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Dual Diagnosis in 22Q13 Deletion Syndrome

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Dual Diagnosis in 22Q13 Deletion Syndrome Dual Diagnosis in 22q13 Deletion Syndrome Running head: DUAL DIAGNOSIS IN 22q13 DELETION SYNDROME Dual Diagnosis in Individuals with 22q13 Deletion Syndrome Akanksha A. Sharma Department of Educational and Counselling Psychology McGill University, Montreal Masters of Arts in Educational Psychology August 2009 A thesis submitted to McGill University in partial fulfillment of the requirements of the degree of a Masters of Arts in Educational Psychology (Concentration in School and Applied Child Psychology) © Akanksha A. Sharma (2009) Library and Archives Bibliothèque et Canada Archives Canada Published Heritage Direction du Branch Patrimoine de l’édition 395 Wellington Street 395, rue Wellington Ottawa ON K1A 0N4 Ottawa ON K1A 0N4 Canada Canada Your file Votre référence ISBN: 978-0-494-66362-2 Our file Notre référence ISBN: 978-0-494-66362-2 NOTICE: AVIS: The author has granted a non- L’auteur a accordé une licence non exclusive exclusive license allowing Library and permettant à la Bibliothèque et Archives Archives Canada to reproduce, Canada de reproduire, publier, archiver, publish, archive, preserve, conserve, sauvegarder, conserver, transmettre au public communicate to the public by par télécommunication ou par l’Internet, prêter, telecommunication or on the Internet, distribuer et vendre des thèses partout dans le loan, distribute and sell theses monde, à des fins commerciales ou autres, sur worldwide, for commercial or non- support microforme, papier, électronique et/ou commercial purposes, in microform, autres formats. paper, electronic and/or any other formats. The author retains copyright L’auteur conserve la propriété du droit d’auteur ownership and moral rights in this et des droits moraux qui protège cette thèse. Ni thesis. Neither the thesis nor la thèse ni des extraits substantiels de celle-ci substantial extracts from it may be ne doivent être imprimés ou autrement printed or otherwise reproduced reproduits sans son autorisation. without the author’s permission. In compliance with the Canadian Conformément à la loi canadienne sur la Privacy Act some supporting forms protection de la vie privée, quelques may have been removed from this formulaires secondaires ont été enlevés de thesis. cette thèse. While these forms may be included Bien que ces formulaires aient inclus dans in the document page count, their la pagination, il n’y aura aucun contenu removal does not represent any loss manquant. of content from the thesis. Dual Diagnosis in 22q13 Deletion Syndrome Abstract Dual Diagnosis, the co-occurrence of intellectual disability and psychopathology, was evaluated in 31 individuals with 22q13 deletion syndrome. Parents filled out the Reiss Scales for Children’s Dual Diagnosis, The Vineland Adaptive Behavior Scales, and the Family Quality of Life Survey in order to describe the mental health, adaptive functioning and family quality of life of the subjects. Six subjects (19.35%) met the criteria for dual diagnosis, three had significant attention problems and another four had significant withdrawn Behavior. Dual Diagnosis was associated with overall mental health, attention problems, withdrawn behavior, autistic symptoms, anger/self control problems and social skills. Psychotic and attention deficit symptoms were the most frequent symptoms among the Reiss scales. Psychosis was not associated with overall mental health or dual diagnosis; however, it significantly correlated with family interaction, parenting, emotional well-being and quality of life. Maladaptive behavior was marked by a significant increase in externalizing behaviors with age. i Dual Diagnosis in 22q13 Deletion Syndrome Résumé Le double diagnostic, la cooccurrence d’une incapacité intellectuelle et psychopathologique, fut évalué avec 31 individus souffrant du syndrome de délétion 22q13. Les parents ont passé le test des échelles de Reiss pour le double diagnostic des enfants, Le Vineland Adaptive Behavior Scales, et le sondage sur la qualité de vie familiale de manière à décrire la santé mentale, le fonctionnement adaptif et la qualité de vie familiale des sujets. six sujets (19.35%) ont rempli le critère du double diagnostic, trois souffraient de problèmes d’attention significatifs et quatre autres individus souffraient d’un comportement de retrait significatif. Le double diagnostic fut associé avec la santé mentale générale, les problèmes d’attention, le comportement de retrait, des symptômes autistiques, des problèmes de colères ou de contrôle de soi et les habiletés sociales. Les syndromes psychotiques ou de déficits d’attention furent les plus fréquents dans les échelles de Reiss. La psychose ne fut pas associée avec la santé mentale générale ou le double diagnostic; cependant on observa une corrélation significative avec l’interaction familiale, le parentage, le bien-être émotionnel et la qualité de vie. Les comportements mésadaptés furent marqués par une augmentation significative de l’externalisation des comportements avec l’âge. ii Dual Diagnosis in 22q13 Deletion Syndrome ACKNOWLEDGEMENTS I would like to express my heartfelt gratitude to my supervisor, Dr. Steven Shaw for his support, guidance and encouragement over the past two years. Thank you for providing me with the opportunities and the tools to grow and achieve, and for allowing me the independence to carry out my thesis in my own way while supporting me whenever I needed the help. I would also like to thank Jennifer Bruce for being a wonderful support, critic and friend throughout the past two years and for always providing constructive feedback when I required it. I am also grateful to Amira Rahman for helping me with the recruitment of additional participants, for giving me useful pointers, and for her kind words. The success of this thesis, much like my survival through the natural selection process of academia, is highly attributable to my wonderful parents. I thank my father for believing in me, for ensuring that I am not troubled by financial concerns, for investing immense concern and emotion into my academic success, and for always being there. I thank my mother for her undying love and support, for her constant reminders about all my deadlines, for her endless patience with all my thesis and non-thesis related complaints and for being my pillar of strength. I would also like to thank my wonderful friends and loved ones for helping me transition into and adjust with my life in Montreal and my sister for giving me a home to visit whenever I needed family. iii Dual Diagnosis in 22q13 Deletion Syndrome TABLE OF CONTENTS ABSTRACT…………………………………………………………………………………....i RESUMÉ……………………………………………………………………………………....ii ACKNOWLEDGEMENTS…………………………………………………………………...iii LIST OF TABLES…………………………………………………………………………….vii CLAIMS TO ORIGINALITY…………………………………………………………………viii CHAPTER 1…………………………………………………………………………………….1 Introduction……………………………………………………………………………………..1 CHAPTER II……………………………………………………………………………………4 Review of Literature…………………………………………………………………………….4 Dual Diagnosis…………………………………………………………………………..4 History of Dual Diagnosis……………………………………………………….4 Prevalence Studies about Dual Diagnosis……………………………………….5 Challenging Behavior and Dual Diagnosis……………………………………...9 Issues in Dual Diagnosis………………………………………………………..12 Risk Factors Associated with Dual Diagnosis………………………………….13 22q13 Deletion Syndrome………………………………………………………………17 Genetic Vulnerabilities to specific psychopathologies in 22q13……………….17 The Psychological Profile of 22q13…………………………………………….20 Conclusion………………………………………………………………………………22 Rationale for Current Study…………………………………………………………….22 Objective of Current Study……………………………………………………………..24 CHAPTER III…………………………………………………………………………………..25 iv Dual Diagnosis in 22q13 Deletion Syndrome Method…………………………………………………………………………………………..25 Participants………………………………………………………………………………25 Recruitment……………………………………………………………………………………...…26 Measures…………………………………………………………………………………………...26 The Family Quality of Life Survey…………………………………………….....27 The Reiss Scales for Children’s Dual Diagnosis………….……………………..28 The Vineland Adaptive Behavior Scales…………………………………………29 Procedure………………………………………………………………………………..30 Data Analyses……………………………………………………………………………31 CHAPTER IV……………………………………………………………………………………32 Results……………………………………………………………………………………………32 Age & Sibling Effects…………………………………………………………………….32 The Family Quality of Life Survey……………….………………………………………...33 The Reiss Scales for Children’s Dual Diagnosis….……………………………………..35 The Vineland Adaptive Behavior Scale...………………………………………………..39 Relation between Family, Adaptive and Mental Health Variables………………...……42 CHAPTER V ……………………………………………………………………………………46 Discussion………………………………………………………………………………………..46 Mental Health Profile of 22q13………………………………………………………….46 Prevalence and nature of Dual Diagnosis……………………………………………….48 Additional Findings……………………………………………………………………...50 .Clinical Implications…………………………………………………………………….51 Limitations……………………………………………………………………………….52 v Dual Diagnosis in 22q13 Deletion Syndrome Directions for Future Research………………………………………………………….53 Conclusion……………………………………………………………………………….55 References……………………………………………………………………………………….57 APPENDIX A: Consent forms for Parents: Biennial Conference…….…………………………71 APPENDIX B: Consent forms for Parents: Post-conference……………………………............73 APPENDIX C: Demographic Questionnaire…………………………………………………….75 APPENDIX D: Family Quality of Life Survey …………………………………………………78 vi Dual Diagnosis in 22q13 Deletion Syndrome LIST OF TABLES Table 1: Mean Values of Continuous Variables…………………………………………………25 Table 2: Demographic Variables:
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