Fuggle, Peter William; (1993) Psychological outcome in early treated children with congenital hypothyroidism. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The aim of the study was to determine the intellectual and behavioural status of children with congenital hypothy­ roidism (CH) following the introduction of neonatal screen­ ing and early treatment in the UK in 1982. All 472 children with CH detected by this programme in England, Wales and Northern Ireland during 1982-84 were recruited for the study. Diagnostic data and treatment records were obtained to the age of five years when a standard psychological assessment was carried out on the CH children along with matched classroom controls. Children were assessed for intelligence, motor skills and behaviour problems using the Wechsler Pre-school and Primary scale of Intelligence (WPPSI), the Bruinincks-Oseretsky test of Motor Proficiency and the Conners Teacher and Parent behaviour questionnaires and the Richman Behaviour Checklist. Intellectual outcome was significantly associated with the severity of CH at diagnosis as measured by pre-treat­ ment T4. This association was significantly non-linear. After controlling for parental occupation and educational background, children with a pre-treatment T4 less than 4Onmol/1 had a significant IQ deficit (df=2; F=20.16; p<0.0001) of 9.75 points (95% C/I 6.74-12.76) compared with controls. This represented a fivefold increased risk of learning impairment. In contrast, children with T4 greater than 40 nmol/1 showed no intellectual impairments compared with controls. CH children also showed significant deficits with respect to motor skills compared with their peers (t=~7.56; p<0.0001) and there was a significant positive association between pre-treatment T4 and motor skills after controlling for gender and parental educational background (df=5; F= 13.30; p<0.0001). Both parents and teachers reported an increased frequency of attentional problems (20-30%) for all CH children compared with 10-15% of their peers. Although the introduction of early treatment has clearly reduced the overall impairment of CH, this study suggests that a significant impairment remains. The prena­ tal thyroid/neurological mechanisms that may underpin these deficits are discussed.

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