The temperament of Down's syndrome toddlers and their siblings

Sleep problems and temperament in young children with Down syndrome and typically developing controls

BACKGROUND

Although group differences have been found between children with Down syndrome (DS) and typically developing (TD) children when considering sleep problems and temperament independently, none of the research conducted to date has examined sleep-temperament associations in children with DS. The present research was conducted to determine (1) whether the sleep problems experienced by children with DS are associated with temperament or (2) if the demonstrated relations between sleep and temperament differ from those that are observed in TD children.

METHOD

The present study included examination of relations between parent-reported sleep problems and temperament in 19 children with DS and 20 TD controls matched on developmental age.

RESULTS

The results revealed group differences in temperament and sleep problems. Mediation models indicated that temperament (effortful control and inhibitory control) mediated the association between group and sleep problems; sleep problems also mediated the association between group and temperament (effortful and inhibitory control).

CONCLUSION

Findings indicated that sleep problems may serve as both cause and consequence of variability in effortful and inhibitory control and provide insight as to future experimental studies that should be conducted to better elucidate these relations.

Neurobehavioral disorders in children, adolescents, and young adults with Down syndrome

The term dual-diagnosis refers to a person with mental retardation and a psychiatric disorder. Most children with Down syndrome (DS) do not have a psychiatric or neurobehavioral disorder. Current prevalence estimates of neurobehavioral and psychiatric co-morbidity in children with DS range from 18% to 38%. We have found it useful to distinguish conditions with a pre-pubertal onset from those presenting in the post-pubertal period, as these are biologically distinct periods each with a unique vulnerability to specific psychiatric disorders. Due to the increased recognition that psychiatric symptoms may co-occur with mental retardation, and are not inextricably linked to cognitive impairment, these conditions are considered treatable, in part, under a medical model. Improvement in physiologic regulation, emotional stability, and neurocognitive processing is one of the most elusive but fundamental goals of pharmacologic intervention in these disorders.

Gender differences in temperament: A meta-analysis

The authors used meta-analytical techniques to estimate the magnitude of gender differences in mean level and variability of 35 dimensions and 3 factors of temperament in children ages 3 months to 13 years. Effortful control showed a large difference favoring girls and the dimensions within that factor (e.g., inhibitory control: d = -.41, perceptual sensitivity: d = -0.38) showed moderate gender differences favoring girls, consistent with boys' greater incidence of externalizing disorders. Surgency showed a difference favoring boys, as did some of the dimensions within that factor (e.g., activity: d = 0.33, high-intensity pleasure: d = 0.30), consistent with boys' greater involvement in active rough-and-tumble play. Negative affectivity showed negligible gender differences.

Neuropsychiatric symptoms of fragile X syndrome: pathophysiology and pharmacotherapy

Fragile X syndrome is the leading inherited form of mental retardation, and second only to Down's syndrome as a cause of mental retardation attributable to an identifiable genetic abnormality. Fragile X syndrome is caused by a defect in the fragile X mental retardation 1 gene (FMR1), located near the end of the long arm of the X chromosome. FMR1 normally synthesises the fragile X protein (FMRP), but mutations in FMR1 lead to a lack of FMRP synthesis, resulting in fragile X syndrome. While the specific function of FMRP is not yet fully understood, the protein is known to be important for normal brain development. The physical, cognitive and behavioural features of individuals with fragile X syndrome depend on gender (females have two X chromosomes, one active and one inactive) and the molecular status of the mutation (premutation, full mutation or mosaic). Features of the behavioural profile of individuals with fragile X syndrome include hypersensitivity to stimuli, overarousability, inattention, hyperactivity and (mostly in men) explosive and aggressive behaviour to others or self. Social anxiety, other anxiety disorders, depression, impulse control disorder and mood disorders are the most common psychiatric disorders diagnosed in individuals with fragile X syndrome, although no formal studies have been undertaken. There have been very few psychopharmacological studies of the treatment of behaviours associated with fragile X syndrome. These limited studies and surveys of psychotropic drugs used in individuals with fragile X syndrome suggest that stimulants are helpful for hyperactivity, that alpha(2)-adrenoceptor agonists and beta-adrenoceptor antagonists help to control overarousability, impulsivity and aggressiveness, and that SSRIs can control anxiety, impulsivity and irritability, alleviate depressive symptoms and decrease aggressive and self-injurious behaviour. Typical and atypical antipsychotics in combination with other psychotropics have been used for control of psychotic disorders and severe aggressive behaviours. Mood stabilisers have been found to be useful when mood dysregulation or mood disorders are present with or without aggressive behaviour. Folic acid and L-acetylcarnitine (levacecarnine) have not been found to improve deficits or behaviours. As there is no specific psychotropic drug for any of the deficits or behaviours associated with fragile X syndrome, clinicians are advised to diagnose any psychiatric syndromes or disorders present and treat them with the appropriate psychotropic drug. If no psychiatric disorder can be diagnosed and the patient's challenging behaviours cannot be controlled with environmental manipulation or behaviour modification techniques, the most benign psychotropic drug should be used. Antipsychotics should be reserved for psychotic disorders, for impulse control disorders (used in combination with other psychotropics), or when challenging behaviours constitute an emergency. In the future, new medications targeting molecules implicated in the modulation of anxiety, fear and fear responding will be useful for treating the social anxiety and overarousability exhibited by individuals with fragile X syndrome.

Clinical Implications of Temperamental Characteristics in Young Children with Developmental Disabilities

Temperament refers to the behavioral style of an individual, or the tendency to behave in a certain way in a certain situation. Although temperament has been studied extensively in typically developing children, relatively little research concerning individual differences in the behavioral styles of young children with developmental disabilities has been conducted. The purposes of this article are: (1) to provide a brief review of the literature with regard to temperament and outcomes for children with developmental disabilities and, (2) to explore methods for integrating temperament information into early intervention practice. Consistent with the research on temperament and goodness of fit (Chess & Thomas, 1996), this article proposes that children with developmental disabilities who present with extreme scores in specific domains of temperament may benefit from specific early intervention practices. Ideas for linking practice with child temperament are presented, particularly for children who are resistant to change, non-persistent, or difficult to distract.

Aspectos genéticos e sociais da sexualidade em pessoas com síndrome de Down

As representações que pais e educadores fazem da sexualidade de pessoas com a síndrome de Down (SD) referem, muitas vezes, a atitudes agressivas ou, então, condutas assexuadas, exclusivamente fundamentadas na afetividade. Este trabalho faz uma análise da literatura referente à sexualidade e à reprodução em portadores dessa síndrome e avalia as possibilidades de recorrência do distúrbio a partir da segregação cromossômica em portadores de diferentes tipos de trissomia 21. Diversas publicações mostram a existência de diferentes níveis de maturidade e de adaptação social na SD que, associados a fatores como excesso de cuidados parentais, falta de amigos e preconceito social, constituem barreiras para a vivência plena da sexualidade. Os relatos de procriação em portadores da síndrome de Down revelam progênie normal ou com a síndrome, com maior prevalência de filhos normais. A análise de segregação cromossômica mostra probabilidade de 50% para conceptos com trissomia 21 e de 25% de filhos normais em casais com SD, caso os mesmos sejam férteis. O percentual restante corresponde a conceptos certamente inviáveis, com tetrassomia 21. Quando apenas um dos parceiros é portador da SD, a probabilidade de filhos normais ou com a síndrome passa para 50%. Nos casos de SD com trissomia por rearranjo estrutural como nas translocações 14/21 ou 21/21, a probabilidade de filhos normais é também de 50%. Portadores de mosaicismo podem apresentar riscos inferiores a esse percentual a depender da freqüência de células trissômicas no tecido gonadal. O direito à sexualidade e, por outro lado, o alto risco genético de recorrência da síndrome evidenciam não apenas a necessidade de se discutir a questão, como também a importância do apoio emocional e da educação sexual para a pessoa com SD.

Problem behavior in boys with fragile X syndrome

This study examines problem behavior over time in 59 boys with fragile X syndrome (FXS), aged 4-12 years, using the Child Behavior Checklist (CBCL). Approximately 49% of the boys scored within the borderline or clinical range on total problem behavior, while 56-57% scored in the borderline or clinical range on the attention and thought problems subscales, and 26% scored in this range on the social problems subscale. With a mean of 2.5 assessments per child, behavior problems were stable during the 3-year period of study. Total problem behavior was higher for children who displayed autistic behavior, were rated as low in adaptability, had mothers with higher maternal education levels, and were on medication. Mothers with more education also rated their children as having more attention, thought, and total problems. Children taking medication differed from boys who were not taking medication on social problems, but not on attention and thought problems. Low adaptability and more autistic characteristics predicted thought problems.

Temperament in children with Down syndrome and in prematurely born children

Parents of three groups of children completed the Children's Behavior Questionnaire (CBQ). Participants were children with Down syndrome aged 4-11 years (n = 55), prematurely born children aged 5 years (n = 97), and a group of normally developing kindergarten children 5-7 years of age (n = 91). Mean levels and factor structures on the CBQ were compared between the three groups. The children with Down syndrome had less attentional focusing and expressed less inhibitory control and less sadness than the normally developing children. There were also group differences in temperament structures, especially a clearer emotional factor of "surgency" among the children with Down syndrome. The only significant difference in mean temperament scores between the premature children and the control group was that the former evinced less attentional focussing. The temperament structures in the Norwegian samples were very similar to those reported in earlier studies, conducted in China and the US.

Infants with Down syndrome: a look at temperament

INTRODUCTION

This research describes temperament characteristics of infants with Down syndrome who are 1 to 4 months old. In the literature children with Down syndrome have been stereotyped. It was hypothesized that temperament characteristics may be evident and unique in newborns with Down syndrome.

METHOD

A standardized questionnaire, The Early Infancy Temperament Questionnaire, a cover letter, informed consent forms, and a brief explanation of the project were given to families with a newborn infant with Down syndrome. Thirty-two (families with infants with Down syndrome completed the study.

RESULTS

Mean scores indicate that infants with Down syndrome are rated more active, less intense, more distractible, and have a tendency to demonstrate more approach behaviors compared with normally developing infants. Data suggest infants with Down syndrome have some unique characteristics but are more like their normally developing peers than different.

DISCUSSION

Integration and mainstreaming of infants and children with Down syndrome emphasizes the need for nurse practitioners to appreciate the temperament characteristics of these infants.

Intellectual handicap in contemporary psychiatry

OBJECTIVE

To apprise readers of the 'state of play' in the psychiatry of intellectual handicap.

METHOD

A review was conducted of relevant journals and conference abstracts covering a range of scientific aspects of intellectual disability. Those developments considered to be most significant were summarised. In addition, consideration is given to issues relevant to the politics of disability affecting psychiatric practice in Australia.

RESULTS

There have been considerable developments in our understanding of the pathogenesis of intellectual handicap in pharmacotherapy and the behavioural therapies, in the taxonomy of psychopathology, in epidemiology, in delineation of behaviour phenotypes, and in assessment and measurement of psychopathology.

CONCLUSION

Intellectual handicap and psychiatry have had a chequered relationship in Australia, but the two fields are now clearly moving again to a closer and more productive collaboration. Recent scientific advances have provided a stimulating environment for this increased activity and interest.

Temperament of the infant with myelomeningocele

This preliminary study examined the temperament of infants with myelomeningocele. Mothers of infants with myelomeningocele rated their infants as less active, more adaptable, and more approachable than mothers of matched control infants, and tended to rate their infants as more positive in mood. In addition, the older the mother, the more likely she was to see her infant as more approachable, more adaptable, less intense, less negative, and with a higher threshold for stimulation. Older mothers also tended to rate their infants as less active and more rhythmical. Mothers with more education rated their infants as more positive in mood and with a higher threshold to stimulation than mothers with less education.

Conversational skills of individuals with fragile-X syndrome: a comparison with autism and Down syndrome

The conversational skills of 18 individuals with fragile-X syndrome (FXS) were compared with those of two other matched groups with autism and Down syndrome. The FXS group used more eliciting forms in conversation than those with Down syndrome, and also used partial self-repetition more often than the other two groups. The Down syndrome group had more speech dysfluencies than those with autism, but not more than those with FXS. The autistic group used more inappropriate phrases. Qualitative analysis of behavioral phenotype may reveal differences in communicative organization among subgroups whose retardation is based on different genotypes. In addition, analysis of verbal strategies during conversation suggests important differences between individuals with FXS and autism.

The effects of experience on attribution of a stereotyped personality to children with Down's syndrome

A questionnaire in the form of a bipolar rating scale was constructed using 26 personality attributes drawn from the literature on personality of children with Down's syndrome (DS). This was administered to nine groups of adults with differing levels of experience and contact with children with DS. Adults who had frequent contact proved to be significantly less likely to rate the personality of children with DS as stereotypical than those with little contact. The implications of acceptance of the stereotype are discussed in relation to integration and to development of the mother-child relationship.

Family background of children with Down's syndrome and of children with a similar degree of mental retardation

The families of Down's Syndrome children and another group with a similar degree of retardation were compared using data collected at interview. Differences in social class distribution were explained by the maternal age effect in the Down's group. Divorce was more common in the control group but the quality of marriage in those parents still together and the health of parents were similar. No close associations were found between behaviour disorders in the children and family factors, except that behaviour disorders were likely to be associated with similar disturbance in siblings next in age and to be more common in the less happy marriages.