Psychosocial adaptations of 39 adolescents with sex chromosome abnormalities

Teenagers with sex chromosome abnormalities (SCA) may score lower on intelligence tests while facing more psychological and social problems than their healthy siblings. SCA is a genetic disorder with an extra or missing X or Y chromosome. Researchers compared the results of psychiatric interviews and intelligence testing among 39 SCA teenagers and their healthy 27 siblings (the control group). The participants were between 12 and 19 years old. SCA teenagers scored an average of 21 points below the IQ levels of the control group. Despite more special education efforts during school, less SCA teenagers completed high school. Depression was the most frequent diagnosis among other psychiatric conditions. The 11 girls with a 47,XXX genetic abnormality functioned at low levels of adaptation and had the most psychiatric and behavioral problems. A stable and loving family life was thought to be responsible for the high degree of adaptation among some patients.
Objectives. Children with sex chromosome abnormalities (SCA) are known to be at increased risk for neuromotor, language, learning, and behavioral problems, but little is known of psychosocial adaptation of SCA adolescents. This study was conducted to evaluate psychologic characteristics of unselected SCA adolescents, including socialization, educational progress, separation from family, and incidence and severity of psychiatric disturbance. Methods. Thirty-nine propositi identified through the screening of 40 000 consecutive Denver newborns, including boys with 47,XXY karyotypes and girls with 47,XXX, 45,X, and partial X monosomy, or SCA mosaic karyotypes, have been followed longitudinally into adolescence. Twenty-seven siblings served as controls. Between 12 and 19 years of age, all participated in blind psychiatric interviews and were administered standardized intelligence and achievement tests. Results. SCA propositi demonstrated a mean IQ score 21 points lower than that of control subjects. In addition, lower mean scores were seen on achievement test results as well as lower overall psychosocial adaptation scores and increased incidence of psychiatric disturbance. Depression was the most frequent psychiatric diagnosis. Propositi were more likely to receive special education assistance in high school and were less likely to graduate from high school than were controls. Of the three nonmosaic propositi groups, the 47,XXX girls demonstrated the poorest overall psychosocial adaptation and highest degree of psychiatric disturbance. Mosaic girls were indistinguishable from control subjects. Marked variability was found among all three nonmosaic groups, with some individuals in each group demonstrating relatively strong psychosocial adaptation. Conclusions. The presence of nonmosaic sex chromosome abnormality increases the risk for impeded cognitive skills, learning abilities, and psychosocial adaptation in adolescence. The factors that allow for stronger adaptation in some of these adolescents include the presence of a stable and supportive family environment. The outlook for adaptation in unselected SCA adults remains uncertain. Pediatrics 1995; 96:302-308; sex chromosomes, adolescents, psychosocial.
ABBREVIATIONS. SCA, sex chromosome abnormalities; GAS, Global Assessment Scale. Sex chromosome abnormalities (SCA) are the result of the addition, deletion, or structural variation of an X or Y chromosome and [...]