Spatial reasoning in children with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

It has been proposed that exposure of the central nervous system to high concentrations of androgens during sensitive periods in early development may facilitate the ability to process spatial information. Most tests of this proposal have been derived from nonhuman species. To test this hypothesis in humans, we evaluated spatial reasoning in preadolescent children with congenital adrenal hyperplasia (CAH), a condition characterized by elevated androgens during gestation. The Primary Mental Abilities (PMA) Spatial Relations test was administered to 12 children with CAH (7 girls, 5 boys) and 10 unaffected sibling controls (6 girls, 4 boys), ranging in age from 8 to 12 years. Results showed a significant interaction between sex and clinical status. Girls with CAH achieved significantly higher spatial scores than control girls, whereas boys with CAH showed significantly lower spatial scores than control boys. On the PMA Perceptual Speed test, given for comparison, girls with CAH scored significantly lower than control girls, producing a double dissociation. The results demonstrate that group differences in spatial proficiency can be detected in preadolescent children with CAH. The findings replicate and extend results reported previously by Resnick, Berenbaum, Gottesman, and Bouchard (1986), and are consistent with an organizing effect of early androgens on brain areas subserving spatial processes.