Issues and Challenges in XYY Syndrome

Transcription

1 Issues and Challenges in XYY Syndrome ERIN TORRES MSN, CRNP-PMH DEVELOPMENTAL NEUROGENOMICS UNIT, NIMH NATIONAL INSTITUTES OF HEALTH BETHESDA, MD, USA

2 Objectives Discuss the profile of mental health issues present in a large clinical research sample of individuals with XYY syndrome Discuss the wide range of presentations seen in youth with XYY syndrome Discuss the priorities for future research on the profile of developmental and mental issues in individuals with XYY syndrome

3 Sex Chromosome Aneuploidy Typically there are 22 pairs of chromosomes plus one pair of sex chromosomes (X,Y) 47, XYY-males have an extra Y chromosome Mosaic vs non-mosaic

4 Sex Chromosome Aneuploidy Typically there are 22 pairs of chromosomes plus one pair of sex chromosomes (X,Y) 47, XYY-males have an extra Y chromosome Mosaic vs non-mosaic

5 Sex Chromosome Aneuploidy Typically there are 22 pairs of chromosomes plus one pair of sex chromosomes (X,Y) 47, XYY-males have an extra Y chromosome Mosaic vs non-mosaic

6 XYY Occurs in about 1 out of 1,000 newborn males Believed that many men with XYY are undiagnosed Increased amount of fetuses are being diagnosed due to increased amount of prenatal testing

7 First Reports , XYY first identified Early studies falsely associated XYY with violent crime 1965 Patricia Jacobs conducted a research study examining XYY males in institutional settings State Hospital in Scotland-high number of men with XYY Careful studies of XYY began in 1976 with Witkin et al

8 Key Findings Since Birth cohorts (low ascertainment bias, but few individuals + measures) 1 VIQ PIQ Motor and language delay/difficulties temper tantrums Self-referred (ascertainment bias, but more individuals and measures) Raised rates of.. Motor and language difficulties ADHD and externalizing disorders (e.g. oppositional defiant disorder) Difficulties in social interaction and Autism Spectrum Disorder diagnoses GOOD REVIEWS: 1. Leggett et al, Dev Med Child Neurol, Hong et al, Lancert Neurology, 2014

9 Key Findings Since Birth cohorts (low ascertainment bias, but few individuals + measures) 1 VIQ PIQ Motor and language delay/difficulties temper tantrums Non birth cohorts (ascertainment bias, but more individuals and measures) Raised rates of.. Motor and language difficulties ADHD and externalizing disorders (e.g. oppositional defiant disorder) Difficulties in social interaction and Autism Spectrum Disorder diagnoses GOOD REVIEWS: 1. Leggett et al, Dev Med Child Neurol, Hong et al, Lancert Neurology, 2014

10 X And Y Chromosome Variation Development Study At NIH

11 Families From North America and Europe

12 Participants seen so far Demographics:

13 Our Research Program

14 Talking About Differences: We all have strengths and weaknesses

15 IQ Milestones and Cognitive Development Prenatal Post

16 IQ Milestones and Cognitive Development Prenatal Postnatal Diagnosis Timing

17 K-SADS Schedule for Affective Disorders and Schizophrenia for School Aged Children Assessment completed with parent/guardian and child Current Diagnoses Past Diagnoses

18 Neurodevelopment And Mental Health DIAGNOSIS Autism Spectrum Disorder Tic Disorder Previous [N (% of 65)] KSADS [N (% of 65)] 20 (31%) 9 (14%) 4 (6%) 10 (15%) 35 (54%) 43 (66%) 6 (9%) 4 (6%) 9 (14%) 11 (17%) 11 (17%) 6 (9%) 1 (1%) 2 (3%) Attention Deficit Hyperactivity Disorder Oppositional Defiant Disorder Mood Disorder Anxiety Disorder Obsessive Compulsive Spectrum Disorder

19 Neurodevelopment And Mental Health DIAGNOSIS KSADS Prenatal Diagnosis [n (% of 24) Postnatal Diagnosis [n (% of 41) Autism Spectrum Disorder 1 (4%) 8 (19%) Tic Disorder 1 (4%) 9 (22%) 17 (71%) 26 (63%) Oppositional Defiant Disorder - 4 (10%) Mood Disorder 5 (21%) 6 (15%) Anxiety Disorder 1 (4%) 5 (12%) - 2 (5%) Attention Deficit Hyperactivity Disorder Obsessive Compulsive Spectrum Disorder

20 Neurodevelopment And Mental Health DIAGNOSIS KSADS DIAGNOSES Autism Spectrum Disorder FULL ONLY [n (% of 65) 9 (14%) FULL or PARTIAL [n (% of 65) N/A Tic Disorder 10 (15%) 14 (22%) 43 (66%) 50 (77%) 4 (6%) 10 (15%) Mood Disorder 11 (17%) 20 (31%) Anxiety Disorder 6 (9%) 19 (30%) 2 (3%) 4 (6%) Attention Deficit Hyperactivity Disorder Oppositional Defiant Disorder Obsessive Compulsive Spectrum Disorder

21 Autism Spectrum Disorder (ASD) Persistent deficits in social communication and social interaction across multiple contexts Restricted repetitive patterns of behavior, interests or activities Symptoms must have been present during early developmental period Symptoms cause clinically significant impairment in social, occupational or other important areas of functioning

22 ASD in XYY Social Communication deficits Difficulty socializing with peers Repetitive behaviors Difficulty with change Preoccupation with a certain object or subject

23 Attention Deficit Hyperactivity Disorder (ADHD) A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development 1 Inattention must have 6 or more symptoms present for at least 6 months 2 Hyperactivity and impulsivity must have 6 or more symptoms present for at least 6 months Several symptoms present before 12 Symptoms present in 2 or more settings Clearly interfere with functioning

24 ADHD in XYY Inattentive Hyperactive/Impulsive Difficult to engage Unable to sit through a meal Loses focus Doing before thinking Unable to follow multiple step instructions Fidgety or restless Combined Having symptoms from both categories that cause an impairment in functioning

25 Tic Disorders Motor Tic Uncontrollable muscle movements frequent eye blinking raising eyebrows scrunching up nose shrugging shoulders Vocal Tic Uncontrolled noises clearing throat sniffing grunting animal sounds Tourette s Both motor and vocal tics

26 Tics in XYY Motor tic Mouth movements Vocal tic Sniffing

27 Behavioral Difficulties Oppositional behaviors Irritable Mood Tantrums

28 Recommendations Individualized Education Plan Speech therapy Social Skills groups

29 Next StepsUNDERSTAND VARIABLITY IQ Prenatal Postnatal Diagnosis Timing

30 Next Steps UNDERSTAND VARIABLITY FROM CATEGORIES TO DIMENSIONS

31 Next Steps UNDERSTAND VARIABLITY FROM CATEGORIES TO DIMENSIONS FROM BRAIN TO BEHAVIOR Cortical thickness XYY<XY XYY>XY

32 Next Steps UNDERSTAND VARIABLITY FROM CATEGORIES TO DIMENSIONS FROM BRAIN TO BEHAVIOR FROM GENES TO BRAIN TO BEHAVIOR

33 Next Steps UNDERSTAND VARIABLITY FROM CATEGORIES TO DIMENSIONS FROM BRAIN TO BEHAVIOR FROM GENES TO BRAIN TO BEHAVIOR EXTENDING THIS SYSTEMATIC APPROACH TO ALL X-/Y-CHROMOSOME VARIATIONS XY, XYY, XXY, XXYY, XXXY, XXXXY, XX, XXX, XXXX,

34 Developmental Neurogenomics Unit Armin Raznahan, MD, PhD Erin Torres, CRNP-PMH Francois Lalonde, PhD Catherine Mankiw, AB Jonathan Blumenthal, MA Liv Clausen, PhD Jakob Seidlitz, BS Anastasia Xenophontos, BS Ari Fish, BS David Lee Kirk Reardon, AB

35 Thank you!!!

36 References Bardsley, M. Z., Kowal, K., Levy, C., Gosek, A., Ayari, N., Tartaglia, N.,... Ross, J. L. (2013). 47,XYY Syndrome: Clinical Phenotype and Timing of Ascertainment. The Journal of Pediatrics, 163(4), doi: /j.jpeds Benn, P., Cuckle, H., & Pergament, E. (2013). Non-invasive prenatal testing for aneuploidy: current status and future prospects. Ultrasound in Obstetrics & Gynecology, 42(1), doi: /uog Cover, Virginia Isaacs, MSW. Living with Klinefelter Syndrome (47,XXY) Trisomy X (47,XXX) and 47, XYY. New York: Virginia Isaacs Cover, Lalatta, Faustina, Emanuela Folliero, Ugo Cavallari, Marina Di Segni, Barbara Gentilin, Roberto Fogliani, Donatella Quagliarini, Paola Vizziello, Federico Monti, and Luigi Gargantini. "Early Manifestations in a Cohort of Children Prenatally Diagnosed with 47,XYY. Role of Multidisciplinary Counseling for Parental Guidance and Prevention of Aggressive Behavior." Ital J Pediatr Italian Journal of Pediatrics 38.1 (2012): 52. Web. Leggett, V., Jacobs, P., Nation, K., Scerif, G., & Bishop, D. V. (2010). Neurocognitive outcomes of individuals with a sex chromosome trisomy: XXX, XYY, or XXY: a systematic review*. Developmental Medicine & Child Neurology, 52(2), doi: /j x Re, L., & Birkhoff, J. M. (2015). The 47,XYY syndrome, 50 years of certainties and doubts: A systematic review. Aggression and Violent Behavior, 22, doi: /j.avb Ross, J. L., N. Tartaglia, D. E. Merry, M. Dalva, and A. R. Zinn. "Behavioral Phenotypes in Males with XYY and Possible Role of Increased NLGN4Y Expression in Autism Features." Genes, Brain and Behavior 14.2 (2015): Stochholm, K., A. Bojesen, A. S. Jensen, S. Juul, and C. H. Gravholt. "Criminality in Men with Klinefelter's Syndrome and XYY Syndrome: A Cohort Study." BMJ Open 2.1 (2012) Witkin, H., Mednick, S., Schulsinger, F., Bakkestrom, E., Christiansen, K., Goodenough, D.,... Stocking, M. (1976). Criminality in XYY and XXY men. Science,193(4253), doi: /science