Autism spectrum disorder in Kabuki syndrome: clinical, diagnostic and rehabilitative aspects assessed through the presentation of three cases

Kabuki syndrome (KS) (Kabuki make-up syndrome, Niikawa-Kuroki syndrome) is a rare genetic disorder first diagnosed in 1981. Kabuki make-up syndrome (KMS) is a multiple malformation/intellectual disability syndrome that was first described in Japan but is now reported in many other ethnic groups. KMS is characterized by multiple congenital abnormalities: craniofacial, skeletal, and dermatoglyphic abnormalities; intellectual disability; and short stature. Other findings may include: congenital heart defects, genitourinary anomalies, cleft lip and/or palate, gastrointestinal anomalies including anal atresia, ptosis and strabismus, and widely spaced teeth and hypodontia. The KS is associated with mutations in the MLL2 gene in some cases were also observed deletions of KDM6A. This study describes three children with autism spectrum disorders (ASDs) and KS and rehabilitative intervention that must be implemented.

Referential communication skills in children with Down Syndrome

AIM

The aim of this study was to investigate referential communication skills in children with Down Syndrome (DS). We studied the development of pragmatic language in relation to nonverbal skills by analyzing referential communication skills in children with DS, in both production and comprehension of referential messages: oriented and/or ambiguous, adequate (appropriate) and inadequate (inappropriate).

METHODS

The study population was 24 children: 12 with DS (mean age, 7.8 years) and 12 with normal development (control group) (mean age, 7.4 years). In the first phase (F1), all 24 children were administered a test to evaluate their nonverbal skills, followed in a second phase (F2) by a test to specifically evaluate their referential communication skills.

RESULTS

A strong relationship between nonverbal and referential communication skills was found, in which the nonverbal skills contributed to variations in referential performance, especially among the children with DS. Furthermore, the children with DS showed better performance in the "talking" than the "listener" condition. Within the listener condition, a significant correlation emerged between adequate and inadequate messages.

CONCLUSION

Referential communication skills are influenced by several verbal and nonverbal factors.

The quality of life in developing age children with celiac disease

AIM

The moments that follow the diagnosis of celiac disease and the early stages of the gluten-free diet are extremely difficult and complex for parents and child, because they face an important change punctuated by self-denial and deprivation. The main objective of this research is to assess the impact of celiac disease on quality of life in subjects in developmental age, taking into account the perceptions of parents about the child's illness, with the aim to highlight the effect of disease on the child and the entire family.

METHODS

The study included both parents of 45 children aged between 2 and 10 years, with established celiac disease. To evaluate the effect of celiac disease on the lifestyle of affected children and their families has been used, after having adapted to the Italian context, the Impact Scale of Childhood Diseases of Hoare and Russell (1995). This study shows that celiac disease is a condition that has a significant impact on both the child and his family.

RESULTS AND CONCLUSION

The results obtained by administration of Impact Scale of Childhood Diseases to parents showed that subjects in developmental age with celiac disease could have difficulty on emotional level that affect child development and the whole family context. Acceptance of the illness by the child depends mainly by how much and how this has been accepted by parents.

A rare unbalanced translocation 1;18 in a child with epilepsy, mild dysmorphology and mental retardation

A syndrome due to deletion of distal long arm of 1q was delineated by several groups. Up to now different terminal deletions 1q are described often clinically resulting in diagnosed mental retardation syndromes. We report on a 7-year-old male with distal monosomy 1q and additional genetic material on the short arm of chromosome 18. As expected, cytogenetic studies of the infant and his mother showed that the altered regions result from an unbalanced translocation of part of the long arm of chromosome 1. Comparison of our patient's data with those previously reported reveals neurological similarities but an unique genotype-phenotype correlation. The importance of a following better molecular characterization through array comparative genomic hybridization and especially the DNA sequence analysis around its breakpoints are discussed.

Evaluation of creative thinking in children with idiopathic epilepsy (absence epilepsy)

AIM

Creativity represents the silent character of human behaviour. In children with epilepsy, cognitive performance of has mainly been investigated under the assumption that the disorder represents a risk factor for the development of intellectual function. In subjects with different forms of epilepsy, neuropsychologic disorders have been detected even when cognitive-global functioning is unimpaired. The cognitive functions of subjects with epilepsy have been widely studied, but their creativity has been never evaluated to date. The aim of this study was to describe the development of creative thinking in a group of children with absence epilepsy.

METHODS

The test battery included: the Torrance Test of Creative Thinking (TTCT), the Wechsler Intelligence Scale for Children-revised (WISC-R) and the Goodenough Human Figure Drawing Test.

RESULTS

Statistical analysis (Mann-Whitney test) showed a statistically significant difference (P <0.05) in test scores between two groups of subjects (children with epilesy vs control group), with higher scores for figure originality, figure fluidity and figure elaboration in the control group. There was a significant correlation (Spearman's rho) between verbal IQ and verbal fluidity and verbal flexibility subscale scores and between performance IQ and figure elaboration, between total IQ and verbal fluidity and verbal flexibility subscales (P <0.05; r >0.30).

CONCLUSION

Low scores on the figure originality subscales seem to confirm the hypothesis that adverse psychodynamic and relational factors impoverish autonomy, flexibility and manipulator interests. The communication channels between subjects with epilepsy and their family members were affected by the disorder, as were the type of emotional dynamics and affective flux.

Hypomelanosis of Ito: neurological and psychiatric pictures in developmental age

Hypomelanosis of Ito (HOI) is a multisystem neurocutaneous disorder. In the described cases, cutaneous manifestations (unilateral or bilateral streaks and swirls of hypomelanosis with regular and confluent borders) and extracutaneous abnormalities are often associated. Extracutaneous abnormalities involve the musculoskeletal system (scoliosis, vertebral anomalies, cranial-facial malformations) and other organs, as well as the central nervous system (CNS). The most significant anomalies of the CNS are psychomotor retardation and cognitive deficit. Autism, epilepsy, language disorders, cerebral malformations (neural migration disorders, cerebral hypoplasia, cortical atrophy, agenesis of the corpus callosum) are sometimes present. Numerous abnormal chromosomal patterns have been observed. HOI is usually a sporadic disorder; though autosomal dominant transmission has been suggested, recessive and X-linked inheritance patterns have also been reported. This study describes five children with HOI presenting with various features of the clinical spectrum of the syndrome. Some of these cases were referred for psychomotor therapy as part of an integrated neuropsychologic and psychomotor treatment support program. In this view, psychomotor treatment aims to promote the emotional-relational component, to overcome rigid divisions, and to integrate learning-related cognitive aspects with psychodynamic concepts. Finally, the goals of psychological and social support are to help the parents accept their child's handicap, understand the child's behavior, plan future pregnancies, and foster an environment for their child's integration.

A case of femoral-facial syndrome in a patient with autism spectrum disorders

The Femoral hypoplasia - unusual facies syndrome (FHUF) or Femoral - facial syndrome (FFS) was at first described in 1975. Up to now about 60 cases have been reported. According to our knowledge only 4 cases have had congenital central nervous system's malformations, furthermore the main stages of psychomotor development are almost always reported as normal or slightly altered in early childhood. We describe the first case of autism spectrum disorders (ASD) in a patient with FFS, emphasizing that this rare association could be one of many unrecognized underlying features.

Primary nocturnal enuresis and learning disability

AIM

Primary nocturnal enuresis (PNE) is the most common sleep disorder in developmental age, with a prevalence of 6-10% between 5 and 16 years of age, impacting on normal emotional and relational developing. Assessing the prevalence of mild learning disorders in enuretic children and the role of enuresis as risk factor to develop them.

METHODS

Twenty-five patients (14 males) aged 7.59 referred for primary nocturnal enuresis to Sleep Disorder Center for developmental age and Nocturnal Enuresis of Second University of Naples (frequency ≥3/week), were enrolled in study. Reading abilities were evaluated using MT (Memory and Learning Transfer) and cognitive performance was assessed using Wechsler Intelligence Scale for Children-Revised version to excluded the subjects with IQ≤75. The control group consisted in 54 children (23 males) matched for age and sex distribution recruited in Campania region schools. Chi Square test was used to verify the different prevalence of academic problems in group of bedwetters and healthy controls. The P level was set at <0.05 for statistical significance. A logistic regression analysis was performed in order to assess the risk of developing learning disabilities by being enuretic.

RESULTS

Learning difficulties were present in 18 enuretic and in 7 healthy children (χ2 24.873; P<0.001). χ2 test showed a statistic relevant difference in prevalence of "Attention request" (χ2 20.058; P<0.001) and "Border-line level" (χ2 12.979, P<0.001) identified in mild reading learning disorders in bedwetters respect of control group. Logistic regression analysis showed a strong increase to have mild academic impairment due to be a enuretic with an odd ratio (OR) of 17.26 (CI95% 5.30-56.19).

CONCLUSION

Our study shows the higher pre-valence of mild reading difficulties in enuretic children than controls.

Cosleeping in childhood migraine

AIM

Cosleeping is the practice of parents and children sleeping together in body contact for all or part of the night. There is a close relationship between sleep habits and headache disorders. Aim of the study was to identify prevalence of cosleeping in children with migraine disorder.

METHODS

A total of 181 school-aged children referred to Headache Center for Developmental Age for Migraine without aura (MoA). Sex and age matched control group consists of 729 children recruited in schools in Campania.

RESULTS

Cosleeping's prevalence is higher in children with MoA than in the control group (P=0.003) and an OR of 2.32 (95% CI 1.36-3.97).

CONCLUSION

At our knowledge, our study is the first specific on prevalence of cosleeping in MoA school-aged children and show the importance of migraine power to invade all aspect of life of children affecting also their family management.

The quality of life of children with pervasive developmental disorders

AIM

Quality of life is increasingly the focus of attention by health, psychological and social services. Pervasive developmental disorders (PDD) are a group of psychiatric conditions in which the patient's clinical case history is characterized by disturbances in social interaction, deterioration of verbal and non-verbal communication, and presence of bizarre, limited and stereotyped activity. These disturbances affect multiple developmental areas and show up in very early stages of development, resulting in a permanent disorder. Many studies have sought to recognize causes and interventions for persons with PDD, however, they often take insufficient account of the effects these disorder can have on the lifestyle of patients and their families. These clinical case histories are so pervasive that they cause a disorder which upsets the equilibrium of the person's entire life. The aim of this study was to assess the effect of living with PDD on the person's quality of life and to highlight the factors that impact on the person and his/her family.

METHODS

Both parents of 54 subjects (46 males and 8 females; age range 4-28 years) with diagnosed PDD (43 with autistic disorder, 2 with childhood disintegrative disorder, 3 with Asperger Syndrome, 6 with pervasive development disorder NAS) were enrolled in the study. The subjects affected with PDD were recruited at the AGSAS Onlus and IsMeC. Diagnosis was based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders. Quality of life was assessed using the Italian version of the Impact of Childhood Illness Scale (Hoare and Russell, 1995). This scale consists of 30 questions that investigate the effect of illness on children, parents and families. For each question, the parent was asked to rate two variables: frequency and importance. Another questionnaire was administered to obtain medical history, diagnostic and therapeutic data of the persons with PDD.

RESULTS

Analysis of frequencies and percentages of questionnaire answers showed that the most important problems related to illness; specifically, according to the Frequency and Importance Parameters, the problems centered around self-care skills, difficulty in explaining the child's illness to others and looking after the child. The most important problems about the other children in the family concerned providing them with necessary attention and the restrictions their brother/sister's illness placed on their own activities. No significant correlations emerged between diagnosis type and answers on individual subscale items (Pearson's r).

CONCLUSIONS

Our data show that PDD has a considerable impact on both the child's development and the entire family. Parents' answers demonstrated that their child's illness had consequences for the child and how the family coped with it. For this reason, attention should be directed at psychological and social aspects, as well as attitudes, manners, reactions and effects such disturbances can have on the entire family.

People with Down's sindrome: adolescence and the journey towards adulthood

AIM

Sexuality in disabled people is faced with difficulty and inadequateness, if not with complete refusal, the result being that young disabled people are often relegated to a destiny of solitude and abandon. This is even more true when the disability includes mental retardation.

METHODS

Twenty-five youngsters between the age of 13 and 25 years 14 males (56%) and 11 females (44%) were recruited together with their mothers for this study. All attend the Family Association for Down people in Palermo. The youngsters with Down's syndrome were invited to carry out a drawing activity and then to describe what they had drawn. The mothers, on the other hand, replied to a semi-structured interview, the contents of which were organised into three areas: 1) the reaction of parents when the doctors communicate the birth of a child with Down's syndrome; 2) parents and the sexuality of a child with Down's syndrome; 3) the expectations of parents with regard to the future of their child with Down's syndrome.

RESULTS

The free designs and their description demonstrated a clear emergence of themes that regard sexuality in 6 protocols out of 25. In 9 cases out of 25 the reference to sexuality is hidden behind allusive designs and descriptions. Six protocols testify, even if indirectly referable to the theme of sexuality, the emergence of an autonomy conflict, typical of adolescents, which demonstrates the beginning of the transitory process towards adulthood. Only in four situations was a sexuality reference not interpretable in the productions of the children. The qualitative analysis of the interviews carried out with the mothers evidences how the theme of the sexuality of the disabled child is lived in a conflictual way by the parents.

CONCLUSIONS

The results obtained lead to affirm that the ''question regarding sexuality'' is more problematic from the parents' point of view rather than from that child's. In this prospective, in order to advantage the parents, it is necessary to plan psychological and clinical interventions regarding an education to sexuality.

Symbolic function explored in children with epilepsy and headache

AIM

When the body gets ill, the attack on the ability to think is one of the possible effects that can be observed. The aim of this study is to explore symbolic functions in children with epilepsy and primary headache.

METHODS

Fifty five little patients have been recruited from the Neuropsychiatry infant Clinic of the University of Palermo; 48 males (61%) and 27 females (39%), all suffering from epilepsy (53-71%) and primary headache (22-29%), their ages varying from 7 to 11 (average: 9.4+/-1.2). Subjects that had never suffered from chronic or neurological diseases were also recruited as a control group. The control group was levelled with the group to be tested in age and number (75 subjects), age (range: 7-11; average: 9.1+/-9) sex (males: 48-61%; females: 27-39%). The instruments that have been used were: colored progressive matrices in order to measure the development of the cognitive functions; semi-structured interview on dreams in order to estimate the quality of the mentalization; drawing stories technique in order to estimate the quality of the psychological suffering; fairytales method of Düss in order to observe the defensive strategies used by the subjects.

RESULTS

The cognitive performances were the same in the two groups. The answers to the semi-structured interview on dreams were different as far as coherent theory on dreams and memory of the last dream and its quality are concerned. The Drawing stories technique and the Fairytales method of Düss with the children in the clinical group - especially the epileptic patients - showed a high presence of psychical suffering, unprocessed or impossible to process.

CONCLUSIONS

The results allow to estimate a psychological suffering, focusing onbody sickness and to discriminate some specific ways of constriction of the imaginary, linked to either repression or to splitting/dissociation.

[Description and evaluation of creative thinking in preterm low birth weight infants]

AIM

Since the 1950s, the problem of how to evaluate creativity has been addressed in studies on the definition of measurement criteria and on the relationship between intelligence and creative thinking. Many revealed cognitive and relational disorders in preterm infants, particularly in preterm very low birth weight infants (birth weight <1500 g) and in infants with serious complications. This study describes the development of creative thinking in a group of children born preterm.

METHODS

The study sample was 43 children (21 males, 22 females; age range 6-11 years), regularly attending school, born with low birth weight (1050-2450 g) at 29-32 weeks gestational age, and compared with a control group with birth weight >2500 g. The test battery included: Torrance Test of Creative Thinking (TCTT); WISC-R intelligence test; Goodenough Human Figure Drawing Test.

RESULTS

Statistical analysis (Mann-Whitney U test) showed a statistically significant difference (P>0.05) between the 2 groups; scores for figure originality, figure fluidity and figure elaboration were consistently higher in the control group. Within the low birth weight group, there was a significant correlation (Spearman r) between verbal IQ and verbal fluidity and verbal flexibility subscale scores and between IQ performance and figure elaboration. Scores on the figure drawing tests showed higher creative ability in the control group.

CONCLUSIONS

In children born preterm with low birth weight, emotive dynamics and flow of affection may influence the channels of communication between child and family. The low figure originality subscale scores support the hypothesis that psychodynamic and relational factors (worry about the preterm condition, overprotective behaviour by parents and others) could lead to diminished autonomy, flexibility and manipulatory interest in the child.

Maternal hyperphenylalaninemia syndrome: neuropsychological evaluation of four subjects during childhood and adolescence

Maternal hyperphenylalanemia during pregnancy may induce a severe embryopathy characterized by microcephaly, mental retardation, facial dysmorphy and congenital heart defects. Four subjects, two pairs of sibs, with maternal hyperphenylalaninemia syndrome were included in this study and their neuropsychological performances were assessed. Maternal levels of hyperphenylalaninemia were similar in both mothers, one of them had not been diagnosed with the condition until her two children were examined at the ages of 10 and 6 years. A severe cognitive deficit was detected in all 4 subjects, with a typical profile of impaired perceptive abilities, behavioural disturbances, motor difficulties and poor familiar integration.

Expressions of discomfort in adolescents. Clinical reflections resulting from an exploratory study of a group of students

AIM

The aim of this study was to explore some fundamental dimensions of adolescent discomfort relating to food, the body, sexuality, relationships in general and health care.

METHODS

We recruited 206 students (66 males, 140 females; average age=19.4+/-2) and we administered 4 questionnaires: the first two to examine their relationship with food, the third to explore adolescents' attitudes to their social context, sexuality and first sexual experiences; the fourth to measure their ability to look after their health.

RESULTS

The results show the different role that sexual styles have in the expression of juvenile discomfort. Girls tend to live the discomfort by mentalizing it in relationships and sexuality and contextualizing it in their bodies; boys direct their discomfort towards occasional drug taking or drug addiction, or alcohol abuse, the excitement of speed, or dangerous driving.

CONCLUSIONS

In clinical work with adolescents it seems appropriate to refer to the relational gradient of risk behaviours, that is their linking function within their peer group. Behaviours with a high relational gradient, which develop within the group or are related to the group, in most cases are normal modalities for facing the important challenges of adolescence. These behaviours are symptoms of the normal process of adolescent development. We should pay particular attention to behaviours with a low relational gradient because they indicate a possible interruption in their development.

Risk behaviours among young people. Evaluation and descriptive analysis

AIM

Risk behaviours--as they are defined by specialist literature for the damage these behaviours cause to young people's health and/or life--are getting more and more frequent among young people. They range from self-injuring behaviours to the consequences of a precocious, high-risk and/or promiscuous sexual activity, from abnormal eating behaviours to the deaths from fun.

METHODS

The inquiry concerned a group of university students (100 males and 100 females), selected at random from the Faculties of Medicine and Surgery, Psychology, Economy and Jurisprudence of the University of Palermo, who were asked to answer a questionnaire composed of 91 questions and structured in 4 sections. The first section regards associate-identifying information; the second one inquires on experiences and requirements concerning sexuality; the third section explores the state of health and the use of drugs and alcohol; the fourth section looks into relations with others.

RESULTS

The analysis of our data revealed that young people have different high-risk behaviours (use of drugs and alcohol, non protected sexual intercourse, carelessness for one's and one's partner's serological state); this is associated to poor information, as complained by the people interviewed, on the prevention of sexually transmissible diseases, use of drugs and alcohol.

CONCLUSIONS

The conclusion is drawn that the new modalities of the assumption of risk by young people would correspond to the climate of vagueness, lack of limits, meanings and values which characterize the present society.

Predictive signs and indicators of aggressiveness and violence: a comparison between a group of adolescents attending an external penal area, a group of prisoners and a group of patients with borderline personality disorder

AIM

Aggressive and violent behaviours in juveniles and young adults have become increasingly widespread. Most such behaviours have 2 common roots: lack of actual motivation and brutality. The most reliable indicators and predictive signs have been linked to structural personality features (e.g. defensive strategies, impulse control). With this cross-sectional study we wanted to determine specific indicators and predictive signs of violent and aggressive behaviours in these population segments.

METHODS

We compared the structural personality features of 3 groups: one with 26 male adolescents with conduct disorder (F91.8), one with 29 male patients with borderline personality disorder (F60.31) and one with 34 male prisoners with antisocial personality disorder (F60.2). The test battery included: the ''Structured clinical interview for DSM-IV axis II disorders'' (for the recruitment of adult groups); the ''Indicators of aggressive conduct'' and the ''Profile of mood states'' (for the recruitment of the adolescent group); the ''Defense mechanisms inventory'' (DMI).

RESULTS

The predominant defensive strategies and starting emotional backgrounds differed significantly among the groups. A profile of low emotional response was found to support aggressiveness, while a profile of aggressiveness and violence was associated with clinically significant impulsivity.

CONCLUSIONS

Several indicators and clinical predictors of aggressiveness and violence, as well as high-risk-profiles, may be determined using these instruments.

[The quality of life in developing age subjects with chronic renal diseases]

AIM

Renal pathologies have an hard impact on ill children's life style, psychic and physical development. In the last years, even if medical cures allowed these children to live longer and to have a better quality of life, today both their families and themselves have to face a lot of difficulties due to the kind of pathology. These children show behaviour troubles, bad sociability, aggressiveness, poor school performance, anxiety and depression, and then the subjects with chronic renal failure show a retard in neurological and cognitive development. In this study we evaluated the impact that the chronic renal illness has on children and adolescents' quality life.

METHODS

For this study, we have used the Impact of Childhood Illness Scale. It includes 30 questions that value 4 aspects of the child and family's life style: illness and its treatment, impact on the child, impact on parents and impact on the family. For every question, it considers the frequency of the problem and the degree of the worry that it causes. We gave the questionnaire to 47 couples of parents' children who are suffering from chronic renal diseases (19 subjects with nephrotic syndrome, 7 with chronic glomerulenephritis, 10 with chronic renal failure, 5 dialysed, 6 with kidney transplant). All parents compiled the questionnaire.

RESULTS

The obtained results showed that developing age subjects, who are affected by chronic renal diseases, can have emotional and behavioural difficulties that have an effect on subject and on his family. Their parents live in a continuous stress state because chronic pain and anxiety cause depression, a sense of inadequacy and frustration.

CONCLUSIONS

As in every chronic physical illness, the sick child and his family are obliged to face a series of physical, behavioural and emotional changes. Besides, they are faced by possible collateral effects of the illness and of its treatments on development.

[New addictions in the third millennium: anabolic steroids as a substance of abuse]

AIM

The abuse of anabolic steroids is emerging as a psychosocially significant issue. In the last few years the use of the substances has shifted from professional sports to amateur sports and certain occupations (bouncers, models, etc.). In the literature, steroid users are portrayed as multidrug users who engage in dangerous and aggressive behavior towards themselves and others. This study looks into the habits, lifestyles and psychological profiles of a group of subjects who make regular use of sports centres in the city of Palermo, Italy, with the aim of establishing how the abuse of anabolic substances is associated with a specific lifestyle and particular psychosocial behaviour.

METHODS

A revision of the American Massachusetts Youth Risk Survey questionnaire (1993), adapted for the Italian context, and a personality assessment scale, The Adjective Check List (1980), were administered to a group of 71 subjects.

RESULTS

Fifteen of these subjects admitted taking steroids with differing frequencies. Using Spearman's rho rank correlation, repeated use of anabolic steroids was found to be correlated with abuse of other types of drugs, risk behavior and a distinct personality pattern. Steroid abuse was found to be significantly correlated (r = 0.35, 0.31, 0.30, 0.28, P < 0.01) with illegal drug use (LSD, cocaine and heroin).

CONCLUSIONS

It is therefore imperative to develop studies and analyses to investigate more thoroughly the phenomenon and its related psychological and social context in order to lay the foundations for a targeted prevention programme, especially in countries such as Italy where this type of drug abuse is still largely unrecognised and risks degenerating into a new, full-blown social disease.

[Children of homoparental families: psychological and sexual development]

AIM

In the last few years some studies have been made about homosexual parenthood and especially if this interferes with the child's development, identity and future sexual tendency. These studies prove that the parents' homosexuality does not seem to compromise the child's psychosexual development and that the child's possible homosexuality does not depend on the parents' sexual behaviour but on different factors linked to the relationship; as a matter of fact there are no relevant differences in the occurrence of homosexuality in children born from homosexual and heterosexual parents. The present study investigated the psychological and sexual development in a group of children of homoparental family.

METHODS

The sample observed included 37 children, 22 male and 15 female. The following psychodiagnostic tests were used for assessment: spontaneous drawing, draw-a-person test, family drawing, blacky pictures test. The developmental of the child's sexual identity was determined through the preferences and fantasies he/she showed while playing, in the relationship with his/her mates, in the way of dressing. We used interviews with the child and the parents.

RESULTS

All the children showed a good adherence to their sexual role. The observations and interviews proved that the children's disorders are not linked to the parents' homosexuality.

CONCLUSIONS

Being brought up by homosexual parents does not seem to compromise the child's future sexual tendency. However, in these children the sexual preference could change in adult life, being influenced by future situations and circumstances.

[Neuropsychological profiles in preterm low birth weight children]

AIM

Several studies focus on the psychic development of extremely low birth weight (ELBW) preterm infants and highlight the presence of neurological, cognitive and relating disorders. Several contributions have in fact shown that in these subjects in school age disturbances of cognitive functions may be encountered; in particular, disturbances of specific neuropsychological functions, such as attention defects, impaired visuo-spatial function, memory and language have been reported in subjects with a globally normal intelligence quotient.

METHODS

Forty-three school-aged children were studied (21 males and 22 females). They had a low birth weight (weight between 1,050-2,450 g), the gestation period was between 29 and 32 weeks and they were compared with a control sample whose birth weight was >2,500 g. Cognitive development was assessed by a test battery including WISC-R, Zazzo "deux Barrage" Test, Benton Visual Retention Test and Frostig Developmental Test of Visual Perception. Parents were also called in to evaluate how they had experienced the birth of their child and how long the mother had been kept in the clinic.

RESULTS

The overall analysis of our study suggests normal cognitive development in these children. No significant diffences were detected in the 2 studied groups. The lack of differences could be associated with the criteria used to select our sample because no children with severe perinatal disorders were included in the study. In addition, a good mother-child relationship seems to have been established in these children and this has certainly contributed to cognitive development adequate to their age.

CONCLUSION

The prognosis of these children is therefore closely related both to the birth weight and, especially, to the difficulties faced in the neonatal age (severe perinatal diseases).

Psychopathological assessment in children affected by Duchenne de Boulogne muscular dystrophy

BACKGROUND

Several studies on the intelligence of children suffering from Duchenne muscular dystrophy (DMD) found impairments in linguistic functions, memory and affective development. Memory deficit mainly involves long-term memory; short-term memory impairment was also present, even if less frequently. Some studies tried to establish a correlation between the distal deletion of the dystrophin gene and low intelligence levels.

METHODS

The present study investigated the cognitive, emotional and relational states in a group of DMD children. The patients were selected on the basis of physical examination, muscle biopsy, histochemical analysis, genetic testing, regular schooling. Molecular genetic testing detected a deletion in 2 high frequency deletion regions in all subjects. The following psychodiagnostic tests were used for assessment: WISC-R, Spontaneous Drawing, Draw-A-Person test, Family Drawing, Thematic Apperception test and Rorschach test.

RESULTS

No impairment of the intellectual function was detected in the group of children we examined; only 2 subjects had a total IQ below average. Instead, psychic disorders were detected such as proneness to isolation, self-depreciation, past experiences of marginalization, minor depressive symptoms, insecurity signs, hypochondriac worries and high level of anxiety. In addition children exhibited poor adaptation to the environment and labile affectivity, scarcely controlled by the higher conscious levels.

CONCLUSIONS

These disorders are often a dynamic prolongation of a psychological process starting when the diagnosis is made and continuing in a slow and latent fashion throughout the evolution of the disease.

Fetal alcohol syndrome in developmental age. Neuropsychiatric aspects

Alcohol constitutes one of the main risk factors for the health of the newborn infant and is also one of the leading causes of cognitive deficit. The distinctive pattern of abnormalities that characterizes fetal alcohol syndrome (FAS) includes: pre- and postnatal growth retardation, cognitive deficit, behavior and language disorders, cerebral malformations (schizencephaly, polymicrogyria, agenesis of the corpus callosum), facial changes (short palpebral fissures, low nasal bridge, anomalies of the auricle, maxillary hypoplasia, cleft lip and palate) and organ anomalies (heart defects, renal and skeletal malformations). As occurs with any teratogenic agent, the variability of phenotypic expression is wide and depends on dose, gestational stage, duration of exposure, maternal and fetal metabolism and other environmental and genetic factors. This study describes 6 subjects with FAS who express various characteristics of the clinical spectrum of the syndrome.

[The evaluation of creative thought: a comparison of methodologies]

BACKGROUND

To verify the reliability of the evaluation of the original thought through verbal tests, processed and standardised with reference to different socio-cultural contexts. In this respect we focused our attention on the Torrence Test on Creative Thought (TTCT), considering the trans-cultural studies carried out by Torrence.

METHODS

The analyses were carried out on the linguistic output of 116 subjects attending the 4th and 5th years of primary school, responding to the first verbal activity of the TTCT. For the evaluation of the Italian output, pointing out the Type and Token, morphemes and phrases were considered as basic units. The authors calculated the percentage values of occurrence of phrases, morphemes and grammatical functions. Then they made cross comparisons between the resulting percentage values, found unique morphemes, morphemes recurring only twice, as well as phrases characterised by the presence of the aforesaid typology of words.

RESULTS

TTCT prescriptive evaluation: the percentage (41.19%) is in favour of a widespread originality in the phraseological output of our sample. Evaluation of phrases/units according to their statistical frequency: 93.39 and 83.91% respectively of the type/phrases and of the overall phraseological output turned out to consist of unique phrases. Originality: Italian linguistic production is highly original. Analysis of phrases containing unique and double words: the evaluation of Originality according to Torrence's criteria was not adequately confirmed in our sample. Functional analysis: it showed that 23.17 and 41.67% of unique productions acted respectively verbs and as nouns; the only analogies in the comparison between American and Italian productions were pointed out by analyses carried out according to the criterion of the grammatical function of words.

CONCLUSIONS

The data from this research bring forward the use of tests with verbal contents whose ideational solutions are articulate and complex linguistic propositions, validated on people that are different in terms of lexical structures and reference context, from those on whom the prescriptive criteria are identified and built. With reference to the higher levels of Originality noticed in the Italian linguistic output in comparison with American, the question is still open if they are linked to creative modes of thought or can be referred to specific cultural styles of the Italian language.

The type A botulinum toxin in the treatment of spasticity in evolutive age

BACKGROUND

Spastic hypertonia with or without athetosis is the main cause of impairment of motor functions. In actual treatments to this condition, it is provided the application of the type A botulinic toxin, which allows the decrease of spasticity and, at the same time, the amelioration of the movement control, reducing the incidence and gravity of contractures.

METHODS

This work relates about the treatment of spasticity with the use of type A botulinic toxin in a group of 18 subjects in evolutive age. Before the treatment and during the follow-up, each clinical case had an objective general test, a neurologic test, a video recording and, at the same time, the administration of the Physician Rating Scale (PRS) to evaluate both pace and amplitude of the circular movement.

RESULTS

Ten subjects showed a prominent reduction of hypertonia and contractures, amelioration in ambulating and grievous symptomatology. Eight cases presented a light amelioration; only a case suffered of a temporary hyposthomia. The sensibility of the subject to the toxin can ever since be researched, through the toxin inoculation in a not jet involved distal muscle, and through a following clinical or electromyographic evaluation on the caused effect. This allows to put in evidence the increasing resistance to the toxin after repeated administrations.

CONCLUSIONS

It is interesting to evaluate the way in which the lives of patients and their parents have been influenced by the disease, and how the use of botulinic toxin may positively interfere on it.

Antioxidant pattern in uveal melanocytes and melanoma cell cultures

PURPOSE

To investigate the antioxidant status of cultured uveal melanocytes from patients with uveal melanoma and uveal melanoma cells to characterize some of the biochemical properties of these cells in respect to the normal cutaneous melanocytes.

METHODS

The fatty acid pattern of membrane phospholipids, intracellular vitamin E level, and superoxide dismutase (SOD) and catalase activities were studied in uveal melanocytes (n = 10) and uveal melanoma cell (n = 10) cultures, by gas chromatography mass spectrometry or by spectrophotometer.

RESULTS

Among the uveal melanocyte cultures, two groups were differentiated, according to catalase activity: group A with catalase values comparable to those of cutaneous ones and higher SOD activity and group B with catalase values 2 SD lower (P<0.001) and lower SOD activity. Vitamin E concentration was not significantly different between melanoma cells and melanocytes, whereas a significantly higher percentage of polyunsaturated fatty acids was found in melanoma cells and the B group of melanocytes (P = 0.022). In uveal melanoma cells SOD activity was significantly lower than that detected in uveal melanocytes (P< 0.005).

CONCLUSIONS

These results show a different pattern of antioxidants in uveal melanocytes with respect to cutaneous ones, possibly related to the anatomic distribution. However, as in cutaneous melanocytes, two subgroups were identified on the basis of the antioxidant pattern that could be the expression of a constitutional increased susceptibility to oxidative stress in some subjects. Moreover, an imbalance of the antioxidants was observed in melanoma cells, possibly related to the disease status and progression.

Niikawa-Kuroki syndrome

In 1967 a baby was observed who presented post-natal progressive growth deficit, mental retardation, craniofacial dysmorphias and other malformations which didn't form part of the syndromes till then known. However the first description of patients with this combination of anomalies dates back to 1981, when Niikawa and Kuroki described the main clinical signs which characterize the syndromic table. The size and weight deficit is progressive and it reveals itself during the first year of life. The features of the face are like the make-up of kabuki actors, the word from which the denomination comes. The mental retardation is of a slight degree; there is also a retardation in the acquisition of evolutive psychomotor stages. Speech is not very structured, it begins with the first syllables at about three years and remains poor with close, unclear and tied words. Other elements which define the syndrome are: the skeleton anomalies, dermatoglyphic anomalies, cardiological and renal anomalies. The aetiology is still unknown; it is thought that it may be X-linked or autosomal predominant transmission by new mutation. The genetic analysis has shown chromosomic anomalies only in a few cases. The rareness of the syndrome and the unmistakable clinical characteristics which make diagnosis possible leads to a description of three new case. All cases present a post-natal deficit of growth, psychomotor and/or mental retardation, autistic traits, dysmorphic facies, skeleton anomalies, partial epilepsy; two cases present cardiovascular defects. In one case the GH-dependent deficit of size has been corrected by hormonal treatment.

The Smith-Magenis syndrome: a new case with infant spasms

The Smith-Magenis syndrome (SMS) is characterized by congenital anomalies, mental retardation and the interstitial deletion of the 17p. 11.2 chromosome. The subjects affected by this syndrome show cranio-facial dysmorphias, brachycephalia, skeletal, ocular, cardiac, genitourinary and otolaryngological anomalies. The central nervous system is affected and this may be shown by psychomotor retardation, intellective deficit, electroencephalographic alterations (reduced/missing REM phase); the neuroradiological tests detect megacisterna magna, cerebellar hypoplasia, cortical dysplasia, ventricular asymmetry. Behavioural troubles are frequent and, among them, self-aggressive conducts (tearing out the nails). The syndrome is associated with the interstitial deletion of the 17p. 11.2 chromosome. The diagnosis can be made in the pre-natal period and a mosaic situation is possible. Even though the cases of SMS reported in the literature allow defining a characteristic phenotype, studies have been carried out to quantify the deletion of the chromosome 17 in order to identify the chromosomic tract which is responsible for the phenotypical induction. The deletion can either appear de novo or come from one of the parents. In addition, these subjects can show peripheral neuropathy, missing or reduced deep tendon reflexes and (rarely) epileptic crises. However, by reviewing the literature, no descriptions of patients affected by infant spasms are pointed out. This report refers to a new case of Smith-Magenis syndrome in a nine-month-old girl with spasms in extension.

3p13 region: a possible location of a tumor suppressor gene involved in uveal melanoma

To contribute to a better understanding of the role of chromosomal rearrangements in the tumorigenesis of uveal melanoma, we present a case in which a structural aberration of chromosome 3 could indicate the specific region in which an uveal melanoma tumor suppressor gene could be located. We obtained a primary cell culture, characterized by cytogenetic study, through GTG- and CBG-banding techniques by using a mechanical dissection of a tumor sample obtained from an uveal melanoma. Cytogenetic analysis performed in the primary cell culture highlighted the presence of a structural rearrangement involving chromosomes 3 and 22. A t(3;22)(p13;p11) was observed as the only present clonal aberration. The 3p13 breakpoint involved in the aberration observed in our case could be essential in restricting the candidate region for the locus of an uveal melanoma tumor suppressor gene located on chromosome 3.