Objective: Attentional problems, hyperactivity, and impulsivity have been described as behavioral features associated with sex chromosome aneuploidy (SCA). In this study, the authors compare attention-deficit hyperactivity disorder (ADHD) symptoms in 167 participants aged 6 to 20 years with 4 types of SCA (XXY n = 56, XYY n = 33, XXX n = 25, and XXYY n = 53). They also evaluate factors associated with ADHD symptomatology (cognitive and adaptive scores, prenatal vs postnatal ascertainment) and describe the clinical response to psychopharmacologic medications in a subset of patients treated for ADHD. Methods: Evaluation included medical and developmental history, cognitive and adaptive functioning assessment, and parent and teacher ADHD questionnaires containing DSM-IV criteria. Results: In the total study group, 58% (96/167) met DSM-IV criteria for ADHD on parent-report questionnaires (36% in XXY, 52% in XXX, 76% in XYY, and 72% in XXYY). The Inattentive subtype was most common in XXY and XXX, whereas the XYY and XXYY groups were more likely to also have hyperactive/impulsive symptoms. There were no significant differences in Verbal, Performance, or Full Scale IQ between children with symptom scores in the ADHD range compared with those below the ADHD range. However, adaptive functioning scores were significantly lower in the group whose scores in the ADHD range were compared with those of the group who did not meet ADHD DSM-IV criteria. Those with a prenatal diagnosis of XXY were less likely to meet criteria for ADHD compared with the postnatally diagnosed group. Psychopharmacologic treatment with stimulants was effective in 78.6% (66/84). Conclusions: Children and adolescents with SCA are at increased risk for ADHD symptoms. Recommendations for ADHD evaluation and treatment in consideration of other aspects of the SCA medical and behavioral phenotype are provided.
From the *Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO; †Neurology, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO.
Received July 2011; accepted December 2011.
This study was supported by NIH/NCRR Colorado CTSI Grant UL1 RR025780, NIH/NINDS 1K23NS070337-01A1 (to N.R.T.), Children's Hospital Colorado Research Institute, The XXYY Project, Madigan Foundation, and KS&A.
Contents are the authors' sole responsibility and do not necessarily represent official NIH views.
Disclosure: The first author receives support for clinical trials in fragile X syndrome from Seaside Therapeutics.
Address for reprints: Nicole Tartaglia, MD, Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 16th Avenue, B140, Aurora, CO 80045; e-mail: Nicole.firstname.lastname@example.org.