Study of Social and Cognitive Functioning in Children with Congenital Adrenal Hyperplasia

Background: Congenital adrenal hyperplasia (CAH) is a genetic problem of steroidogenesis in adrenals. Due to a particular enzyme deficiency causing lack of steroids, negative feedback involving hypothalamic-pituitary-adrenal axis is lost. This would result in increased production of adrenocorticotrophic hormone and corticotropin-releasing hormone which may have their effects on learning and memory. CAH is the most common cause of hyperandrogenism which may influence the psychological behavior in girls leading to psychiatric manifestations such as aggressiveness and attention-deficit hyperactivity disorder (ADHD). The prevalence of these behavioral and cognitive impairment is studied here. Aims and Objectives: Aims and objectives of the study were to study the social and cognitive functioning in children with CAH on treatment and to determine the prevalence of aggression and ADHD in CAH children. Materials and Methods: In total, 55 children from 2 to 12 years satisfying the criteria were enrolled in the study. Complete history recorded, physical examination done, and blood 17-hydroxyprogesterone and bone age were measured. Materials used include social adaptive behavior from Vineland social adaptive behavior scale, child behavior checklist to look for any aggressiveness, intelligence quotient (IQ) assessment using Gesssel’s for children between 2 and 3 years, Binet Kamat test for children 3-6 years, and Malin’s intelligence scale for more than 6 years. Observation and Results: About 53% of the population had adequate adaptability and 40% of them had moderately low adaptability. 7% had low adaptability. 20% of the total study population were found to be aggressive as per child behavior checklist. Aggressiveness and gender were not dependent to each other in CAH. 15% of the total population had attentiondeficit hyperactivity disorder (ADHD), 16% of the girls, and only 10% of the boys had ADHD. 53% of the total population had only borderline IQ levels IQ distribution pattern among the two sex is not much different from the total with a P = 0.4375. Conclusion: From our study, we conclude that nearly half of the children with CAH had only borderline IQ and low social adaptability. Hence, all CAH patients should be subjected to psychological and cognitive assessment at least once a year.