Cognitive functions in children at risk for congenital adrenal hyperplasia treated prenatally with dexamethasone.
OBJECTIVE
In Sweden, from 1985 through 1995, 40 fetuses at risk for congenital adrenal hyperplasia (CAH) were treated with dexamethasone (DEX) to prevent virilization of affected females. We report long-term effects on neuropsychological functions and scholastic performance of this controversial treatment.


METHODS
Prenatally treated children, 7 to 17 yr old, were assessed with standardized neuropsychological tests (A Developmental Neuropsychological Assessment and Wechsler Intelligence Scales for Children) and child-completed questionnaires measuring self-perceived scholastic competence (Self-Perception Profile for Children). A parent-completed questionnaire (Child Behavior Checklist/4-18 School Scale) was used to evaluate whether the treatment had any impact on the children's school performance. In addition, a child-completed questionnaire measuring social anxiety (The Social Anxiety Scale for Children-Revised) was completed by the prenatally treated children aged 8 to 17 yr (n = 21) and age- and sex-matched controls (n = 26).


RESULTS
Of 40 DEX-treated children, 26 (median age, 11 yr) participated in the study. Thirty-five sex- and age-matched healthy children were controls. There were no between-group differences concerning psychometric intelligence, measures of cerebral lateralization, memory encoding, and long-term memory. Short-term treated, CAH-unaffected children performed poorer than the control group on a test assessing verbal working memory (P = 0.003), and they rated lower on a questionnaire assessing self-perception of scholastic competence (P = 0.003). This group also showed increased self-rated social anxiety assessed by The Social Anxiety Scale for Children-Revised (P = 0.026). Prenatally treated, CAH-affected children performed poorer than controls on tests measuring verbal processing speed, although this difference disappeared when controlling for the child's full-scale IQ.


CONCLUSIONS
This study indicates that prenatal DEX treatment is associated with previously not described long-term effects on verbal working memory and on certain aspects of self-perception that could be related to poorer verbal working memory. These findings may thus question future DEX treatment of congenital adrenal hyperplasia. Therefore, we encourage additional retrospective studies of larger cohorts to either confirm or challenge the present findings.
Hirvikoski
Tatja
T
Department of Psychiatry, Karolinska Institutet/Karolinska University Hospital, 171 76 Stockholm, Sweden.
Nordenström
Anna
A
Lindholm
Torun
T
Lindblad
Frank
F
Ritzén
E Martin
EM
Wedell
Anna
A
Lajic
Svetlana
S
D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D000328:Adult; D001007:Anxiety / Q000139:chemically induced; D002648:Child; D003071:Cognition / Q000187:drug effects*; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects*; D004521:Educational Measurement; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007175:Impulsive Behavior / Q000139:chemically induced; D008297:Male; D008570:Memory, Short-Term / Q000187:drug effects; D009483:Neuropsychological Tests; D010290:Parents; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D012307:Risk Factors; D012649:Self Concept; D011795:Surveys and Questionnaires; D014770:Virilism / Q000188:drug therapy / Q000517:prevention & control
D005938:Glucocorticoids; D003907:Dexamethasone