Renato Cocchi M.D., Ph.D. (Sociology)
Italian Journal of Intellective Impairment 1 (1): 89-95 (1988)
  Reprinted with the permission of Renato Cocchi
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A group of 40 psychotic Down children (26 M and 16 F; Average age: 7 years at the first consultation) was compared with a group of 20 non-Down psychotic children (11 M + 9 F; same average age at the first consultation). Not meaningful difference found as for the epidemiological features and aspecific clinical data, although larger prevalence of prematurity and/or low birthweight and squint in the Down group; EEG anomalies in the non-Down group. The diagnoses, done according to the DSM-III, showed the poor reliability of this manual, in this field. As for psychotic symptoms, the difference is meaningful (p = 0.05) with larger prevalence of groundless anxiety, need of the sameness, troubles of the sensory sensibility, rituals and aggressiveness in the group of non-Down psychotics.
Key words: Childhood psychoses, Down syndrome, Stress, Epidemiology, Prematurity, Low Birthweight, Squint, EEG, Symptoms, Anxiety, Sameness, Sensibility, Rituals, Aggression.

Scoggin and Patterson (1982) affirmed that the presence of relatively many Down individuals could help in understanding of illnesses that affect both these subjects and normal ones.

This fact could be true even for childhood psychoses, whose incidence, about 10% of Down children, has been found similar in two investigations carried out in two different countries (Gath and Gumley, 1986; Cocchi, 1988).

With this short work I want to start comparisons, between them, a group of psychotic Down children and a group of psychotic non-Down children.

Materials and methods

The group of 40 psychotic Down children (39 standard trisomy 21 and one mosaicism), came out from a consecutive, non selected series of 389 Down subjects with no more than 15 years, all living in their family and all personally visited by the author. This group was already described elsewhere (Cocchi, 1988).

The group of 20 non-Down psychotic children represented the whole series of the psychotic children, all living in their family, and visited by the author between 1982 and end April 1988. A part of them was taking a drug therapy.

For them too, I select 15 years as the maximum age to the first visit, as the age considered as the conventional limit of paediatric and child neuropsychiatric competence.

For both groups' clinical cards I transcribed the following data:

Hallucinations, delusions, loss of the association ability or incoherence doesn't ever found, during the first visit, and the following checkups.

Both groups had the diagnosis, as for what possible, according with the DSM-III.

The same ones were compared between them, for what concerns every investigated characteristic and the statistical analysis used the the Chi Square test.


The resulwereere summarized in table 1 (epidemiological and aspecific clinical features), in table 2 (diagnosis) and in table 3 (psychotic symptoms).

Table 1: Epidemiological and aspecific clinical features
Parameter Down
 Group Ss 
%  Non-Down 
Group Ss
No. of Ss 40    100.00 20    100.00
Males 26 65.00 11 55.00
Females 14 35.00 9 45.00
M/F Ratio 185.71 122.22
Average age at 1st consult. 7 + 3.5 7 + 3.7
Prematurity 6 15.00 2 10.00
Low birthweight 1 2.5 2 10.00
Prematurity + low birthweight 4 10.00 0 0.00
Squint 15 37.5 5 20.00
Bruxism 29 72.50 13 65.00
Fits, epilepsia and/or altered EEG      5 12.50 5 25.00
Chi Square = 9.7842 NS

Table 2: Comparison amondiagnosesnosess according with the DSM-III
Diagnosis Down
 Group Ss 
%  Non-Down 
Group Ss
Autism 12    30.00 7    35.00
Pervasive Develop. Disorder 5 12.50 6 30.00
Atypical Pervasive Develop. Disorder      2 5.00 7 35.00
Cannot be decided (*) 21 52.00 0 0.00
(*) see discussion.

Table 3: Psychotic symptoms detected
Symptom Down
 Group Ss 
%  Non-Down 
Group Ss
Social isolation 40    100.00 20    100.00
Speech troubles: but echolalia (*)      40 100.00 20 100.00
Motor stereotypes 40 100.00 20 100.00
Self-aggression 21 52.50 11 55.00
Disturbed affect 18 45.00 9 45.00
Gaze aversion 18 45.00 12 60.00
Echolalia 17 42.50 8 40.00
Groundless anxiety 16 40.00 12 60.00
Nethef rthe sameness 14 35.00 9 45.00
Sensory sensibility troubles 11 27.50 14 70
Rituals 2 5.00 4 20.00
Aggression 0 0.00 7 35.00
(*) One child with Asperger language.
Chi Square = 19.7432 with 11 df and p < 0.05.


Several points of this comparison, deserve deepening.

While I am enough sure about the representativeness of the sample of the psychotic Down children, as collected from a large survey (Cocchi, 1988) I cannot say the same on the sample of the psychotic non-Down children.

At least two reasons lead to doubt; the inferior numerical consistence and the M/F ratio absolutely lead unbalanced in favour of the males, in clear contrast with what reported in the literature, even recent (Lotter, 1966; Brask, 1967; Lotter, 1967; Burd, Fisher and Kerbeshian, 1987).

So, it is therefore possible that not statistic significance of the differences of the epidemiological and aspecific clinical features, is a not to be generalized datum.

No results however about gender differences in psychotic symptoms, for which, as for it, I should deny the risk of drawing wrong conclusions, because a wrong selection of the sample.

By still referring to epidemiological data, it is to point up the different prevalence of prematurity and/or low birthweight, larger in Downs, not psychotic also (Cocchi, 1987).

There is a growing interest towards the investigation of these risk factors, to try to explain a possible biological cause, as exact and identifiable, in childhood psychoses (DeMyer, Hingtgen and Jackson, 1981; Ritvo and Freeman, 1984; Lelord and coll., 1986; Mason-Brothers and coll., 1987).

We may think that the larger prevalence these risk factors in Downs, besides so higher incidence of childhood psychoses, be an element to not underestimate.

The squint presence, as a sign of brain suffering, was found again as larger in psychotic Downs, while that of the bruxism is nearly the same, in both groups, as a sign of current stress (Morse, 1982; Cocchi and Lamma, 1987; Lamma, 1987; Lamma and Cocchi, 1988).

For what concerns the diagnosis, according to the DSM-III, here too happened what Burd, Fisher and Kerbeshian (1987) debated.

The diagnosis of Atypical Pervasive Developmental Disorder, as made because the beginning of the symptoms before 30 months prevents to use that of Child Pervasive Developmental Disorder, that otherwise should be the right one, is a shift unsatisfactory at all.

The large number of diagnoses "not to be chosen", in the group of psychotic Down children, is creditable to the fact that the parents of these latter ones, differently from the parents of psychotic non-Down children, were unable to specify the time when psychotic symptoms appeared.

It is probable that their reduced expectations about their Down child have induced to believe, for a time, that some particular symptoms were characteristic of the Down syndrome, and not symptoms of psychotic development.

All this cases could have been included in the diagnosis of Atypical Pervasive Developmental Disorder, but a such choice would have been even more debatable.

Finally, about the psychotic symptoms, if, in part, they are superimposed. The different prevalence of the groundless anxiety, of the need of the sameness, of the troubles of the sensory sensibility, of the rituals, but, above all, of the aggressiveness, is what led to statistical significance. I have to add that I admittedstereotypesotypies, to rip the paper, found in five psychotic non-Down children and, if I am not wrong, in none of the Down. It could be an other differential symptom.

Personally I think that it is a symptom closer to the aggressive behaviors than tstereotypesotypies.

On other hand, the presence of aggressiveness in the non-Down children and its possible absence in the Down children would require an explanation for it, if confirmed. To say that is not in the character of the Down child to be aggressive, though being true, it is at most a verification, but not an explanation.


The comparison between Down and not-Down psychotic children is surely one detective strategy to understand better the origin and the morbid development of childhood psychoses.

The different prevalence of symptoms like the need of the sameness, the troubles of the sensory sensibility, the rituals and the aggressiveness, if confirmed from other investigations, could already help, in a neuropsychological perspective of explaining.


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