Issues and Challenges in XYY Syndrome ERIN TORRES MSN, CRNP-PMH DEVELOPMENTAL NEUROGENOMICS UNIT, NIMH NATIONAL INSTITUTES OF HEALTH BETHESDA, MD, USA
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
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
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
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
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
First Reports 1959 47, 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
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, 2010 2. Hong et al, Lancert Neurology, 2014
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, 2010 2. Hong et al, Lancert Neurology, 2014
X And Y Chromosome Variation Development Study At NIH
Families From North America and Europe
Participants seen so far Demographics:
Our Research Program
Talking About Differences: We all have strengths and weaknesses
IQ Milestones and Cognitive Development Prenatal Post
IQ Milestones and Cognitive Development Prenatal Postnatal Diagnosis Timing
K-SADS Schedule for Affective Disorders and Schizophrenia for School Aged Children Assessment completed with parent/guardian and child Current Diagnoses Past Diagnoses
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
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
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
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
ASD in XYY Social Communication deficits Difficulty socializing with peers Repetitive behaviors Difficulty with change Preoccupation with a certain object or subject
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
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
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
Tics in XYY Motor tic Mouth movements Vocal tic Sniffing
Behavioral Difficulties Oppositional behaviors Irritable Mood Tantrums
Recommendations Individualized Education Plan Speech therapy Social Skills groups
Next StepsUNDERSTAND VARIABLITY IQ Prenatal Postnatal Diagnosis Timing
Next Steps UNDERSTAND VARIABLITY FROM CATEGORIES TO DIMENSIONS
Next Steps UNDERSTAND VARIABLITY FROM CATEGORIES TO DIMENSIONS FROM BRAIN TO BEHAVIOR Cortical thickness XYY<XY XYY>XY
Next Steps UNDERSTAND VARIABLITY FROM CATEGORIES TO DIMENSIONS FROM BRAIN TO BEHAVIOR FROM GENES TO BRAIN TO BEHAVIOR
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,
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
Thank you!!!
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