Spatial function in adolescents and young adults with congenital adrenal hyperplasia: Clinical phenotype and implications for the androgen hypothesis

Reduced short term memory in congenital adrenal hyperplasia (CAH) and its relationship to spatial and quantitative performance

“…Although the current study found no evidence for significantly enhanced spatial performance in females with CAH, some other studies have reported superior mental rotation or other spatial skills, such as virtual navigation, in females with CAH (Berenbaum et al, 2012; Resnick et al, 1986) or in females with the salt-wasting form of the disease (Hampson & Rovet, 2015; Mueller et al, 2008). …”

“…Focusing specifically on the visuospatial task of mental rotation which typically shows one of the largest cognitive sex difference favoring males (Voyer et al, 1995), results have been inconsistent. Mental rotation ability was not altered in prior analyses from our sample of females with CAH (Hines et al, 2003) nor was it altered in three other studies of girls or women with CAH (Baker & Ehrhardt, 1974; Helleday et al, 1994; Malouf et al, 2006); however, three studies have found enhancement of mental rotation, although in some cases this was restricted to females with the more severe, salt-wasting form of CAH (Berenbaum et al, 2012; Hampson & Rovet, 2015; Resnick et al, 1986). In addition, in one of the studies (Hampson & Rovet, 2015) the effect was found only when a subgroup of female participants with CAH, deemed to show “questionable neurological status” perhaps related to the consequences of salt-wasting crises, was removed from the analyses.…”

“…Mental rotation ability was not altered in prior analyses from our sample of females with CAH (Hines et al, 2003) nor was it altered in three other studies of girls or women with CAH (Baker & Ehrhardt, 1974; Helleday et al, 1994; Malouf et al, 2006); however, three studies have found enhancement of mental rotation, although in some cases this was restricted to females with the more severe, salt-wasting form of CAH (Berenbaum et al, 2012; Hampson & Rovet, 2015; Resnick et al, 1986). In addition, in one of the studies (Hampson & Rovet, 2015) the effect was found only when a subgroup of female participants with CAH, deemed to show “questionable neurological status” perhaps related to the consequences of salt-wasting crises, was removed from the analyses. Visuospatial abilities other than mental rotation also have sometimes been found to show no differences for girls and women with CAH compared to controls or to show reduced performance (Baker & Ehrhardt, 1974; Helleday et al, 1994; Hines, 2011; McGuire et al, 1975; Perlman, 1973), although enhanced performance also has sometimes been reported for these measures in females with CAH (Berenbaum et al, 2012; Hampson et al, 1998; Mueller et al, 2008).…”

“…Finally, to investigate whether intellectual deficiency in some CAH patients, hypothetically due to salt-wasting crises, might mask androgen effects (see Hampson & Rovet, 2015), analyses on the spatial and on both quantitative composite scores were rerun after restricting the sample to those with estimated IQs of 70 points or greater (Vocabulary scaled scores of 7 or more), a typical cut off for intellectual disability (Schalock et al, 2007). The pattern of significant findings remained the same for the spatial and first quantitative composite.…”

“…We also sought to replicate our finding of reduced STM (digit span) in patients with CAH, and secondarily hypothesized that such decreases may limit performance on cognitive tasks that relate to STM (Ackerman et al, 2005), including spatial and quantitative tasks. As a control, we also investigated whether general intelligence, as assessed by Vocabulary, varied between groups and whether reduced intelligence, perhaps caused by salt-wasting crises as suggested by Hampson & Rovet (2015), might also influence our findings. Vocabulary, considered to be a measure of crystallized rather than fluid intelligence, does not rely substantially on STM (Hayslip & Kennelly, 1982).…”