ABBREVIATIONS
3Di-svDevelopmental, Diagnostic and Dimensional Interview -short version ASD Autistic spectrum disorder CBCL Child Behavior Checklist DMD Duchenne muscular dystrophy SCDC Social Communication Disorder Checklist AIM Duchenne muscular dystrophy (DMD) is associated with neuropsychiatric disorders. The aim of the study was to characterize the DMD neuropsychiatric profile fully and to explore underlying genotype/phenotype associations.METHOD One hundred and thirty males with DMD (mean age 9y 10mo, range 5-17y) in four European centres were included and completed IQ assessment and a neurodevelopmentalscreening questionnaire. Of these, 87 underwent comprehensive neuropsychiatric assessment using structured diagnostic interview and parent-reported questionnaires.
RESULTSThe overall mean score on the neurodevelopmental questionnaire was significantly abnormal compared with the general population of children (p<0.001). On average, intelligence was below the population mean, with intellectual disability observed in 34 males (26%). Autistic spectrum disorder was identified in 18 (21%), hyperactivity in 21 (24%), and inattention in 38 (44%). Clinical levels of internalizing and externalizing problems were observed in 21 (24%) and 13 (15%) respectively. Over a third of males scored more than two measures of emotional, behavioural, or neurodevelopmental problems. Males with mutations at the 3 0 end of the DMD gene affecting all protein isoforms had higher rates of intellectual disability and clusters of symptoms.INTERPRETATION Males with DMD are at very high risk of neuropsychiatric disturbance, and this risk appears to increase with mutations at the 3 0 end of the gene. Patterns of symptom clusters suggest a DMD neuropsychiatric syndrome, which may require prompt evaluation and early intervention.Duchenne muscular dystrophy (DMD) is an X-linked recessive neuromuscular disorder affecting one in 5000 live male births, which causes progressive muscle weakness leading to loss of ambulation in the mid-adolescent years. Affected males generally present in the first few years of life with motor symptoms and enlarged calves. However, neurodevelopmental disorders are increasingly recognized features and can be the initial presenting symptoms. 1,2 DMD occurs as a result of mutations in the dystrophin gene. The large dystrophin gene contains 79 exons plus seven promoters. These tightly regulated internal promoters generate a range of different protein isoforms, with diverse expression in tissues. Mutations in the 5 0 end of the gene (i.e. mutations from exons 1-31) only affect the three longest isoforms, Dp427M, Dp427C, and Dp427P, which are expressed in skeletal and cardiac muscles, in the neurons in the cortex, and in cerebellar Purkinje cells respectively. However, mutations progressively further along the gene affect increasingly more isoforms. Mutations between exons 31 and 44, in addition to disrupting expression of the long isoforms, will also disrupt Dp260 (expressed mostly in the retina); mutations between exons 4...