXY; 47,XYY), which results in a sex chromosome trisomy (SCT). This international cross-sectional study was designed to investigate gaze towards faces and affect recognition during early life of children with SCT, with the aim to find indicators for support and treatment. METHODS A group of 101 children with SCT (aged 1-7 years old; Mage= 3.7 years) was included in this study, as well as a population-based sample of 98 children without SCT (Mage= 3.7). Eye gaze patterns to faces were measured using an eye tracking method that quantifies first fixations and fixation durations on eyes of static faces and fixation durations on eyes and faces in a dynamic paradigm (with two conditions: single face and multiple faces). Affect recognition was measured using the subtest Affect Recognition of the NEPSY-II neuropsychological test battery. Recruitment and assessment took place in the Netherlands and the USA. RESULTS Eye tracking results reveal that children with SCT show lower proportion fixation duration on faces already from the age of 3 years, compared to children without SCT. Also, impairments in the clinical range for affect recognition were found (32.2% of the SCT group scored in the well below average range). CONCLUSIONS These results highlight the importance to further explore the development of social cognitive skills of children with SCT in a longitudinal design, the monitoring of affect recognition skills, and the implementation of (preventive) interventions aiming to support the development of attention to social important information and affect recognition.
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Affiliation(s)
- Nienke Bouw
- Clinical Neurodevelopmental Sciences, Faculty of Social and Behavioral Sciences, Leiden University, PO Box 9500, 2300 RA, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Hanna Swaab
- Clinical Neurodevelopmental Sciences, Faculty of Social and Behavioral Sciences, Leiden University, PO Box 9500, 2300 RA, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Nicole Tartaglia
- Developmental Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lisa Cordeiro
- Developmental Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sophie van Rijn
- Clinical Neurodevelopmental Sciences, Faculty of Social and Behavioral Sciences, Leiden University, PO Box 9500, 2300 RA, Leiden, The Netherlands.
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
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13
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Albizua I, Charen K, Shubeck L, Talboy A, Berry‐Kravis E, Kaufmann WE, Stallworth JL, Drazba KT, Erickson CA, Sweeney JA, Tartaglia N, Warren SF, Hagerman R, Sherman SL, Warren ST, Jin P, Allen EG. Descriptive analysis of seizures and comorbidities associated with fragile X syndrome. Mol Genet Genomic Med 2022; 10:e2001. [PMID: 35852003 PMCID: PMC9356544 DOI: 10.1002/mgg3.2001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/28/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Fragile X syndrome is characterized by a myriad of physical features, behavioral features, and medical problems. Commonly found behavioral features are hyperactivity, anxiety, socialization difficulties, and ASD. There is also a higher incidence than in the general population of strabismus, otitis media, and mitral valve prolapse. In addition, one of the most common medical problems associated with FXS is an increased risk of seizures. A subset of individuals carrying the full mutation of the FMR1 gene and diagnosed with fragile X syndrome (FXS) are reported to experience seizures, mostly during the first 10 years of their life span. METHODS As part of a larger project to identify genetic variants that modify the risk of seizures, we collected clinical information from 49 carriers with FXS who experienced seizures and 46 without seizures. We compared seizure type and comorbid conditions based on the source of data as well as family history of seizures. RESULTS We found that the concordance of seizure types observed by parents and medical specialists varied by type of seizure. The most common comorbid condition among those with seizures was autism spectrum disorder (47% per medical records vs. 33% per parent report compared with 19% among those without seizures per parent report); the frequency of other comorbid conditions did not differ among groups. We found a slightly higher frequency of family members who experienced seizures among the seizure group compared with the nonseizure group. CONCLUSION This study confirms previously reported features of seizures in FXS, supports additional genetic factors, and highlights the importance of information sources, altogether contributing to a better understanding of seizures in FXS.
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Affiliation(s)
- Igor Albizua
- Department of Human GeneticsEmory University School of MedicineAtlantaGeorgiaUSA
- Department of PathologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Krista Charen
- Department of Human GeneticsEmory University School of MedicineAtlantaGeorgiaUSA
| | - Lisa Shubeck
- Department of Human GeneticsEmory University School of MedicineAtlantaGeorgiaUSA
| | - Amy Talboy
- Department of Human GeneticsEmory University School of MedicineAtlantaGeorgiaUSA
| | - Elizabeth Berry‐Kravis
- Department of Pediatrics, Neurological Sciences, BiochemistryRush University Medical CenterChicagoIllinoisUSA
| | - Walter E. Kaufmann
- Department of Human GeneticsEmory University School of MedicineAtlantaGeorgiaUSA
- Greenwood Genetic CenterGreenwoodSouth CarolinaUSA
| | | | | | - Craig A. Erickson
- Cincinnati Children's Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - John A. Sweeney
- Department of PsychiatryUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Nicole Tartaglia
- Department of PediatricsChildren's Hospital Colorado, University of Colorado School of MedicineAuroraColoradoUSA
| | - Steven F. Warren
- Department of Speech‐Language‐Hearing: Sciences & DisordersThe University of KansasLawrenceKansasUSA
| | - Randi Hagerman
- Department of PediatricsUniversity of California Davis MIND InstituteSacramentoCaliforniaUSA
| | - Stephanie L. Sherman
- Department of Human GeneticsEmory University School of MedicineAtlantaGeorgiaUSA
| | - Stephen T. Warren
- Department of Human GeneticsEmory University School of MedicineAtlantaGeorgiaUSA
| | - Peng Jin
- Department of Human GeneticsEmory University School of MedicineAtlantaGeorgiaUSA
| | - Emily G. Allen
- Department of Human GeneticsEmory University School of MedicineAtlantaGeorgiaUSA
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14
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Kuiper KC, Swaab H, Tartaglia N, van Buggenhout G, Wouters C, van Rijn S. The developmental impact of sex chromosome trisomies on emerging executive functions in young children: Evidence from neurocognitive tests and daily life skills. Genes Brain Behav 2022; 21:e12811. [PMID: 35584398 PMCID: PMC9744538 DOI: 10.1111/gbb.12811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
Sex chromosomal trisomies (SCT) are associated with impairments in executive functions in school-aged children, adolescents, and adults. However, knowledge on preschool development of executive functions is limited but greatly needed to guide early intervention. The current study examined emerging executive functions in young children with SCT. Participants were 72 SCT children and 70 population-based controls, aged 3-7 years, who completed a neurocognitive assessment of both global executive function (MEFS) and verbal executive function skills (NEPSY Word Generation). Caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF) questionnaire to capture real-world behavioral manifestations of impairments in executive functions. Results showed that impairments were significantly more prevalent in SCT than in controls and already present from 3 years, specifically verbal executive functions and working memory. Broader more pronounced impairments were found in older children with SCT. Age was significantly related to executive functions, but specific domains showed different relations with age. For example, deficits in planning and organizing remained evident with older age in SCT whereas it declined with age in controls. Impairments in executive functions were present across different levels of intelligence. Already at an early age, impairments across executive functions should be considered part of the neurodevelopmental profile of SCT, which appear more prominent at later age. Future studies should investigate developmental pathways of executive functions in SCT, given its relevance in cognitive, social, and emotional development. Executive functions should be screened and monitored in children with SCT and could be an important target of preventive intervention.
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Affiliation(s)
- Kimberly C. Kuiper
- Clinical Neurodevelopmental SciencesLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
| | - Hanna Swaab
- Clinical Neurodevelopmental SciencesLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
| | - Nicole Tartaglia
- eXtraordinarY Kids Clinic, Developmental PediatricsChildren's Hospital ColoradoAuroraColoradoUSA
- Department of PediatricsUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Griet van Buggenhout
- Center for Human GeneticsUniversity Hospital GasthuisbergLeuvenBelgium
- Department of Human GeneticsKU Leuven (University of Leuven)LeuvenBelgium
| | - Caroline Wouters
- Center for Human GeneticsUniversity Hospital GasthuisbergLeuvenBelgium
| | - Sophie van Rijn
- Clinical Neurodevelopmental SciencesLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
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15
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Thompson T, Stinnett N, Tartaglia N, Davis S, Janusz J. 'I Wish the School Had a Better Understanding of the Diagnosis': parent perspectives on educational needs of students with sex chromosome aneuploidies. J Res Spec Educ Needs 2022; 22:175-187. [PMID: 35529320 PMCID: PMC9074887 DOI: 10.1111/1471-3802.12558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Students with sex chromosome aneuploidies (SCAs) are at increased risk for learning disabilities and often require individualized supports in the school setting. Parents of students with rare disorders such as SCAs possess a unique understanding of their child's educational experiences and play a crucial role in the development of successful school support plans. This international survey study aimed to inductively capture parent perspectives on educational needs and supports for students with SCAs. Parents of youth with SCAs ages 5-21 years (n = 305) provided free-text responses to open-ended questions about their child's education. Qualitative content analysis using a bioecological systems framework resulted in three overarching themes. Overall, parents identified multiple factors related to the SCA diagnosis that act as barriers to learning, a strong need for school-based social and emotional supports, and elusive or incomplete educational support plans. Based on these findings, we recommend developing robust family-school partnerships, increased collaboration between the school and the child's medical team, and acknowledgement of the significant role the genetic condition plays in the educational experiences of students with SCAs. Specific suggestions for school support plans for students with SCAs are explored, such as providing school-based behavioral health supports and explicit teaching of executive function strategies.
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Affiliation(s)
- Talia Thompson
- University of Colorado School of Medicine, USA
- Children’s Hospital Colorado, USA
| | | | - Nicole Tartaglia
- University of Colorado School of Medicine, USA
- Children’s Hospital Colorado, USA
| | - Shanlee Davis
- University of Colorado School of Medicine, USA
- Children’s Hospital Colorado, USA
| | - Jennifer Janusz
- University of Colorado School of Medicine, USA
- Children’s Hospital Colorado, USA
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16
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Bouw N, Swaab H, Tartaglia N, Jansen AC, van Rijn S. Early impact of X- and Y-chromosome variations (XXX, XXY, XYY) on social communication and social emotional development in 1-2-year-old children. Am J Med Genet A 2022; 188:1943-1953. [PMID: 35285124 PMCID: PMC9311155 DOI: 10.1002/ajmg.a.62720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/12/2022] [Accepted: 02/18/2022] [Indexed: 11/10/2022]
Abstract
Sex chromosome trisomies (SCTs) are characterized by an extra X‐ or Y‐chromosome (XXX, XXY, XYY). The present study aims to investigate early signs of social communication and social emotional development in very young children with SCT. Thirty‐four children with SCT (aged 12–24 months) were included in this study, as well as 31 age‐matched controls. Social communication was measured with structured behavior observations according to the Early Social Communication Scales, and social emotional developmental level with the Bayley Social Emotional parental questionnaire. Recruitment and assessment took place in the Netherlands and in the United States. On average, 12–24‐month old children with SCT showed difficulties with early social communication, more so in responding to others as compared to initiating social communications. During social interactions, children with SCT made less frequent eye contact, compared to controls. Also, difficulties in acquiring social emotional milestones were found in 1‐year old children with SCT, with 44% of the children having social emotional vulnerabilities in the borderline or extremely low range, compared to typically developing children. In this cohort, no significant predictive effects of karyotype‐subtype (XXX, XXY, XYY) were found. Already from a very early age, SCT can be associated with increased risk for vulnerabilities in adaptive social functioning. These findings suggest that SCT impact the maturation of the social brain already from an early age, and stress the importance of early monitoring and (preventive) support early social development in young children with SCT.
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Affiliation(s)
- Nienke Bouw
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Hanna Swaab
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden, the Netherlands
| | - Nicole Tartaglia
- Developmental Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Anna C Jansen
- Pediatric Neurology Unit, Department of Pediatrics, UZ Brussel, Jette, Belgium.,Neurogenetics Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sophie van Rijn
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden, the Netherlands
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17
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Urbanus E, Swaab H, Tartaglia N, Boada R, van Rijn S. [Formula: see text]A cross-sectional study of early language abilities in children with sex chromosome trisomy (XXY, XXX, XYY) aged 1-6 years. Child Neuropsychol 2022; 28:171-196. [PMID: 34346838 PMCID: PMC11033700 DOI: 10.1080/09297049.2021.1960959] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
Children with sex chromosome trisomy (SCT) are at increased risk for developing language difficulties. Earlier studies have reported that as many as 70-80% of individuals with SCT show some form of language difficulties. Language develops rapidly in the first years of life; knowledge about language development at an early age is needed. The present study aims to identify the language abilities of young children with SCT across multiple language domains and to identify the percentage of children that, according to clinical guidelines, have language difficulties. Children between the ages of 1-6-years (NSCT = 103, Ncontrols = 102) were included. Nonverbal communication, early vocabulary, semantic, syntax, and phonological skills were assessed. Language difficulties were already present in 1-year-old children with SCT and across the age range in various language domains. Clinical classification showed that, depending on the assessed domain, 14.8-50.0% of the children scored below the 16th percentile. There was no effect of time of diagnosis, ascertainment bias, research site, nor SCT specific karyotype (XXX, XXY, XYY) on language outcomes. Overall, language difficulties can already be present in very young children with SCT within various language domains. These findings appear to be robust within the SCT group. These results highlight the importance of monitoring both receptive and expressive language development already at the earliest stages of nonverbal communication. Finally, as early language skills are the building blocks for later social communication, literacy, and self-expression, studies that investigate the effect of early interventions on later language outcomes are warranted.
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Affiliation(s)
- Evelien Urbanus
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Hanna Swaab
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Nicole Tartaglia
- eXtraordinarY Kids Clinic, Developmental Pediatrics, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Richard Boada
- eXtraordinarY Kids Clinic, Developmental Pediatrics, Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sophie van Rijn
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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18
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Bouw N, Swaab H, Tartaglia N, van Rijn S. The Impact of Sex Chromosome Trisomies (XXX, XXY, XYY) on Early Social Cognition: Social Orienting, Joint Attention, and Theory of Mind. Arch Clin Neuropsychol 2022; 37:63-77. [PMID: 34101798 PMCID: PMC8763088 DOI: 10.1093/arclin/acab042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/28/2021] [Accepted: 05/16/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE About 1:650-1,000 children are born with an extra X or Y chromosome (XXX; XXY; XYY), which results in a sex chromosome trisomy (SCT). This study aims to cross-sectionally investigate the impact of SCT on early social cognitive skills. Basic orienting toward social cues, joint attention, and theory of mind (ToM) in young children with SCT were evaluated. METHOD About 105 children with SCT (range: 1-7 years old) were included in this study, as well as 96 age-matched nonclinical controls. Eyetracking paradigms were used to investigate the eye gaze patterns indicative of joint attention skills and orienting to social interactions. The ToM abilities were measured using the subtest ToM of the Developmental NEuroPSYchological Assessment, second edition, neuropsychological test battery. Recruitment and assessment took place in the Netherlands and in the United States. RESULTS Eyetracking results revealed difficulties in children with SCT in social orienting. These difficulties were more pronounced in children aged 3 years and older, and in boys with 47,XYY. Difficulties in joint attention were found over all age groups and karyotypes. Children with SCT showed impairments in ToM (26.3% in the [well] below expected level), increasing with age. These impairments did not differ between karyotypes. CONCLUSIONS An impact of SCT on social cognitive abilities was found already at an early age, indicating the need for early monitoring and support of early social cognition. Future research should explore the longitudinal trajectories of social development in order to evaluate the predictive relationships between social cognition and outcome later in life in terms of social functioning and the risk for psychopathology.
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Affiliation(s)
| | | | | | - S van Rijn
- Corresponding author at: Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands. Tel: +31 71 527 1846; E-mail address: (S. van Rijn)
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19
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Kuiper K, Swaab H, Tartaglia N, van Rijn S. Early developmental impact of sex chromosome trisomies on attention deficit-hyperactivity disorder symptomology in young children. Am J Med Genet A 2021; 185:3664-3674. [PMID: 34240550 PMCID: PMC9292447 DOI: 10.1002/ajmg.a.62418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/14/2021] [Accepted: 06/18/2021] [Indexed: 01/16/2023]
Abstract
Individuals with sex chromosome trisomies ([SCT], XXX, XXY, and XYY)) are at increased risk for neurodevelopmental problems, given that a significant portion of the sex chromosome genes impact brain functioning. An elevated risk for psychopathology has also been described, including attention deficit-hyperactivity disorder (ADHD). The present study aimed at identifying early markers of ADHD, providing the first investigation of ADHD symptomology in very young children with SCT. The variety, type, and severity of ADHD symptomology in 1-6-year-old children with SCT (n = 104) were compared with population-based controls (n = 101) using the strengths and weaknesses of ADHD symptoms and normal-behavior (SWAN) parent-report questionnaire. ADHD symptomology was significantly more prevalent in SCT and already present from toddlerhood on, compared to controls. ADHD inattention symptoms were significantly increased in all karyotypes (XXX, XXY, and XYY), boys with XYY also showed significantly more hyperactivity/impulsivity symptoms than controls. Inattentiveness was more pronounced with increasing age for SCT, in contrast to controls. Within the SCT group, 24% of the children had significantly elevated ADHD symptoms at a clinical level. Already from an early age on, SCT is associated with a risk for ADHD, suggesting that its neurodevelopmental risk lies anchored in early brain maturation. Studying this genetically vulnerable population allows for the prospective study of risk markers to facilitate early and preventive interventions.
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Affiliation(s)
- Kimberly Kuiper
- Clinical Neurodevelopmental SciencesLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
| | - Hanna Swaab
- Clinical Neurodevelopmental SciencesLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
| | - Nicole Tartaglia
- eXtraordinarY Kids Clinic, Developmental PediatricsChildren's Hospital ColoradoAuroraColoradoUSA
- Department of PediatricsUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Sophie van Rijn
- Clinical Neurodevelopmental SciencesLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
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Westmark CJ, Kniss C, Sampene E, Wang A, Milunovich A, Elver K, Hessl D, Talboy A, Picker J, Haas-Givler B, Esler A, Gropman AL, Uy R, Erickson C, Velinov M, Tartaglia N, Berry-Kravis EM. Soy-Based Infant Formula is Associated with an Increased Prevalence of Comorbidities in Fragile X Syndrome. Nutrients 2020; 12:E3136. [PMID: 33066511 PMCID: PMC7602206 DOI: 10.3390/nu12103136] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/18/2022] Open
Abstract
A large number of adults and children consume soy in various forms, but little information is available regarding potential neurological side effects. Prior work indicates an association between the consumption of soy-based diets and seizure prevalence in mouse models of neurological disease and in children with autism. Herein, we sought to evaluate potential associations between the consumption of soy-based formula during infancy and disease comorbidities in persons with fragile X syndrome (FXS), while controlling for potentially confounding issues, through a retrospective case-control survey study of participants with FXS enrolled in the Fragile X Online Registry with Accessible Research Database (FORWARD). There was a 25% usage rate of soy-based infant formula in the study population. We found significant associations between the consumption of soy-based infant formula and the comorbidity of autism, gastrointestinal problems (GI) and allergies. Specifically, there was a 1.5-fold higher prevalence of autism, 1.9-fold GI problems and 1.7-fold allergies in participants reporting the use of soy-based infant formula. The major reason for starting soy-based infant formula was GI problems. The average age of seizure and allergy onset occurred long after the use of soy-based infant formula. We conclude that early-life feeding with soy-based infant formula is associated with the development of several disease comorbidities in FXS.
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Affiliation(s)
- Cara J. Westmark
- Department of Neurology, University of Wisconsin, Madison, WI 53706, USA
| | - Chad Kniss
- Survey Center, University of Wisconsin, Madison, WI 53706, USA; (C.K.); (K.E.)
| | - Emmanuel Sampene
- Department of Biostatistics & Medical Informatics, University of Wisconsin, Madison, WI 53792, USA;
| | - Angel Wang
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA; (A.W.); (E.M.B.-K.)
| | | | - Kelly Elver
- Survey Center, University of Wisconsin, Madison, WI 53706, USA; (C.K.); (K.E.)
| | - David Hessl
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA 95817, USA;
| | - Amy Talboy
- Departments of Human Genetics and Pediatrics, Emory University, Atlanta, GA 30322, USA;
| | | | - Barbara Haas-Givler
- Autism & Developmental Medicine Institute, Geisinger Lewisburg, Lewisburg, PA 17837, USA;
| | - Amy Esler
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55454, USA;
| | - Andrea L. Gropman
- Children’s National Health System, Washington, DC 20010, USA; (A.L.G.); (R.U.)
| | - Ryan Uy
- Children’s National Health System, Washington, DC 20010, USA; (A.L.G.); (R.U.)
| | - Craig Erickson
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
| | - Milen Velinov
- Institute for Basic Research in Developmental Disabilities, Staten Island, NY 10314, USA;
| | - Nicole Tartaglia
- Department of Pediatrics, University of Colorado, Aurora, CO 80045, USA;
| | - Elizabeth M. Berry-Kravis
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA; (A.W.); (E.M.B.-K.)
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21
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Berry-Kravis E, Horrigan JP, Tartaglia N, Hagerman R, Kolevzon A, Erickson CA, Hatti S, Snape M, Yaroshinsky A, Stoms G, Glass L, Jones NE. A Double-Blind, Randomized, Placebo-Controlled Clinical Study of Trofinetide in the Treatment of Fragile X Syndrome. Pediatr Neurol 2020; 110:30-41. [PMID: 32660869 DOI: 10.1016/j.pediatrneurol.2020.04.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/10/2020] [Accepted: 04/25/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND We analyze the safety and tolerability of trofinetide and provide a preliminary evaluation of its efficacy in adolescent and adult males with fragile X syndrome. METHODS This study was an exploratory, phase 2, multicenter, double-blind, placebo-controlled, parallel group study of the safety and tolerability of orally administered trofinetide in 72 adolescent and adult males with fragile X syndrome. Subjects were randomly assigned in a 1:1:1 ratio to 35 or 70 mg/kg twice daily trofinetide or placebo for 28 days. Safety assessments included adverse events, clinical laboratory tests, vital signs, electrocardiograms, physical examinations, and concomitant medications. Efficacy measurements were categorized into four efficacy domains, which related to clinically relevant phenotypic dimensions of impairment associated with fragile X syndrome. RESULTS Both 35 and 70 mg/kg dose levels of trofinetide were well tolerated and appeared to be generally safe. Trofinetide at the 70 mg/kg dose level demonstrated efficacy compared with placebo based on prespecified criteria. On the basis of a permutation test, the probability of a false-positive outcome for the achieved prespecified success was 0.045. In the group analysis, improvement from treatment baseline was demonstrated on three fragile X syndrome-specific outcome measures. CONCLUSIONS Trofinetide was well tolerated in adolescent and adult males with fragile X syndrome. Despite the relatively short duration of the study, a consistent signal of efficacy at the higher dose was observed in both caregiver and clinician assessments, based on a novel analytical model incorporating evaluation of multiple key symptom areas of fragile X syndrome. This finding suggests a potential for trofinetide treatment to provide clinically meaningful improvement in core fragile X syndrome symptoms.
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Affiliation(s)
- Elizabeth Berry-Kravis
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois; Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois; Department of Biochemistry, Rush University Medical Center, Chicago, Illinois.
| | - Joseph P Horrigan
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Nicole Tartaglia
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Randi Hagerman
- Department of Pediatrics, University of California Davis MIND Institute, Sacramento, California
| | - Alexander Kolevzon
- Division of Child and Adolescent Psychiatry, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Child and Adolescent Psychiatry, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Craig A Erickson
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | | | | | | | - Larry Glass
- Neuren Pharmaceuticals, Ltd., Melbourne, Victoria, Australia
| | - Nancy E Jones
- Neuren Pharmaceuticals, Ltd., Melbourne, Victoria, Australia
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22
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Wigby K, Cordeiro L, Wilson R, Angkustsiri K, Simon TJ, Tartaglia N. Adaptive functioning in children and adolescents with Trisomy X: An exploratory analysis. Am J Med Genet C Semin Med Genet 2020; 184:456-468. [PMID: 32548885 DOI: 10.1002/ajmg.c.31803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 01/30/2023]
Abstract
Identifying the factors related to adaptive functioning will improve the information available to families and providers of females with Trisomy X. Cognitive and behavioral features were assessed in 50 females ages 12.2 ± 3.6 years using the Behavior Assessment System for Children Second Edition (BASC-2) and Wechsler Scales of Intelligence. Executive functioning, social skills, and autistic traits were evaluated in a subset. Adaptive functioning was assessed using the BASC-2 adaptive skills composite score (ASC). Participants were classified as average adaptive skills (ASC T-score > 40) or deficits (ASC T-score < 40). Group comparisons were conducted. Multiple linear regression examined which factors contributed to ASC score. Twenty-eight females (55.6%) had adaptive skills deficits with functional communication being the most commonly affected adaptive domain. The group with ASC in the average range had higher verbal IQ (VIQ) and lower rates of numerous behavioral concerns. Internalizing behavior composite, DSM-IV inattentive symptoms score, and VIQ were significant predictors of ASC. Prenatally diagnosed females comprised over 70% of those with average adaptive skills. In this study, internalizing behaviors, inattentive ADHD symptoms, and VIQ were associated with poorer adaptive functioning. Early interventions targeting internalizing behaviors, attention/executive functioning, and communication skills may improve adaptive skills and deserve further study.
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Affiliation(s)
- Kristen Wigby
- Department of Pediatrics, Division of Genetics, University of California, San Diego and Rady Children's Hospital-San Diego, San Diego, California, USA.,Rady Children's Institute for Genomic Medicine, San Diego, California, USA
| | - Lisa Cordeiro
- Department of Pediatrics, Section of Developmental Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Rebecca Wilson
- Department of Pediatrics, Section of Developmental Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Kathleen Angkustsiri
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, University of California, Davis, California, USA.,MIND Institute, University of California, Davis, California, USA
| | - Tony J Simon
- MIND Institute, University of California, Davis, California, USA.,Department of Psychiatry and Behavioral Sciences, University of California, Davis, California, USA
| | - Nicole Tartaglia
- Department of Pediatrics, Section of Developmental Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
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23
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Janusz J, Harrison C, Boada C, Cordeiro L, Howell S, Tartaglia N, Boada R. Executive function in XXY: Comparison of performance-based measures and rating scales. Am J Med Genet C Semin Med Genet 2020; 184:469-481. [PMID: 32519473 DOI: 10.1002/ajmg.c.31804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/28/2020] [Accepted: 05/11/2020] [Indexed: 11/07/2022]
Abstract
Few studies have systematically assessed executive functioning (EF) skills in boys with XXY, and these are limited by small samples and restricted EF assessment. This study used a broader battery of performance-based measures as well as parent-rating scales of EF in 77 boys and adolescents with XXY (mean age = 12.5 years), recruited from a clinical trial and an outpatient clinic. Exploratory factor analyses were used to create EF domains from performance-based measures, and similar domains were measured using the Behavior Rating Inventory of Executive Function and Conners Parent-Rating Scales. The boys with XXY showed a distinct EF profile, with the greatest deficit in attention and more moderate deficits in working memory, switching, and planning/problem solving. Parent ratings showed similar challenges, as well as impaired inhibition. Independent sample t-tests showed no difference on performance measures between boys diagnosed or not diagnosed with attention-deficit/hyperactivity disorder (ADHD), although parents of boys diagnosed with ADHD reported more difficulties. There were no differences on performance-based tests between those diagnosed pre- and postnatally, although parents of postnatally diagnosed boys reported more metacognitive problems. Language deficits, cognition, and socio-economic status did not account for EF deficits.
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Affiliation(s)
- Jennifer Janusz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Neurology, Children's Hospital Colorado, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Caroline Harrison
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cristina Boada
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lisa Cordeiro
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Susan Howell
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Nicole Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Richard Boada
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Neurology, Children's Hospital Colorado, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
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24
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Tartaglia N, Howell S, Davis S, Kowal K, Tanda T, Brown M, Boada C, Alston A, Crawford L, Thompson T, van Rijn S, Wilson R, Janusz J, Ross J. Early neurodevelopmental and medical profile in children with sex chromosome trisomies: Background for the prospective eXtraordinarY babies study to identify early risk factors and targets for intervention. Am J Med Genet C Semin Med Genet 2020; 184:428-443. [PMID: 32506668 DOI: 10.1002/ajmg.c.31807] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 01/03/2023]
Abstract
Sex chromosome trisomies (SCT), including Klinefelter syndrome/XXY, Trisomy X, and XYY syndrome, occur in 1 of every 500 births. The past decades of research have resulted in a broadening of known associated medical comorbidities as well as advances in psychological research. This review summarizes what is known about early neurodevelopmental, behavioral, and medical manifestations in young children with SCT. We focus on recent research and unanswered questions related to the risk for neurodevelopmental disorders that commonly present in the first years of life and discuss the medical and endocrine manifestations of SCT at this young age. The increasing rate of prenatal SCT diagnoses provides the opportunity to address gaps in the existing literature in a new birth cohort, leading to development of the eXtraordinarY Babies Study. This study aims to better describe and compare the natural history of SCT conditions, identify predictors of positive and negative outcomes in SCT, evaluate developmental and autism screening measures commonly used in primary care practices for the SCT population, and build a rich data set linked to a bank of biological samples for future study. Results from this study and ongoing international research efforts will inform evidence-based care and improve health and neurodevelopmental outcomes.
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Affiliation(s)
- Nicole Tartaglia
- eXtraordinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA.,Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Susan Howell
- eXtraordinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA.,Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Shanlee Davis
- eXtraordinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA.,Pediatric Endocrinology, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Karen Kowal
- Department of Pediatric Endocrinology, Nemours-Dupont Hospital for Children, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tanea Tanda
- Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Mariah Brown
- Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA.,Pediatric Endocrinology, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Cristina Boada
- Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Amanda Alston
- Department of Pediatric Endocrinology, Nemours-Dupont Hospital for Children, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Leah Crawford
- Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Talia Thompson
- Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Sophie van Rijn
- Clinical Neurodevelopment Sciences, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Rebecca Wilson
- eXtraordinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA.,Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Jennifer Janusz
- eXtraordinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA.,Neurology and Neuropsychology, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Judith Ross
- Pediatric Endocrinology, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA.,Department of Pediatric Endocrinology, Nemours-Dupont Hospital for Children, Wilmington, Delaware, USA
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25
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Cordeiro L, Villagomez A, Swain D, Deklotz S, Tartaglia N. Adaptive Skills in FXS: A Review of the Literature and Evaluation of the PEDI-Computer Adaptive Test (PEDI-CAT) to Measure Adaptive Skills. Brain Sci 2020; 10:E351. [PMID: 32517224 PMCID: PMC7349498 DOI: 10.3390/brainsci10060351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 11/17/2022] Open
Abstract
As adaptive skills (AS) are dynamic and may indicate the success of an intervention, they are a common domain measured in clinical trials. Typical interview tools for measuring AS are time-consuming, and questionnaire measures often lead to inconsistent information. The present study was designed to evaluate the feasibility, validity and test-retest performance of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) in Fragile X syndrome (FXS). The PEDI-CAT is administered via tablet and uses the item response theory to efficiently determine the items administered. The PEDI-CAT was administered to 42 individuals with FXS (27 males; 15 females) aged 1.6-50.9 years (M = 14.9; SD = 11.2), followed by the Vineland-3 (VABS-3) interview for comparison. Administration was efficient (M = 21.7 min; SD = 9.5; range 8-45 min; mode = 19). Males and females did not significantly differ on the PEDI-CAT domains, except for daily activities (t(40) = -2.22, p = 0.037). Floor effects were significant for both measures, although the PEDI-CAT showed more floor effects in the mobility (35.7%) and social-cognitive (50%) domains. PEDI-CAT daily activities, mobility, social-cognitive and responsibility domains were all significantly correlated with most of the VABS-3 domains (all rho > 0.5; p < 0.01). Test-rest of the PEDI-CAT was comparable to the VABS-3. Results suggest that the PEDI-CAT is efficient, and minimal training is needed to administer it; however, it lacks specificity and shares a high rate of floor effects with the VABS-3.
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Affiliation(s)
- Lisa Cordeiro
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (L.C.); (A.V.); (S.D.)
| | - Adrienne Villagomez
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (L.C.); (A.V.); (S.D.)
- Developmental Pediatrics, Children’s Hospital Colorado, Aurora, CO 80045, USA;
| | - Deanna Swain
- Developmental Pediatrics, Children’s Hospital Colorado, Aurora, CO 80045, USA;
- Department of Psychiatry, Weill Cornell Medicine, White Plains, NY 10605, USA
| | - Sophia Deklotz
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (L.C.); (A.V.); (S.D.)
| | - Nicole Tartaglia
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (L.C.); (A.V.); (S.D.)
- Developmental Pediatrics, Children’s Hospital Colorado, Aurora, CO 80045, USA;
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26
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Gravholt CH, Tartaglia N, Disteche C. Sex chromosome aneuploidies in 2020-The state of care and research in the world. Am J Med Genet C Semin Med Genet 2020; 184:197-201. [PMID: 32496026 PMCID: PMC7419158 DOI: 10.1002/ajmg.c.31808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Claus H. Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Nicole Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- Developmental Pediatrics, Children’s Hospital Colorado, Aurora, Colorado
| | - Christine Disteche
- Department of Pathology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
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27
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Thompson T, Howell S, Davis S, Wilson R, Janusz J, Boada R, Pyle L, Tartaglia N. Current survey of early childhood intervention services in infants and young children with sex chromosome aneuploidies. Am J Med Genet C Semin Med Genet 2020; 184:414-427. [PMID: 32449585 DOI: 10.1002/ajmg.c.31785] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 01/23/2023]
Abstract
Sex chromosome aneuploidies (SCAs) are the most commonly occurring aneuploidies in children with a collective prevalence rate of 1 in 500 live births. Prior research has documented SCAs are associated with an increased risk for early expressive language and gross motor delays, learning disorders, ADHD, autism spectrum disorder, anxiety, and executive function problems. Although SCAs have been historically underdiagnosed in young children, recent advances in noninvasive prenatal testing have resulted in an increasing nationwide cohort of infants with confirmed diagnoses. Consequently, early childhood support systems must prepare for an influx of children with known risks for associated developmental delays and potential school problems. This national survey aimed to update our understanding of current early childhood intervention services for young children with SCA in the United States and to describe parent perspectives and priorities. Descriptive statistics, chi-square tests, and logistic regression models controlling for parent education revealed a majority of respondents reported receiving public early childhood intervention services with speech therapy as the most common service. There were significant differences in early childhood intervention services by timing of diagnosis (prenatal vs. postnatal), number of sex chromosomes (trisomy vs. tetra/pentasomy), and geographic location. Parents described interventions as desirable and effective yet also difficult to obtain due to issues with the SCA phenotype, lack of provider knowledge, and challenges navigating the intervention systems. Results support the need for enhanced provider training in SCAs, policy change for early childhood intervention qualification criteria for SCA conditions, and collaboration between medical and early childhood settings.
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Affiliation(s)
- Talia Thompson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Susan Howell
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Shanlee Davis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Rebecca Wilson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jennifer Janusz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Richard Boada
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Laura Pyle
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Nicole Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,eXtraordinarY Kids Program, Children's Hospital Colorado, Aurora, Colorado, USA
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28
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Urbanus E, Swaab H, Tartaglia N, Cordeiro L, van Rijn S. The behavioral profile of children aged 1-5 years with sex chromosome trisomy (47,XXX, 47,XXY, 47,XYY). Am J Med Genet C Semin Med Genet 2020; 184:444-455. [PMID: 32432413 PMCID: PMC7384033 DOI: 10.1002/ajmg.c.31788] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/27/2020] [Accepted: 04/09/2020] [Indexed: 12/18/2022]
Abstract
Children with SCT have an increased risk of suboptimal neurodevelopment. Previous studies have shown an elevated risk for neurobehavioral problems in individuals with SCT. However, not much is known about neurobehavioral problems in very young children; knowledge that could help with early identification of children at risk for suboptimal development, and that could help establish targets for early intervention. This study addressed the question of what the behavioral profile of children with SCT aged 1–5 years looks like. In total, 182 children aged 1–5 years participated in this study (NSCT=87, Nnonclinical controls = 95). Recruitment and assessment took place in the Netherlands and the United States. The SCT group was recruited through prospective follow‐up (50%), information seeking parents (31%), and clinical referral (18%). Behavioral profiles were assessed with the child behavior checklist and the ages‐and‐stages social–emotional questionnaire. Levels of parent‐rated problem behavior were higher in children with SCT. Difficulties with overall social–emotional functioning were already present in 1‐year‐olds, and elevated scores were persistent across the full age range. Affective and pervasive developmental behaviors were seen in late toddlerhood and prominent at preschool age. Anxiety, attention deficit, and oppositional defiant behaviors were seen in preschool‐aged children. Within this cross‐sectional study, the developmental trajectory of affective, pervasive developmental, and oppositional defiant behaviors seemed to be different for SCT children than nonclinical controls. Collectively, these results demonstrate the importance of behavioral screening for behavioral problems in routine clinical care for children with SCT from a young age. Social–emotional problems may require special attention, as these problems seem most prominent, showing increased risk across the full age range, and with these problems occurring regardless of the timing of diagnosis, and across all three SCT karyotypes.
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Affiliation(s)
- Evelien Urbanus
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Hanna Swaab
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Nicole Tartaglia
- eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lisa Cordeiro
- eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sophie van Rijn
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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29
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Cordeiro L, Braden M, Coan E, Welnick N, Tanda T, Tartaglia N. Evaluating Social Interactions Using the Autism Screening Instrument for Education Planning-3rd Edition (ASIEP-3): Interaction Assessment in Children and Adults with Fragile X Syndrome. Brain Sci 2020; 10:E248. [PMID: 32331269 PMCID: PMC7226214 DOI: 10.3390/brainsci10040248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 11/16/2022] Open
Abstract
An efficient and direct measure of social interactions and autism symptoms is needed for fragile X syndrome (FXS) research and clinical care. The Autism Screening Instrument for Educational Planning-Third Edition (ASIEP-3) Interaction assessment is a brief standardized measure that quantifies social responses under different conditions. The feasibility and validity of the ASIEP-3 was evaluated in 26 males and 13 females with FXS, along with cognitive testing and behavior questionnaires. The videos were scored at 10-second intervals, and the observed behaviors were scored as an interaction, independent play, no response, or aggression. In total, 39/41 participants successfully completed the ASIEP-3 (age M = 14.4 ± 10.2), with a range of cognitive abilities (abbreviated IQ (ABIQ) M = 58.9 ± 17.3, median = 50), behaviors (Aberrant Behavior Checklist (ABC) Total M = 37.00 ± 27.3), and autism diagnoses (N = 22/39). Reliable administration was demonstrated by all team members. The mean coded behaviors included interaction (40.6%), independent play (36.8%), no response (21.1%), and aggressive behavior (<10%). The interaction score was negatively correlated with the Social Communication Questionnaire (SCQ) score (p = 0.037), and the profiles differed by autism spectrum disorder (ASD) diagnosis. The intraclass correlation coefficients (ICCs) ranged from 0.79 to 0.93 for master's level and above. Administration of the ASIEP-3 was feasible for FXS across sex, age, ability, and behavior ratings by a trained research team. Reliable scoring required advanced training in the assessment of social development and FXS experience. The scores correlated to ratings and diagnoses of ASD. The ASIEP-3 shows promise to reliably index social interactions in FXS.
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Affiliation(s)
- Lisa Cordeiro
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (E.C.); (T.T.)
| | - Marcia Braden
- Licensed Psychologist, Private Practice, Colorado Springs, CO 80903, USA;
| | - Elizabeth Coan
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (E.C.); (T.T.)
- Developmental Pediatrics, Children’s Hospital Colorado, Aurora, CO 80045, USA;
| | - Nanastasia Welnick
- Developmental Pediatrics, Children’s Hospital Colorado, Aurora, CO 80045, USA;
| | - Tanea Tanda
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (E.C.); (T.T.)
| | - Nicole Tartaglia
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (E.C.); (T.T.)
- Developmental Pediatrics, Children’s Hospital Colorado, Aurora, CO 80045, USA;
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Reisinger DL, Shaffer RC, Tartaglia N, Berry-Kravis E, Erickson CA. Delineating Repetitive Behavior Profiles across the Lifespan in Fragile X Syndrome. Brain Sci 2020; 10:brainsci10040239. [PMID: 32316611 PMCID: PMC7226450 DOI: 10.3390/brainsci10040239] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 01/19/2023] Open
Abstract
Restricted repetitive behaviors (RRBs) are a core area of impairment in autism spectrum disorder (ASD), but also affect several other neurodevelopmental disorders including fragile X syndrome (FXS). Current literature has begun to describe the RRB profile in FXS up through adolescence; however, little is known about the subtypes of RRBs in adolescents and adults. Further, literature on the RRB profile of females with FXS is limited. The present study examines the RRB profile across subtypes and specific items in both males and females with FXS while assessing for differences based on age, ASD diagnosis and the impact of IQ. Participants included 154 individuals with FXS (ages 2 to 50 years old). Results revealed a peak in RRB severity in FXS between 7–12 years for the majority of RRB subscales with the exception of Sensory-Motor behaviors peaking between 2 and 12 years before declining. Distinct RRB profiles in males and females with FXS emerged in addition to significant overlap among the item and subscale levels of RRBs across gender. Further, an added diagnosis of ASD significantly increased rates of RRBs across all subscale levels, but not necessarily across all items. Lastly, IQ did not solely account for the presence of RRBs in FXS, with Sensory-Motor behaviors being driven by comorbid ASD in males with FXS, and Restricted Interest behaviors being driven by comorbid ASD regardless of gender. These findings build on the current understanding of RRBs in FXS based on gender and comorbid ASD and lay important groundwork for the development of targeted behavioral and pharmacological treatments.
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Affiliation(s)
- Debra L. Reisinger
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (D.L.R.); (R.C.S.)
| | - Rebecca C. Shaffer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (D.L.R.); (R.C.S.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Nicole Tartaglia
- Developmental Pediatrics, Children’s Hospital Colorado, Aurora, CO 80045, USA;
- Division of Developmental Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, Biochemistry, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Craig A. Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Correspondence: ; Tel.: +1-513-636-6265
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Coffman MC, Shaffer RC, Schmitt LM, Dominick KC, Pedapati E, Wang A, Berry-Kravis E, Tartaglia N, Erickson CA. Examination of Correlates to Health-Related Quality of Life in Individuals with Fragile X Syndrome. Brain Sci 2020; 10:E213. [PMID: 32260381 PMCID: PMC7226021 DOI: 10.3390/brainsci10040213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/18/2022] Open
Abstract
Health-related quality of life (HRQoL) is a multidimensional concept involving physical, psychological, social, and cognitive aspects of life. Individuals with Fragile X syndrome (FXS) experience a life-long disorder that impacts the HRQoL of the affected individual and their family. Thus, HRQoL may be an important outcome measure following intervention. However, it is yet not known whether HRQoL concerns relate to observed impairments in FXS. In the present study, we examined the nature and degree of association between HRQoL and established measures of functioning in FXS using the Parent Report for Children version of the PedsQL 4.0 Generic Core Scales and Cognitive Functioning Scale. We observed significant relationships between HRQoL a nd measures of adaptive behavior, maladaptive behaviors, and social functioning. The present study has implications for treatment outcomes for clinical trials in FXS.
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Affiliation(s)
- Marika C. Coffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.C.C.); (L.M.S.)
| | - Rebecca C. Shaffer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.C.C.); (L.M.S.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Lauren M. Schmitt
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.C.C.); (L.M.S.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Kelli C. Dominick
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (K.C.D.); (E.P.); (C.A.E.)
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Ernest Pedapati
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (K.C.D.); (E.P.); (C.A.E.)
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Division of Child Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Angel Wang
- Departments of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, Biochemistry, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Nicole Tartaglia
- Developmental Pediatrics, Children’s Hospital Colorado, Aurora, CO 80045, USA;
- Division of Developmental Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Craig A. Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (K.C.D.); (E.P.); (C.A.E.)
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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Tartaglia N, Pavone G, Petruzzelli F, DiLascia A, Vovola F, Maddalena F, Cianci P, Fersini A, Pacilli M, Ambrosi A. Robotic sleeve gastrectomy vs laparoscopic sleeve gastrectomy: our preliminary experience and a literature review. Clinical and Experimental Surgery Petrovsky journal 2020. [DOI: 10.33029/2308-1198-2020-8-5-7-15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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McCabe KL, Popa AM, Durdle C, Amato M, Cabaral MH, Cruz J, Wong LM, Harvey D, Tartaglia N, Simon TJ. Quantifying the resolution of spatial and temporal representation in children with 22q11.2 deletion syndrome. J Neurodev Disord 2019; 11:40. [PMID: 31861974 PMCID: PMC6925465 DOI: 10.1186/s11689-019-9301-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/28/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Our ability to generate mental representation of magnitude from sensory information affects how we perceive and experience the world. Reduced resolution of the mental representations formed from sensory inputs may generate impairment in the proximal and distal information processes that utilize these representations. Impairment of spatial and temporal information processing likely underpins the non-verbal cognitive impairments observed in 22q11.2 deletion syndrome (22q11DS). The present study builds on prior research by seeking to quantify the resolution of spatial and temporal representation in children with 22q11DS, sex chromosome aneuploidy (SCA), and a typically developing (TD) control group. PARTICIPANTS AND METHODS Children (22q11DS = 70, SCA = 49, TD = 46) responded to visual or auditory stimuli with varying difference ratios. The participant's task was to identify which of two sequentially presented stimuli was of larger magnitude in terms of, size, duration, or auditory frequency. Detection threshold was calculated as the minimum difference ratio between the "standard" and the "target" stimuli required to achieve 75% accuracy in detecting that the two stimuli were different. RESULTS Children with 22q11DS required larger magnitude difference between spatial stimuli for accurate identification compared with both the SCA and TD groups (% difference from standard: 22q11DS = 14; SCA = 8; TD: 7; F = 8.42, p < 0.001). Temporal detection threshold was also higher for the 22q11DS group to both visual (% difference from standard: 22q11DS = 14; SCA = 8; TD = 7; F = 8.33, p < 0.001) and auditory (% difference from standard: 22q11DS = 23; SCA = 12; TD: 8; F = 8.99, p < 0.001) stimuli compared with both the SCA and TD groups, while the SCA and TD groups displayed equivalent performance on these measures (p's > 0.05). Pitch detection threshold did not differ among the groups (p's > 0.05). CONCLUSIONS The observation of higher detection thresholds to spatial and temporal stimuli indicates further evidence for reduced resolution in both spatial and temporal magnitude representation in 22q11DS, that does not extend to frequency magnitude representation (pitch detection), and which is not explained by generalized cognitive impairment alone. These findings generate further support for the hypothesis that spatiotemporal hypergranularity of mental representations contributes to the non-verbal cognitive impairment seen in 22q11DS.
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Affiliation(s)
- Kathryn L McCabe
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA.
- MIND Institute, University of California, Davis, CA, USA.
| | - Abbie M Popa
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
| | - Courtney Durdle
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
| | - Michele Amato
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
| | - Margarita H Cabaral
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
| | - Joshua Cruz
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
| | - Ling M Wong
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
- MIND Institute, University of California, Davis, CA, USA
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Nicole Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tony J Simon
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
- MIND Institute, University of California, Davis, CA, USA
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Davis S, Howell S, Serena D, Buyers E, Tartaglia N. SUN-263 Evidence for Diminished Ovarian Reserve in Youth with Trisomy X. J Endocr Soc 2019. [PMCID: PMC6553427 DOI: 10.1210/js.2019-sun-263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: An additional X chromosome occurs in 1 in 1,000 females resulting in a 47,XXX karyotype also known as Trisomy X. Abnormal ovarian function was suggested from a cohort of 10 females with Trisomy X followed from birth through young adulthood who had later age of menarche and one girl who developed secondary amenorrhea with elevated gonadotropin levels (1). There have since been several case reports of premature menopause in women with Trisomy X, and 3.8% of women with premature ovarian insufficiency (POI) have been reported to have Trisomy X (2). Ovarian reserve can be estimated by serum anti-mullerian hormone (AMH) concentrations, with low AMH concentrations concerning for diminished ovarian reserve and poor fertility prospects. Ovarian function in youth with Trisomy X has not been evaluated. The purpose of this study was to evaluate AMH as a marker of ovarian reserve in girls with Trisomy X. Methods: Parents and youth with Trisomy X seen at a tertiary care referral center were counselled on the risk for POI and AMH was offered as a screen for ovarian reserve. All participants provided informed consent to use their clinical data for research purposes. A total of 11 girls with a non-mosaic 47,XXX karyotype had AMH measured by chemiluminescent assay (Esoterix Laboratory Services) between December 2015 and October 2018. Results: The median age of participants was 13.3 years (IQR 12.4 – 17.9) and 9 of 11 girls had experienced menarche at a median age of 12.5 years (IQR 11.5-12.6); none had primary or secondary amenorrhea. The median AMH concentration was 0.7 ng/ml (IQR 0.2-1.7), significantly lower than the laboratory provided median of 5.23 ng/ml (one sample Wilcoxin Signed Rank Test p=0.001). 72% had an AMH below 1.05 ng/ml, the lower limit of normal for age. Discussion: Despite normal menarchal timing and ongoing menses, the majority of youth with Trisomy X had a low AMH concerning for diminished ovarian reserve and potentially impaired fertility. Although there is great interest in fertility preservation for girls with oncological diagnoses and Turner syndrome, there is limited awareness of ovarian dysfunction in Trisomy X. Research on ovarian function and fertility in Trisomy X is needed across the lifespan, as well as investigation into the mechanisms of the additional X chromosome leading to the diminished ovarian reserve observed in this adolescent sample. (1) Ratcliffe et al, 1990, Birth Defects: Original Article Series, 26(4): 1-44. (2) Goswami et al, 2003, Fertil Steril, 80(4): 1052-4.
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Affiliation(s)
| | - Susan Howell
- University of Colorado, Aurora, CO, United States
| | - Dovey Serena
- University of Colorado, Aurora, CO, United States
| | - Eliza Buyers
- University of Colorado, Aurora, CO, United States
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Tartaglia N, Bonn-Miller M, Hagerman R. Treatment of Fragile X Syndrome with Cannabidiol: A Case Series Study and Brief Review of the Literature. Cannabis Cannabinoid Res 2019; 4:3-9. [PMID: 30944868 PMCID: PMC6446166 DOI: 10.1089/can.2018.0053] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Fragile X syndrome (FXS) is an X-linked dominant disorder caused by a mutation in the fragile X mental retardation 1 gene. Cannabidiol (CBD) is an exogenous phytocannabinoid with therapeutic potential for individuals with anxiety, poor sleep, and cognitive deficits, as well as populations with endocannabinoid deficiencies, such as those who suffer from FXS. The objective of this study was to provide a brief narrative review of recent literature on endocannabinoids and FXS and to present a case series describing three patients with FXS who were treated with oral CBD-enriched (CBD+) solutions. We review recent animal and human studies of endocannabinoids in FXS and present the cases of one child and two adults with FXS who were treated with various oral botanical CBD+ solutions delivering doses of 32.0 to 63.9 mg daily. Multiple experimental and clinical models of FXS combine to highlight the therapeutic potential of CBD for management of FXS. All three patients described in the case series exhibited functional benefit following the use of oral CBD+ solutions, including noticeable reductions in social avoidance and anxiety, as well as improvements in sleep, feeding, motor coordination, language skills, anxiety, and sensory processing. Two of the described patients exhibited a reemergence of a number of FXS symptoms following cessation of CBD+ treatment (e.g., anxiety), which then improved again after reintroduction of CBD+ treatment. Findings highlight the importance of exploring the therapeutic potential of CBD within the context of rigorous clinical trials.
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Affiliation(s)
- Nicole Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Randi Hagerman
- Department of Pediatrics, MIND Institute, University of California Davis Medical Center, Sacramento, California
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Hutaff-Lee C, Bennett E, Howell S, Tartaglia N. Clinical developmental, neuropsychological, and social-emotional features of Turner syndrome. Am J Med Genet C Semin Med Genet 2019; 181:126-134. [PMID: 30767374 DOI: 10.1002/ajmg.c.31687] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 12/11/2022]
Abstract
Individuals with Turner syndrome (TS) are at risk for a constellation of neurocognitive and psychosocial differences, although there is significant individual variability in these features. TS is associated with an increased risk for difficulties with visual-spatial reasoning, visual-spatial memory, attention, executive functioning, motor, and math skills. Additionally, increased rates of social difficulties, anxiety, and depression are observed. There can be significant interplay between all of these factors contributing to the behavioral phenotype. Neuropsychological features and previous research are reviewed. Clinical considerations and recommendations for evaluation and treatment of psychological and behavioral difficulties are provided, including consideration of medical features in TS, as well as therapies, educational supports, and medication treatment. Future research is needed to evaluate effectiveness of different treatments for neuropsychological and psychosocial features of TS, including modification and validation of existing evidence-based treatments and new approaches to care.
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Affiliation(s)
- Christa Hutaff-Lee
- Division of Neurology, Children's Hospital Colorado, Aurora, Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,Department of Pediatrics, eXtraOrdinary Kids Turner Syndrome Clinic, Children's Hospital Colorado, Aurora, Colorado
| | - Elizabeth Bennett
- Department of Pediatrics, eXtraOrdinary Kids Turner Syndrome Clinic, Children's Hospital Colorado, Aurora, Colorado.,Division of Developmental Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Susan Howell
- Department of Pediatrics, eXtraOrdinary Kids Turner Syndrome Clinic, Children's Hospital Colorado, Aurora, Colorado.,Division of Developmental Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Nicole Tartaglia
- Department of Pediatrics, eXtraOrdinary Kids Turner Syndrome Clinic, Children's Hospital Colorado, Aurora, Colorado.,Division of Developmental Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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Abstract
Aims: Klinefelter (XXY) and XXYY syndromes are genetic disorders in males characterized by additional sex chromosomes compared to the typical male karyotype of 46, XY. Both conditions have been previously associated with motor delays and motor skills deficits. We aimed to describe and compare motor skills in males with XXY and XXYY syndromes, and to analyze associations with age, cognitive abilities, and adaptive functioning. Methods: Sixty-four males with XXY and 46 males with XXYY, ages 4-20 were evaluated using the Beery Test of Visual Motor Integration and the Bruininks-Oseretsky Test of Motor Proficiency - 2nd Edition assessments, Vineland-2 adaptive scales, and cognitive testing. Results: Motor coordination impairments were found in 39% of the males with XXY and 73% of the males with XXYY. Both groups showed strengths in visual perceptual skills. Males with XXYY had lower mean scores compared to males with XXY across all assessments. Fine motor dexterity and coordination deficits were common. There was a positive correlation between VMI scores and adaptive functioning. Conclusion: Occupational and physical therapists should be aware of the motor phenotype in XXY and XXYY both to aid in diagnosis of unidentified cases and to guide intervention.
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Affiliation(s)
- Sydney Martin
- a Occupational Therapy Department , Children's Hospital Colorado , Aurora , Colorado , USA.,b Department of Occupational Therapy , San Jose State University , San Jose , California , USA
| | - Lisa Cordeiro
- c Department of Pediatrics , University of Colorado School of Medicine , Aurora , Colorado , USA
| | - Pamela Richardson
- b Department of Occupational Therapy , San Jose State University , San Jose , California , USA
| | - Shanlee Davis
- c Department of Pediatrics , University of Colorado School of Medicine , Aurora , Colorado , USA
| | - Nicole Tartaglia
- a Occupational Therapy Department , Children's Hospital Colorado , Aurora , Colorado , USA.,c Department of Pediatrics , University of Colorado School of Medicine , Aurora , Colorado , USA
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Dy ABC, Tassone F, Eldeeb M, Salcedo-Arellano MJ, Tartaglia N, Hagerman R. Metformin as targeted treatment in fragile X syndrome. Clin Genet 2017; 93:216-222. [PMID: 28436599 DOI: 10.1111/cge.13039] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/18/2017] [Accepted: 04/20/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Individuals with fragile X syndrome (FXS) have both behavioral and medical comorbidities and the latter include obesity in approximately 30% and the Prader-Willi Phenotype (PWP) characterized by severe hyperphagia and morbid obesity in less than 10%. Metformin is a drug used in individuals with type 2 diabetes, obesity or impaired glucose tolerance and it has a strong safety profile in children and adults. Recently published studies in the Drosophila model and the knock out mouse model of FXS treated with metformin demonstrate the rescue of multiple phenotypes of FXS. MATERIALS AND METHODS We present 7 cases of individuals with FXS who have been treated with metformin clinically. One case with type 2 diabetes, 3 cases with the PWP, 2 adults with obesity and/or behavioral problems and, a young child with FXS. These individuals were clinically treated with metformin and monitored for behavioral changes with the Aberrant Behavior Checklist and metabolic changes with a fasting glucose and HgbA1c. RESULTS We found consistent improvements in irritability, social responsiveness, hyperactivity, and social avoidance, in addition to comments from the family regarding improvements in language and conversational skills. No significant side-effects were noted and most patients with obesity lost weight. CONCLUSION We recommend a controlled trial of metformin in those with FXS. Metformin appears to be an effective treatment of obesity including those with the PWP in FXS. Our study suggests that metformin may also be a targeted treatment for improving behavior and language in children and adults with FXS.
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Affiliation(s)
- A B C Dy
- Ateneo de Manila University School of Medicine and Public Health, Pasig City, Philippines.,MedMom Institute for Human Development, Pasig City, Philippines.,Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis Medical Center, Sacramento, California
| | - F Tassone
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis Medical Center, Sacramento, California.,Department of Biochemistry and Molecular Medicine, University of California Davis Medical Center, Sacramento, California
| | - M Eldeeb
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis Medical Center, Sacramento, California.,Department of Pediatrics, University of California Davis Medical Center, Sacramento, California
| | - M J Salcedo-Arellano
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis Medical Center, Sacramento, California.,Department of Pediatrics, University of California Davis Medical Center, Sacramento, California
| | - N Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - R Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis Medical Center, Sacramento, California.,Department of Pediatrics, University of California Davis Medical Center, Sacramento, California
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Ross JL, Kushner H, Kowal K, Bardsley M, Davis S, Reiss AL, Tartaglia N, Roeltgen D. Androgen Treatment Effects on Motor Function, Cognition, and Behavior in Boys with Klinefelter Syndrome. J Pediatr 2017; 185:193-199.e4. [PMID: 28285751 PMCID: PMC6754744 DOI: 10.1016/j.jpeds.2017.02.036] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/23/2016] [Accepted: 02/10/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the effects of early low-dose androgen on motor, cognitive, and behavioral function in prepubertal boys with Klinefelter syndrome (47,XXY). STUDY DESIGN Double-blind trial of 84 boys, ages 4-12 years, randomized to oxandrolone (Ox; 0.06?mg/kg daily; n?=?43) or placebo (Pl; n?=?41) for 24 months. Standardized assessments were performed at baseline and every 12 months for 24 months evaluating motor, cognitive, and behavioral function. RESULTS The 24-month outcomes were better in the Ox vs. Pl group on 1 of 5 primary endpoints (motor function/strength): Bruininks Visual-Motor scale (P?=?.005), without significant differences between the 2 groups for the other 4 components. Secondary analyses suggested improvement in the Ox vs. Pl group in the anxiety/depression (P?=?.03) and social problems (P?=?.01) scales on the Child Behavior Checklist, anxiety (P?=?.04) on the Piers Harris Self Concept Scale, and interpersonal problems (P?=?.02) on the Children's Depression Inventory, without significant differences in hyperactive or aggressive behaviors. CONCLUSIONS This double-blind, randomized trial demonstrates that 24 months of childhood low-dose androgen treatment in boys with Klinefelter syndrome benefited 1 of 5 primary endpoints (visual-motor function). Secondary analyses demonstrated positive effects of androgen on aspects of psychosocial function (anxiety, depression, social problems), without significant effects on cognitive function, or hyperactive or aggressive behaviors. TRIAL REGISTRATION ClinicalTrials.gov: NCT00348946.
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Affiliation(s)
- Judith L Ross
- Thomas Jefferson University, Department of Pediatrics, Philadelphia, PA; A.I. DuPont Hospital for Children, Wilmington, DE.
| | | | - Karen Kowal
- Thomas Jefferson University, Department of Pediatrics, Philadelphia, PA; A.I. DuPont Hospital for Children, Wilmington, DE
| | - Martha Bardsley
- Thomas Jefferson University, Department of Pediatrics, Philadelphia, PA; A.I. DuPont Hospital for Children, Wilmington, DE
| | - Shanlee Davis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Allan L Reiss
- Department of Psychiatry, Stanford University, Palo Alto, CA
| | - Nicole Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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Rollo G, Tartaglia N, Falzarano G, Pichierri P, Stasi A, Medici A, Meccariello L. The challenge of non-union in subtrochanteric fractures with breakage of intramedullary nail: evaluation of outcomes in surgery revision with angled blade plate and allograft bone strut. Eur J Trauma Emerg Surg 2017; 43:853-861. [PMID: 28258285 DOI: 10.1007/s00068-016-0755-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/23/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE Subtrochanteric fractures have a bimodal age distribution. They usually require open reduction and internal fixation. Closed reduction and intramedullary nail fixation rate are increased for this type of fracture. As a result, the hardware breakage and non-union rate is high among such patients. Our purpose is to evaluate the outcomes of the role of blade plate and bone strut allograft in the management of subtrochanteric non-union by femoral nailing. MATERIALS AND METHODS We reported a group of 22 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail with medial femoral allograft bone and lateral blade plate and wire (PS) s; and a group of 13 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail treated with lateral blade plate and screws (CG). The chosen criteria to evaluate the two group during the clinical and radiological follow-up were the quality of life, measured by The Short Form (12) Health Survey (SF-12), the hip function and quality of life related to it, measured by the Harris Hip Score (HHS), bone healing, measured by Radiographic Union Score (RUS) by XR and CT at 1 year after the surgery, and postoperative complications. The evaluation endpoint was set at 12 months. RESULTS The Bone healing measured by RUS occurred and also the full recovery before the first trauma measured by SF-12 and HHS are better in PS group. We only had three unimportant complications in PS while four breakage hardware in CG. CONCLUSION We conclude that in complicated non-unions, the use of blade plate and bone strut allograft has a definite positive role in the management of such cases.
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Affiliation(s)
- G Rollo
- U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - N Tartaglia
- U.O.C. Orthopedics and Traumatology, Hospital Miulli, Acqua Viva delle Fonti, Italy
| | - G Falzarano
- U.O.C. Orthopedics and Traumatology, Department of Emergency, Azienda Ospedaliera Gaetano Rummo, Via dell'Angelo 1, Benevento, Italy
| | - P Pichierri
- U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - A Stasi
- U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - A Medici
- U.O.C. Orthopedics and Traumatology, Department of Emergency, Azienda Ospedaliera Gaetano Rummo, Via dell'Angelo 1, Benevento, Italy
| | - L Meccariello
- U.O.C. Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
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Abstract
Cerebral arteriovenous malformations (AVMs) present a challenge to diagnose in children with developmental disability, because of the overlap in behavioral symptoms and neurologic manifestations. They have been very rarely reported in conjunction with autism spectrum disorder. This case involves a 13 year old male with a history of autism spectrum disorder and significant behavioral issues diagnosed with a thalamic AVM following lateralizing neurologic symptoms. Despite radiosurgical treatment, hemorrhage followed consequently causing extensive neurologic injury and death. This case emphasizes the need for close follow up and coordination within a medical home for children with developmental disabilities. A multidisciplinary team approach is ideal to allow detection of subtle neurologic changes over time that may be masked as behavioral difficulties.
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Affiliation(s)
- Veena Sison
- Developmental Pediatrics, Children's Hospital Colorado, Aurora, CO.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.,Southern California Kaiser Permanente Medical Group, Woodland Hills, CA
| | | | - Robert Breeze
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO
| | - Terry Hall
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.,JFK Partners, University of Colorado School of Medicine, Aurora, CO
| | - Pamela McKenzie
- Developmental Pediatrics, Children's Hospital Colorado, Aurora, CO.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Nicole Tartaglia
- Developmental Pediatrics, Children's Hospital Colorado, Aurora, CO.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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Tartaglia N, Vicenti G, Carrozzo M, Abate A, Rifino F, Picca G, Solarino G, Moretti B. The treatment of distal third humeral diaphyseal fractures: Is there still a place for the external fixation? Musculoskelet Surg 2016; 100:45-51. [PMID: 27900703 DOI: 10.1007/s12306-016-0419-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/20/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The treatment for humeral diaphyseal fractures is still controversial. The purpose of this study was to evaluate the clinical and radiographic outcomes of treating humeral distal third diaphyseal fractures by using external fixation technique. MATERIALS AND METHODS We retrospectively review 65 cases of diaphyseal humeral fractures (31 type A, 23 type B and 11 type C of the AO/OTA classification) treated with external fixation (Orthofix FAD small) between 2008 and 2013. The mean follow-up was 48 months (24-72 months). There were 12 open fractures; however, no cases of concomitant vascular injury were described. The transolecranic traction was always applied to promote partial reduction through ligamentotaxis. In case of interposition of soft tissues impeding reduction, a small incision was performed allowing mobilization of bone ends. RESULTS All fractures resulted healed at a mean of 11 weeks (range 9-13 weeks); the average time of removal of the external fixator was 88 days (range 65-95 days). At the last follow-up, the mean elbow flexion was 132.6° (Min 126°-Max 137°) and the mean elbow extension was 6.4° (Max 0°-Min 13°). The Cassebaum's index rated as excellent in 47.8 % (31 patients), good in 37 % (24 patients), fair in 9.2 % (6 patients) and poor in 6 % (4 patients). The mean DASH score at the final follow-up was 14.7 (range 0-33); 15 patients had a range score between 10 and 20, 43 had less than 10, and seven had more than 20. We observed three cases of superficial infections and two cases of acute radial nerve palsy recovered within 3 months. CONCLUSION According to the excellent clinical results and full rate of consolidation, we state external fixation as a valid option in the treatment of distal third humeral diaphyseal fractures.
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Affiliation(s)
- N Tartaglia
- Department of Trauma and Orthopaedics, Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | - G Vicenti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - M Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - A Abate
- Department of Orthopedics and Traumatology, Monsignor Raffaele Dimiccoli Hospital, Barletta, Italy
| | - F Rifino
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - G Picca
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - G Solarino
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - B Moretti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
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Wigby K, D'Epagnier C, Howell S, Reicks A, Wilson R, Cordeiro L, Tartaglia N. Expanding the phenotype of Triple X syndrome: A comparison of prenatal versus postnatal diagnosis. Am J Med Genet A 2016; 170:2870-2881. [PMID: 27644018 DOI: 10.1002/ajmg.a.37688] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 04/01/2016] [Indexed: 11/08/2022]
Abstract
Triple X syndrome (47, XXX) occurs in approximately 1:1,000 female births and has a variable phenotype of physical and psychological features. Prenatal diagnosis rates of 47, XXX are increasing due to non-invasive prenatal genetic testing. Previous studies suggest that prenatal diagnosed females have better neurodevelopmental outcomes. This cross-sectional study describes diagnosis, physical features, medical problems, and neurodevelopmental features in a large cohort of females with 47, XXX. Evaluation included review of medical and developmental history, physical exam, cognitive, and adaptive testing. Medical and developmental features were compared between the prenatal and postnatal diagnosis groups using rate calculations and Fisher's exact test. Cognitive and adaptive tests scores were compared using t-tests. Seventy-four females age 6 months-24 years (mean 8.3 years) participated. Forty-four (59.5%) females were in the prenatal diagnosis group. Mean age of postnatal diagnosis was 5.9 years; developmental delay was the most common indication for postnatal genetic testing. Common physical features included hypertelorism, epicanthal folds, clinodactyly, and hypotonia. Medical problems included dental disorders (44.4%), seizure disorders (16.2%), genitourinary malformations (12.2%). The prenatal diagnosis group had higher verbal (P < 0.001), general ability index (P = 0.004), and adaptive functioning scores (P < 0.001). Rates of ADHD (52.2% vs. 45.5%, P = 0.77) and learning disabilities (39.1% vs. 36.3%, P = 1.00) were similar between the two groups. These findings expand on the phenotypic features in females with Triple X syndrome and support that prenatally ascertained females have better cognitive and functional outcomes. However, prenatally diagnosed females are still at risk for neurodevelopmental disorders. Genetic counseling and treatment recommendations are summarized. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Kristen Wigby
- Department of Pediatrics, Developmental Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,Division of Genetics, Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Cheryl D'Epagnier
- Department of Pediatrics, Developmental Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Susan Howell
- Department of Pediatrics, Developmental Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado
| | - Amy Reicks
- Genetic Counseling Program, University of Colorado Denver, Colorado
| | - Rebecca Wilson
- eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado
| | - Lisa Cordeiro
- Department of Pediatrics, Developmental Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Nicole Tartaglia
- Department of Pediatrics, Developmental Pediatrics, University of Colorado School of Medicine, Aurora, Colorado. .,eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado.
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44
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Liu JA, Hagerman RJ, Miller RM, Craft LT, Finucane B, Tartaglia N, Berry-Kravis EM, Sherman SL, Kidd SA, Cohen J. Clinicians' experiences with the fragile X clinical and research consortium. Am J Med Genet A 2016; 170:3138-3143. [PMID: 27604509 DOI: 10.1002/ajmg.a.37948] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 08/14/2016] [Indexed: 01/22/2023]
Abstract
The objectives of the study were to assess the attitudes and experiences of clinicians involved in a consortium of clinics serving people with fragile X-associated disorders to gauge satisfaction with the consortium and its efforts to improve quality of life for patients and the community. An internet survey was sent to 26 fragile X (FX) clinic directors participating in the Fragile X Clinical and Research Consortium (FXCRC). Respondents were asked to complete 19 questions on consortium performance and outcomes relevant for their own clinic. The response rate was 84% (22/26), with two surveys providing incomplete data. Assistance with clinic establishment, opportunities for research collaborations, and access to colleagues and information were highly valued. Approximately 76% of clinicians reported improvements in patient care and 60% reported an increase in patient services. There was a 57% increase in participation in a FX-related clinical trial among clinics since joining the FXCRC (24% vs. 81%). Overall, respondents reported primarily positive experiences from participation in the FXCRC. Common suggestions for improvement included additional financial support and increased utilization of collected patient data for research purposes. Additionally, a Clinic Services Checklist was administered annually to examine changes in services offered over time. There were several important changes regarding the provision of services by clinics, often with multiple clinics changing with respect to a service. In conclusion, the FXCRC has led to the establishment and sustainment of fragile X clinics in the U.S., fostered cooperation among fragile X clinicians, and provided clinics with a platform to share recommendations and best practices to maximize quality of life for their patients and the overall fragile X community. The results from the survey and checklist also provide suggestions to strengthen the FXCRC and enhance future collaborations among FXCRC members. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jessica A Liu
- National Fragile X Foundation, Washington, District of Columbia
| | - Randi J Hagerman
- University of California Davis MIND Institute and Department of Pediatrics, University of California Davis Health System, Sacramento, California
| | - Robert M Miller
- Rob Miller Human Service Consulting, Pleasant Hill, California
| | - Lisa T Craft
- Department of Pediatrics, Weisskopf Child Evaluation Center, University of Louisville, Louisville, Kentucky
| | - Brenda Finucane
- Autism and Developmental Medicine Institute, Geisinger Health System, Lewisburg, Pennsylvania
| | - Nicole Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Elizabeth M Berry-Kravis
- Department of Pediatrics, Neurological Sciences, Biochemistry, Rush University Medical Center, Chicago, Illinois
| | | | - Sharon A Kidd
- National Fragile X Foundation, Washington, District of Columbia
| | - Jeffrey Cohen
- National Fragile X Foundation, Washington, District of Columbia
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45
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Davis S, Howell S, Wilson R, Tanda T, Ross J, Zeitler P, Tartaglia N. Advances in the Interdisciplinary Care of Children with Klinefelter Syndrome. Adv Pediatr 2016; 63:15-46. [PMID: 27426894 PMCID: PMC5340500 DOI: 10.1016/j.yapd.2016.04.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Shanlee Davis
- Department of Pediatrics, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA; Department of Endocrinology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue B265, Aurora, CO 80045, USA
| | - Susan Howell
- Department of Pediatrics, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA; Developmental Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue B140, Aurora, CO 80045, USA
| | - Rebecca Wilson
- Developmental Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue B140, Aurora, CO 80045, USA
| | - Tanea Tanda
- Department of Pediatrics, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA; Developmental Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue B140, Aurora, CO 80045, USA
| | - Judy Ross
- Department of Pediatrics, Thomas Jefferson University School of Medicine, 833 Chestnut Street, Philadelphia, PA 19107, USA; Pediatric Endocrinology, Nemours A.I. DuPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA
| | - Philip Zeitler
- Department of Pediatrics, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA; Department of Endocrinology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue B265, Aurora, CO 80045, USA
| | - Nicole Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA; Developmental Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue B140, Aurora, CO 80045, USA.
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46
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Tartaglia N, Howell S, Wilson R, Janusz J, Boada R, Martin S, Frazier JB, Pfeiffer M, Regan K, McSwegin S, Zeitler P. The eXtraordinarY Kids Clinic: an interdisciplinary model of care for children and adolescents with sex chromosome aneuploidy. J Multidiscip Healthc 2015; 8:323-34. [PMID: 26229481 PMCID: PMC4514383 DOI: 10.2147/jmdh.s80242] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Purpose Individuals with sex chromosome aneuploidies (SCAs) are born with an atypical number of X and/or Y chromosomes, and present with a range of medical, developmental, educational, behavioral, and psychological concerns. Rates of SCA diagnoses in infants and children are increasing, and there is a need for specialized interdisciplinary care to address associated risks. The eXtraordinarY Kids Clinic was established to provide comprehensive and experienced care for children and adolescents with SCA, with an interdisciplinary team composed of developmental–behavioral pediatrics, endocrinology, genetic counseling, child psychology, pediatric neuropsychology, speech–language pathology, occupational therapy, nursing, and social work. The clinic model includes an interdisciplinary approach to care, where assessment results by each discipline are integrated to develop unified diagnostic impressions and treatment plans individualized for each patient. Additional objectives of the eXtraordinarY Kids Clinic program include prenatal genetic counseling, research, education, family support, and advocacy. Methods Satisfaction surveys were distributed to 496 patients, and responses were received from 168 unique patients. Results Satisfaction with the overall clinic visit was ranked as “very satisfied” in 85%, and as “satisfied” in another 9.8%. Results further demonstrate specific benefits from the clinic experience, the importance of a knowledgeable clinic coordinator, and support the need for similar clinics across the country. Three case examples of the interdisciplinary approach to assessment and treatment are included.
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Affiliation(s)
- Nicole Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA ; Child Development Unit, Children's Hospital Colorado, Aurora, CO, USA
| | - Susan Howell
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA ; Child Development Unit, Children's Hospital Colorado, Aurora, CO, USA
| | - Rebecca Wilson
- Child Development Unit, Children's Hospital Colorado, Aurora, CO, USA
| | - Jennifer Janusz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA ; Child Development Unit, Children's Hospital Colorado, Aurora, CO, USA
| | - Richard Boada
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA ; Child Development Unit, Children's Hospital Colorado, Aurora, CO, USA
| | - Sydney Martin
- Child Development Unit, Children's Hospital Colorado, Aurora, CO, USA
| | | | - Michelle Pfeiffer
- Child Development Unit, Children's Hospital Colorado, Aurora, CO, USA
| | - Karen Regan
- Child Development Unit, Children's Hospital Colorado, Aurora, CO, USA
| | - Sarah McSwegin
- Child Development Unit, Children's Hospital Colorado, Aurora, CO, USA
| | - Philip Zeitler
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA ; Child Development Unit, Children's Hospital Colorado, Aurora, CO, USA
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47
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Ross JL, Tartaglia N, Merry DE, Dalva M, Zinn AR. Behavioral phenotypes in males with XYY and possible role of increased NLGN4Y expression in autism features. Genes Brain Behav 2015; 14:137-44. [PMID: 25558953 PMCID: PMC4756915 DOI: 10.1111/gbb.12200] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/22/2014] [Accepted: 12/23/2014] [Indexed: 12/20/2022]
Abstract
The male sex chromosome disorder, 47,XYY syndrome (XYY), is associated with increased risk for social-emotional difficulties, attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). We hypothesize that increased Y chromosome gene copy number in XYY leads to overexpression of Y-linked genes related to brain development and function, thereby increasing risk for these phenotypes. We measured expression in blood of two Y genes NLGN4Y and RPS4Y in 26 boys with XYY and 11 male controls and evaluated whether NLGN4Y expression correlates with anxiety, ADHD, depression and autistic behaviors (from questionnaires) in boys with XYY. The XYY cohort had increased risk of ASD behaviors on the social responsiveness scale (SRS) and increased attention deficits on the Conners' DSM-IV inattention and hyperactive scales. In contrast, there was no increase in reported symptoms of anxiety or depression by the XYY group. Peripheral expression of two Y genes in boys with XYY vs. typically developing controls was increased twofold in the XYY group. Results from the SRS total and autistic mannerisms scales, but not from the attention, anxiety or depression measures, correlated with peripheral expression of NLGN4Y in boys with XYY. Males with XYY have social phenotypes that include increased risk for autism-related behaviors and ADHD. Expression of NLGN4Y, a gene that may be involved in synaptic function, is increased in boys with XYY, and the level of expression correlates with overall social responsiveness and autism symptoms. Thus, further investigation of NLGN4Y as a plausible ASD risk gene in XYY is warranted.
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Affiliation(s)
- J. L. Ross
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA
- Department of Pediatrics, Alfred I duPont Hospital for Children, Wilmington, DE
| | - N. Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO
| | - D. E. Merry
- Department of Biochemistry and Molecular Biology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA
| | - M. Dalva
- Department of Neuroscience, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA
| | - A. R. Zinn
- McDermott Center for Human Growth and Development and Department of Internal Medicine, The University of Texas Southwestern Medical School, Dallas, TX, USA
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48
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Corina G, Mori C, Vicenti G, Galante VN, Conserva V, Speciale D, Scialpi L, Abate A, Tartaglia N, Caiaffa V, Moretti B. Heel displaced intra-articular fractures treated with mini-calcaneal external fixator. Injury 2014; 45 Suppl 6:S64-71. [PMID: 25457322 DOI: 10.1016/j.injury.2014.10.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Treatment of displaced heel fractures is controversial; however, ORIF is widely described in the literature to be the gold-standard. Percutaneous reduction and monolateral external fixation is gaining increasing attention because it provides a good and stable reduction, and minimises soft tissue complications due to open surgery, such as deep infections and delays in wound healing. The aim of this study was to show that the new Orthofix Calcaneal Minifixator (six pins) provides a greater stability than the four-pin version to enable a better and more stable reduction, an earlier weight-bearing (30 days) and improved functional outcomes. METHODS A series of 69 consecutive closed heel intraarticular displaced fractures treated with the new Orthofix Calcaneal Minifixator were evaluated. Patients were assessed clinically with the Maryland Foot Score and radiologically with standard radiographs. RESULTS The clinical results at follow-up were excellent in 37 cases (53.6%), good in 27 (39.2%), fair in two (2.9%) and poor in three (4.3%). The mean preoperative Böhler's angle was 5.2˚ (range 0-18˚) and the mean postoperative value was 28.5˚ (range 16-38˚). CONCLUSION The excellent functional outcomes were despite some radiological images of imperfect posterior facet anatomical reduction and seemed to correlate with the use of a good and stable minimally-invasive surgical technique. This technique enabled early weight-bearing, minimised complications, respected the delicate biology of this anatomical site and restored the good heel volume and Böhler angle.
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Affiliation(s)
- G Corina
- Orthopaedics and Traumatology Department, "Vito Fazzi Hospital", Lecce, Italy
| | - C Mori
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Italy
| | - G Vicenti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Italy.
| | - V N Galante
- Orthopaedics and Traumatology Department, "Az Unita'Sanitaria Locale TA 1", Castellaneta, TA, Italy
| | - V Conserva
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Italy
| | - D Speciale
- Orthopaedics and Traumatology Department, "Hospital Santissima Annunziata", Taranto, Italy
| | - L Scialpi
- Orthopaedics and Traumatology Department, "Hospital Santissima Annunziata", Taranto, Italy
| | - A Abate
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Italy
| | - N Tartaglia
- Orthopaedics and Traumatology Department, "Miulli Hospital", Acquaviva delle Fonti, Bari, Italy
| | - V Caiaffa
- Orthopaedics and Traumatology Department, "Di Venere Hospital", Bari, Italy
| | - B Moretti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Italy
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49
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Vicenti G, Pesce V, Tartaglia N, Abate A, Mori CM, Moretti B. Micromotion in the fracture healing of closed distal metaphyseal tibial fractures: A multicentre prospective study. Injury 2014; 45 Suppl 6:S27-35. [PMID: 25457315 DOI: 10.1016/j.injury.2014.10.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The dynamic locking screw (DLS) in association with minimally invasive plate osteosynthesis (MIPO) in a bridging construct for simple metadiaphyseal long bone fractures enables modulation of the rigidity of the system and facilitates the development of early and triplanar bone callus. Twenty patients affected by distal tibial fracture were treated with MIPO bridging technique and DLS at the proximal side of the fracture. Time of consolidation, quality of the reduction, complications and American Orthopaedic Foot and Ankle Society (AOFAS) score were monitored and the results compared with those from a control group treated with only standard screws on both fracture sides. Student t-test for independent samples was used for the comparison of means between the two groups. Chi-square test was used for the comparison of proportions. A multiple logistic regression model was constructed to assess the possible confounding effects. Performance was considered significant for p<0.05. The mean healing time was 17.6 ± 2.8 weeks in the group treated with standard screws and 13.5 ± 1.8 weeks in the group treated with DLS (t=5.5, p<0.0001). The DLS was associated with early healing and triplanar bone callus.
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Affiliation(s)
- G Vicenti
- Department of Neuroscience and Organs of Sense, Orthopaedic Section I, Faculty of Medicine and Surgery, University of Bari, Bari, Italy.
| | - V Pesce
- Department of Neuroscience and Organs of Sense, Orthopaedic Section I, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - N Tartaglia
- Orthopaedic Section, Hospital Miulli, Acquaviva delle Fonti, Bari, Italy
| | - A Abate
- Department of Neuroscience and Organs of Sense, Orthopaedic Section I, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - C M Mori
- Department of Neuroscience and Organs of Sense, Orthopaedic Section II, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - B Moretti
- Department of Neuroscience and Organs of Sense, Orthopaedic Section I, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
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Dennis A, Howell S, Cordeiro L, Tartaglia N. "How should I tell my child?" Disclosing the diagnosis of sex chromosome aneuploidies. J Genet Couns 2014; 24:88-103. [PMID: 25179748 DOI: 10.1007/s10897-014-9741-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 07/01/2014] [Indexed: 01/15/2023]
Abstract
To date, the disclosure of a sex chromosome aneuploidy (SCA) diagnosis to an affected individual has not been explored. This study aimed to assess the timing and content revealed to an affected child by his or her parent(s), resources accessed in preparation, parental feelings of preparedness, common parental concerns, and recommendations for disclosure approaches. Two online surveys were created: 1) for parents of a child with a diagnosis and 2) for individuals with a diagnosis. One-hundred thirty-nine parent surveys (XXY n = 68, XXX n = 21, XYY n = 9, other SCAs n = 41) and 67 individual surveys (XXY n = 58, XXX n = 9) were analyzed. Parents most frequently discussed the topics of learning disabilities (47 %) and genetics (45 %) with their child during the initial disclosure. A significantly greater proportion of parent respondents reported feeling prepared vs. unprepared for disclosure, regardless of their child's diagnosis (z-test of proportions, all p's < 0.001). Both prepared and unprepared parents most frequently accessed resources such as websites, support groups, and discussion with the child's physician prior to disclosure, with unprepared parents accessing fewer resources (M = 2.0 ± 1.41) than prepared parents [M = 2. ± 1.56; t(101) =-2.02, p < 0.05]. Common parental concerns included making the conversation age-appropriate, discussing infertility, and possible impact on the child's self-esteem. Both parent and individual respondents endorsed being honest with the child, disclosing the diagnosis early and before puberty, and discussing the diagnosis gradually over time. These results provide recommendations for parents, and suggest benefits from additional resources and supports to alleviate concerns when approaching diagnosis disclosure.
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Affiliation(s)
- Anna Dennis
- Graduate Program in Genetic Counseling, University of Colorado Denver, Aurora, CO, USA
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