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Cognitive and Psychological Profile of Males With Becker Muscular Dystrophy

Institute for Neuromuscular Research, The Children's Hospital at Westmead, Sydney, Australia, hyoung{at}nsccahs.health.nsw.gov.au

Belinda A. Barton, PhD

Children'' Hospital Education Research Institute (CHERI), The Children's Hospital at Westmead, Sydney, Australia

Susan Waisbren, PhD

Department of Psychiatry, Harvard Medical School, Boston, MA, Children's Hospital Boston, Boston, MA

Lourdes Portales Dale, PhD

Graduate Institute of Professional Psychology, University of Hartford, West Hartford, UK

Monique M. Ryan, FRACP, MMed

Institute for Neuromuscular Research, The Children's Hospital at Westmead, Sydney, Australia, Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia

Richard I. Webster, FRACP, MMed

Institute for Neuromuscular Research, The Children's Hospital at Westmead, Sydney, Australia, Children'' Hospital Education Research Institute (CHERI), The Children's Hospital at Westmead, Sydney, Australia, Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia

Kathryn N. North, MD

Institute for Neuromuscular Research, The Children's Hospital at Westmead, Sydney, Australia, Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia

Duchenne and Becker muscular dystrophy are allelic X-linked disorders causing progressive muscle weakness in males. Duchenne muscular dystrophy is caused by absence of dystrophin in muscle and brain; boys with Duchenne muscular dystrophy have a static cognitive impairment with mean Full Scale IQ approximately 1 standard deviation below the mean. Less is known of the cognitive profile of males with Becker muscular dystrophy, which is associated with variable alterations in the amount or size of the dystrophin protein. The aim of this study was to describe the cognitive and psychological profile of males with Becker muscular dystrophy. This was a prospective cohort study. Clinical data collected included age at diagnosis and assessment, socioeconomic status, serum creatine kinase level, and site of gene deletion/mutation (by exon number). The following psychological tests were used to assess general intellectual functioning, academic achievement, incidence and nature of behavioral problems: The Wechsler Intelligence Scales, The Wide Range Achievement Test—Revised, The Developmental Test of Visual-Motor Integration, The Child Behavior Checklist, and The Conner's Parent Rating Scale. Twenty-four males were enrolled. The Wechsler Full Scale IQ was normally distributed with a mean of 95.6 (SD 23.3), which did not differ significantly from the population mean. The frequency of learning difficulties for reading was 21%, for spelling was 32%, and for arithmetic was 26%, significantly higher than the frequency in the general population. The frequency of total behavioral problems in the clinical range was 67%, and the frequency of autism was 8.3%. Patients with Becker muscular dystrophy demonstrate a less homogeneous cognitive phenotype than that seen in Duchenne muscular dystrophy. Males with Becker muscular dystrophy have a high incidence of learning difficulties. Autism and behavioral and attention problems are also more common in Becker muscular dystrophy than in the general population.

Key Words: Becker muscular dystrophy • cognition • dystrophin

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