Potocki-Lupski syndrome: a microduplication syndrome associated with oropharyngeal dysphagia and failure to thrive

OBJECTIVE

Failure to thrive (FTT) is a feature of children with Potocki-Lupski syndrome (PTLS) [duplication 17p11.2]. This study was designed to describe the growth characteristics of 24 subjects with PTLS from birth through age 5 years in conjunction with relevant physical features and swallow function studies.

STUDY DESIGN

We evaluated 24 individuals with PTLS who were ascertained by chromosome analysis and/or array comparative genome hybridization. Clinical assessments included review of medical records, physical examination, otolaryngological examination, and swallow function studies. Measures of height and weight were converted to Z-scores.

RESULTS

The mean weight-for-age and weight-for-length Z-scores at birth were lower (P < .01) than the reference standard and did not change with age. A history of poor feeding, hypotonia, and FTT were reported in 92%, 88%, and 71%, respectively. Individuals with hypotonia had lower weight-for-age and body mass index-for-age Z-scores (P = .01). Swallow function studies demonstrated at least one abnormality in all subjects.

CONCLUSIONS

FTT is common in children with PTLS. We hypothesize that oropharyngeal dysphagia and hypotonia likely contribute to FTT in patients with PTLS and recommend that once a diagnosis is established, the individual be assessed for feeding and growth issues and be availed of oromotor therapy and nutritional services.

Effects of varying levels of anxiety within social situations: relationship to memory perspective and attributions in social phobia

Cognitive-behavioral theorists (Clark & Wells, 1995: Clark, D. M. & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York: Guilford Press; Rapee & Heimberg, 1997: Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741-756.) propose that individuals with social phobia form mental images of themselves as if from an external point of view. Research by Wells and colleagues has shown that, when recalling anxiety-provoking social situations, individuals with social phobia are more likely to take an observer perspective (seeing oneself as if from an external point of view) whereas control subjects are more likely to take a field perspective (as if looking out through one's own eyes). Furthermore, this pattern is specific to social events, as both groups recall non-social events from a field perspective (see Wells, Clark & Ahmad, 1998: Wells, A., Clark, D. M., & Ahmad, S. (1998). How do I look with my minds eye: perspective taking in social phobic imagery. Behaviour Research and Therapy, 36, 631-634; Wells & Papageorigou, 1999: Wells, A. & Papageorgiou, C. (1999). The observer perspective: Biased imagery in social phobia, agoraphobia, and blood/injury phobia. Behaviour Research and Therapy, 37, 653-658). In the current study, individuals with social phobia took more of an observer perspective than non-anxious controls when recalling high anxiety social situations. However, both groups took a predominantly field perspective for memories of medium or low anxiety social situations. As memory perspective has also been shown to be related to causal attributions, we examined this relationship in our sample. Memories of low, medium, and high anxiety social situations were differentially related to attributions for each group. Patients' attributions for their performance became more internal, stable, and global as the anxiety level of the situation increased, while the attributions of control subjects showed the opposite pattern.

Multimodal comparisons of social phobia subtypes and avoidant personality disorder

The purpose of the present study was to further clarify the behavioral, physiological, and verbal response of patients with circumscribed social (speech) phobia, generalized social phobia without avoidant personality disorder, and generalized social phobia with avoidant personality disorder. Patients completed a battery of verbal report instruments and participated in two behavioral assessment tests. Measures of avoidance/escape behavior, cardiac response, level of behavioral skill, state anxiety, and positive and negative self-statements during performance were collected. Significant differences across response domains were found between the circumscribed social phobia and the generalized groups. Most of the distinctions were between individuals with circumscribed social phobia and those with both generalized social phobia and avoidant personality disorder, with the former group having less overall psychopathology. In addition, there was substantial overlap of problems between generalized social phobia individuals with and without avoidant personality disorder. Implications for the conceptualization of social phobia are discussed in terms of the differences among social phobia subtypes.

Assessment of contemporary social phobia verbal report instruments

The Social Phobia Scale (SPS), the Social Interaction Anxiety Scale (SIAS) and the Social Phobia and Anxiety Inventory (SPAI) were compared to each other and evaluated in patients with social phobia. We examined the relationship of these three contemporary social phobia verbal report instruments with each other, as well as with behavioral and self-report cognitive criteria. As expected, the three social phobia scales were significantly intercorrelated, although they differed in their relationship to the behavioral and cognitive measures. Specifically, the SPS had a significant negative relationship with time spent in a speech behavioral assessment test. The higher the anxiety scores were on the SPS, the less time patients spent giving an impromptu speech in front of a small audience. The SIAS was consistently related to negative and positive self-reported thoughts in speech and conversation behavioral assessment tests. All instruments differentiated patients with speech phobia from those having both generalized social phobia and avoidant personality disorder; on the SPAI and the SIAS, however, distinguished the former group from individuals with generalized social phobia but not without avoidant personality disorder. All three social phobia instruments were sensitive to treatment changes. Results are discussed in terms of the relative utility of each of these measures' total sores and any and their subscales.

An investigation of gender differences in social phobia

The present study was an exploratory investigation of gender differences in a large sample of persons with social phobia. Potential differences in demographic characteristics, comorbidity, severity of fear, and situations feared were examined. No differences were found on history of social phobia, social phobia subtype, or comorbidity of additional anxiety disorders, mood disorders, or avoidant personality disorder. However, women exhibited more severe social fears as indexed by several assessment instruments. Some differences between men and women also emerged in their report of severity of fear in specific situations. Women reported significantly greater fear than men while talking to authority, acting/performing/giving a talk in front of an audience, working while being observed, entering a room when others are already seated, being the center of attention, speaking up at a meeting, expressing disagreement or disapproval to people they do not know very well, giving a report to a group, and giving a party. Men reported significantly more fear than women regarding urinating in public bathrooms and returning goods to a store. Additionally, there were some differences in the proportion of men and women reporting fear in different situations. Specifically, more women than men reported fear of going to a party, and more men than women reported fear of urinating in a public restroom. Gender differences among patients with social phobia are discussed in the context of traditional sex-role expectations.

Factor structure of the Social Interaction Anxiety Scale and the Social Phobia Scale

In the study of social anxiety, it is common to differentiate between social interaction versus performance anxiety. The Social Interaction Anxiety Scale was designed to assess social interaction anxiety, and the Social Phobia Scale to assess fear of scrutiny by others (Mattick and Clarke, 1989). In common use, these scales are typically administered together and treated as subscales of a larger measure. However, the joint factor structure of these instruments has never been examined; therefore, it is unclear whether or not the items on these scales actually represent distinct aspects of social anxiety. In the present study, a confirmatory factor analysis of the pooled items from the SIAS and SPS failed to adequately fit the data. An exploratory factor analysis yielded three factors: (1) interaction anxiety, (2) anxiety about being observed by others, and (3) fear that others will notice anxiety symptoms. However, hierarchical factor analysis suggested that these factors all load on a single higher-order factor, social anxiety. Relationships of the first-order factors to other measures of social and performance fear and avoidance are examined, and implications of our findings for the assessment of social phobia are discussed.