Demographic and functional aspects may predict behavioral strengths and weaknesses in patients with Duchenne muscular dystrophy (DMD), according to a study recently published by Child Neuropsychology.

“The role of executive function in relation to behavioral strengths and difficulties and age can be of importance to examine more carefully in the future so it can be related to how it interacts and shapes the developmental trajectory and the occurrence of behavioral strengths and difficulties in boys with DMD,” the authors wrote.

Among all variants considered, age showcased the most evident relationship with difficulties. Parents of children aged 11 years reported very high difficulties in 78.9% of the cases, while only 30.8% and 11.1% of the parents of patients aged 9 and 5 years admitted having higher and slightly higher difficulties, respectively. Up to half of the parents noted fewer difficulties in their sons who were aged 14 years.

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A significant variance in the total and impact scores of the Strengths and Difficulties Questionnaire (SDQ) can be attributed to up to 17% and 11.2% of the working memory index, respectively. Likewise, variations in upper motor function along with working memory index corresponded to a 19.7% difference in the SDQ Peer Problems section.

Socioeconomic status played a key role in the SDQ Emotional Problems division, accounting for an 18.9% variability.

This cross-sectional study included 73 patients from Sweden previously diagnosed with DMD at ages 5, 8, 11, and 14 years. The Wechsler scale assessed intelligence according to the age group.

At the same time, the Swedish version of the SDQ parent report addressed behavioral strengths and difficulties, classifying each patient into either close to average, slightly raised, high or low, or very high or low.

Finally, the Hollingshead Four-Factor Index of Social Status with Swedish coding determined the family’s socioeconomic status.

This study demonstrates that besides age, socioeconomic factors, cognition, and motor functioning may predict the behavioral strengths and difficulties in patients with DMD.

“The development of boys with DMD needs to be understood in the context of expected developmental trajectory as well as in the decline of physical functioning,” the authors concluded.


Gillenstrand J, Ekström A, Kroksmark A, Tulinius M, Broberg M. Behavioural strengths and difficulties in relation to intellectual functions and age in Swedish boys with Duchenne muscular dystrophy. Child Neuropsychol. Published online November 28, 2022. doi:10.1080/09297049.2022.2144814