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Protic D, Polli R, Hwang YH, Mendoza G, Hagerman R, Durbin-Johnson B, Hayward BE, Usdin K, Murgia A, Tassone F. Activation Ratio Correlates with IQ in Female Carriers of the FMR1 Premutation. Cells 2023; 12:1711. [PMID: 37443745 PMCID: PMC10341054 DOI: 10.3390/cells12131711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Carriers of the FMR1 premutation (PM) allele are at risk of one or more clinical conditions referred to as FX premutation-associated conditions (FXPAC). Since the FMR1 gene is on the X chromosome, the activation ratio (AR) may impact the risk, age of onset, progression, and severity of these conditions. The aim of this study was to evaluate the reliability of AR measured using different approaches and to investigate potential correlations with clinical outcomes. Molecular and clinical assessments were obtained for 30 PM female participants, and AR was assessed using both Southern blot analysis (AR-Sb) and methylation PCR (AR-mPCR). Higher ARs were associated with lower FMR1 transcript levels for any given repeat length. The higher AR-Sb was significantly associated with performance, verbal, and full-scale IQ scores, confirming previous reports. However, the AR-mPCR was not significantly associated (p > 0.05) with these measures. Similarly, the odds of depression and the number of medical conditions were correlated with higher AR-Sb but not correlated with a higher AR-mPCR. This study suggests that AR-Sb may be a more reliable measure of the AR in female carriers of PM alleles. However, further studies are warranted in a larger sample size to fully evaluate the methylation status in these participants and how it may affect the clinical phenotype.
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Affiliation(s)
- Dragana Protic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Roberta Polli
- Laboratory of Molecular Genetics of Neurodevelopment, Department of Woman and Child Health, University of Padova, 35128 Padova, Italy; (R.P.); (A.M.)
- Fondazione Istituto di Ricerca Pediatrica, Città della Speranza, 35128 Padova, Italy
| | - Ye Hyun Hwang
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, CA 95817, USA; (Y.H.H.); (G.M.)
| | - Guadalupe Mendoza
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, CA 95817, USA; (Y.H.H.); (G.M.)
| | - Randi Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute UCDH, University of California Davis, Sacramento, CA 95817, USA;
- Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, CA 95817, USA
| | - Blythe Durbin-Johnson
- Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, CA 95616, USA;
| | - Bruce E. Hayward
- Laboratory of Cell and Molecular Biology, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA; (B.E.H.); (K.U.)
| | - Karen Usdin
- Laboratory of Cell and Molecular Biology, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA; (B.E.H.); (K.U.)
| | - Alessandra Murgia
- Laboratory of Molecular Genetics of Neurodevelopment, Department of Woman and Child Health, University of Padova, 35128 Padova, Italy; (R.P.); (A.M.)
- Fondazione Istituto di Ricerca Pediatrica, Città della Speranza, 35128 Padova, Italy
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, CA 95817, USA; (Y.H.H.); (G.M.)
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute UCDH, University of California Davis, Sacramento, CA 95817, USA;
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2
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Shaffer RC, Reisinger DL, Schmitt LM, Lamy M, Dominick KC, Smith EG, Coffman MC, Esbensen AJ. Systematic Review: Emotion Dysregulation in Syndromic Causes of Intellectual and Developmental Disabilities. J Am Acad Child Adolesc Psychiatry 2023; 62:518-557. [PMID: 36007813 DOI: 10.1016/j.jaac.2022.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 06/03/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To summarize the current state of the literature regarding emotion dysregulation (ED) in syndromic intellectual disabilities (S-IDs) in 6 of the most common forms of S-IDs-Down syndrome, fragile X syndrome (FXS), tuberous sclerosis complex, Williams syndrome, Prader-Willi syndrome, and Angelman syndrome-and to determine future research directions for identification and treatment of ED. METHOD PubMed bibliographic database was searched from date of inception to May 2021. PRISMA 2020 guidelines were followed with the flowchart, table of included studies, list of excluded studies, and checklist provided. Filters applied included human research and English. Only original research articles were included in the final set, but review articles were used to identify secondary citations of primary studies. All articles were reviewed for appropriateness by 2 authors and summarized. Inclusion criteria were met by 145 articles (Down syndrome = 29, FXS = 55, tuberous sclerosis complex = 11, Williams syndrome = 18, Prader-Willi syndrome = 24, Angelman syndrome = 8). RESULTS Each syndrome review was summarized separately and further subdivided into articles related to underlying neurobiology, behaviors associated with ED, assessment, and targeted intervention. FXS had the most thorough research base, followed by Down syndrome and Prader-Willi syndrome, with the other syndromes having more limited available research. Very limited research was available regarding intervention for all disorders except FXS. CONCLUSION Core underlying characteristics of S-IDs appear to place youth at higher risk for ED, but further research is needed to better assess and treat ED in S-IDs. Future studies should have a standard assessment measure of ED, such as the Emotion Dysregulation Inventory, and explore adapting established curricula for ED from the neurotypical and autism spectrum disorder fields.
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Affiliation(s)
- Rebecca C Shaffer
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati School of Medicine, Cincinnati, Ohio.
| | | | - Lauren M Schmitt
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Martine Lamy
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Kelli C Dominick
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Elizabeth G Smith
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati School of Medicine, Cincinnati, Ohio
| | | | - Anna J Esbensen
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati School of Medicine, Cincinnati, Ohio
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Poteet B, Ali N, Bellcross C, Sherman SL, Espinel W, Hipp H, Allen EG. The diagnostic experience of women with fragile X-associated primary ovarian insufficiency (FXPOI). J Assist Reprod Genet 2023; 40:179-190. [PMID: 36447079 PMCID: PMC9840735 DOI: 10.1007/s10815-022-02671-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE The fragile X premutation occurs when there are 55-200 CGG repeats in the 5' UTR of the FMR1 gene. An estimated 1 in 148 women carry a premutation, with 20-30% of these individuals at risk for fragile X-associated primary ovarian insufficiency (FXPOI). Diagnostic experiences of FXPOI have not previously been included in the literature, limiting insight on experiences surrounding the diagnosis. This study identifies barriers and facilitators to receiving a FXPOI diagnosis and follow-up care, which can inform care and possibly improve quality of life. METHODS We conducted qualitative interviews with 24 women with FXPOI exploring how FMR1 screening, physician education, and supportive care impacted their experience. Three subgroups were compared: women diagnosed through family history who have biological children, women diagnosed through family history who do not have biological children, and women diagnosed through symptoms of POI. RESULTS Themes from interviews included hopes for broader clinician awareness of FXPOI, clear guidelines for clinical treatment, and proper fertility workups to expand reproductive options prior to POI onset. Participants also spoke of difficulty finding centralized sources of care. CONCLUSIONS Our results indicate a lack of optimal care of women with a premutation particularly with respect to FMR1 screening for molecular diagnosis, short- and long-term centralized treatment, and clinical and emotional support. The creation of a "FXPOI health navigator" could serve as a centralized resource for the premutation patient population, assisting in connection to optimal treatment and appropriate referrals, including genetic counseling, mental health resources, advocacy organizations, and better-informed physicians.
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Affiliation(s)
- Bonnie Poteet
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
- Northside Hospital Cancer Institute, Atlanta, GA, USA
| | - Nadia Ali
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Cecelia Bellcross
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie L Sherman
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Whitney Espinel
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Heather Hipp
- Division of Reproductive Endocrinology and Infertility, Emory University School of Medicine, Atlanta, GA, USA
| | - Emily G Allen
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA.
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4
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Potter SN, Bullard L, Banasik A, Feigles RT, Nguyen V, McDuffie A, Thurman AJ, Hagerman R, Abbeduto L. Family and Caregiver Characteristics Contribute to Caregiver Change in Use of Strategies and Growth in Child Spoken Language in a Parent-Implemented Language Intervention in Fragile X Syndrome. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2022; 7:1630-1644. [PMID: 36778100 PMCID: PMC9910303 DOI: 10.1044/2022_persp-22-00016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Purpose This study examined relationships among family characteristics, caregiver change in use of strategies, and child growth in spoken language over the course of a parent-implemented language intervention (PILI) that was developed to address some of the challenges associated with the fragile X syndrome (FXS) phenotype. Method Participants were 43 parent-child dyads from two different PILI studies, both of which taught parents various language facilitation strategies to support child language. Before starting the intervention, parents reported on their mental health, parenting stress, and parenting competence. This study focused on potential barriers to treatment gains by examining correlations between the measures of parent well-being and (a) parent change in use of intervention strategies taught in the PILI and (b) changes in child language outcomes from preto post-intervention. Results Parents in this study had elevated mental health symptoms across several domains and increased rates of parenting stress. Furthermore, although PILI resulted in treatment gains for both parents and children, a variety of parent mental health symptoms were found to be significantly and negatively associated with change in use of strategies and growth in child language over the course of the intervention. Some inconsistent findings also emerged regarding the relationships between parenting stress and competence and change in parent strategy use and growth in child language. Conclusions This study provides preliminary evidence that parents who are experiencing significant mental health challenges may have a more difficult time participating fully in PILIs and that there may be subsequent effects on child outcomes. Future PILIs could benefit from addressing parent well-being as a substantial part of the intervention program.
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Affiliation(s)
- Sarah Nelson Potter
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
| | - Lauren Bullard
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
| | - Amy Banasik
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
| | - Robyn Tempero Feigles
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
| | - Vivian Nguyen
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
| | - Andrea McDuffie
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
| | - Angela John Thurman
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
| | - Randi Hagerman
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Pediatrics, UC Davis Health, Sacramento, CA
| | - Leonard Abbeduto
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
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5
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Behavior Problems and Social Competence in Fragile X Syndrome: A Systematic Review. Genes (Basel) 2022; 13:genes13020280. [PMID: 35205326 PMCID: PMC8871871 DOI: 10.3390/genes13020280] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 02/06/2023] Open
Abstract
Fragile X syndrome (FXS) causes intellectual disability and is the known leading cause of autism. Common problems in FXS include behavior and social problems. Along with syndromic characteristics and autism comorbidity, environmental factors might influence these difficulties. This systematic review focuses on the last 20 years of studies concerning behavior and social problems in FXS, considering environmental and personal variables that might influence both problems. Three databases were reviewed, leading to fifty-one studies meeting the inclusion criteria. Attention deficit hyperactivity disorder (ADHD) problems remain the greatest behavior problems, with behavioral problems and social competence being stable during the 20 years. Some developmental trajectories might have changed due to higher methodological control, such as aggressive behavior and attention problems. The socialization trajectory from childhood to adolescence remains unclear. Comorbidity with autism in individuals with FXS increased behavior problems and worsened social competence profiles. At the same time, comparisons between individuals with comorbid FXS and autism and individuals with autism might help define the comorbid phenotype. Environmental factors and parental characteristics influenced behavior problems and social competence. Higher methodological control is needed in studies including autism symptomatology and parental characteristics. More studies comparing autism in FXS with idiopathic autism are needed to discern differences between conditions.
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6
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Potter SN, Harvey DJ, Sterling A, Abbeduto L. Mental Health Challenges, Parenting Stress, and Features of the Couple Relationship in Parents of Children With Fragile X Syndrome. Front Psychiatry 2022; 13:857633. [PMID: 35432025 PMCID: PMC9012337 DOI: 10.3389/fpsyt.2022.857633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Individuals with fragile X syndrome (FXS) have significant delays in cognition and language, as well as anxiety, symptoms of autism spectrum disorder, and challenging behaviors such as hyperactivity and aggression. Biological mothers of children with FXS, who are themselves FMR1 premutation or full mutation carriers, are at elevated risk for mental health challenges in addition to experiencing stress associated with parenting a child with significant disabilities. However, little is known about fathers in these families, including the ways in which parental well-being influences the mother-father relationship and the impact of child characteristics on paternal and couple functioning. METHOD The current study examined features of, and relationships between, parental well-being, couple well-being, and child functioning in 23 families of young boys with FXS. Mothers and fathers independently completed multiple questionnaires about their individual well-being, couple functioning, and child behavior. One parent per family also completed an interview about the child's adaptive skills. RESULTS Results suggest that both mothers and fathers in these families experience clinically significant levels of mental health challenges and elevated rates of parenting stress relative to the general population. Findings also indicate that the couples' relationship may be a source of strength that potentially buffers against some of the daily stressors faced by these families. Additionally, parents who reported less parenting stress had higher couples satisfaction and dyadic coping. Finally, parents of children with less severe challenging behaviors exhibited fewer mental health challenges, less parenting stress, and higher levels of both couples satisfaction and dyadic coping. Parents of children with higher levels of adaptive behavior also reported less parenting stress and higher couples satisfaction. CONCLUSION Overall, this study provides evidence that families of children with FXS need access to services that not only target improvements in the child's functioning, but also ameliorate parental stress. Family-based services that include both mothers and fathers would lead to better outcomes for all family members.
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Affiliation(s)
- Sarah Nelson Potter
- MIND Institute, UC Davis Health, Sacramento, CA, United States.,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA, United States
| | - Danielle J Harvey
- Department of Public Health Sciences, UC Davis Health, Sacramento, CA, United States
| | - Audra Sterling
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States.,Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, United States
| | - Leonard Abbeduto
- MIND Institute, UC Davis Health, Sacramento, CA, United States.,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA, United States
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7
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Moser C, Mattie L, Abbeduto L, Klusek J. The FMR1 Premutation Phenotype and Mother-Youth Synchrony in Fragile X Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:443-459. [PMID: 34700350 PMCID: PMC8555425 DOI: 10.1352/1944-7558-126.6.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 01/12/2021] [Indexed: 06/13/2023]
Abstract
A subset of mothers who carry the FMR1 premutation may express a unique phenotype. The relationship between the FMR1 phenotype and mother-child interaction in families with fragile X-associated disorders has not been well characterized, despite the importance of high-quality mother-child interaction for child development. This study examined the association between the FMR1 phenotype and the quality of interactions between mothers and their adolescent/young adult sons with fragile X syndrome. Mother-youth synchrony was coded from a dyadic interaction. Maternal anxiety and depression symptoms, executive function deficits, and pragmatic language difficulties were evaluated. Results indicated that pragmatic language was associated with mother-youth synchrony. These findings highlight the importance of family-centered intervention practices for families with fragile X-associated disorders.
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Affiliation(s)
- Carly Moser
- University of South Carolina, Columbia, South Carolina, 29208, USA
| | - Laura Mattie
- University of Illinois, Champaign, Illinois, 61820, USA
| | | | - Jessica Klusek
- University of South Carolina, Columbia, South Carolina, 29208, USA
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8
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Allen EG, Charen K, Hipp HS, Shubeck L, Amin A, He W, Hunter JE, Shelly KE, Sherman SL. Predictors of Comorbid Conditions in Women Who Carry an FMR1 Premutation. Front Psychiatry 2021; 12:715922. [PMID: 34658954 PMCID: PMC8517131 DOI: 10.3389/fpsyt.2021.715922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/06/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose: Women who carry an FMR1 premutation (PM) can experience two well-established PM-associated disorders: fragile X-associated primary ovarian insufficiency (FXPOI, affects ~20-30% carriers) and fragile X-associated tremor-ataxia syndrome (FXTAS, affects ~6-15% carriers); however, emerging evidence indicates that some of these women experience complex health profiles beyond FXPOI and FXTAS. Methods: In an effort to better understand predictors for these comorbid conditions, we collected self-reported medical histories on 413 women who carry an FMR1 PM. Results: There were 22 health conditions reported by at least 9% of women. In an exploratory analysis, 12 variables were tested in logistic regression models for each comorbid condition, including demographic variables, environmental variables, PM-associated factors, and endorsement of depression and/or anxiety. More than half of the comorbid conditions studied were associated with women who self-reported having anxiety. Age, smoking, body mass index (BMI), and depression were also significant predictor variables for specific comorbid conditions. Conclusions: Age, smoking, and BMI were significantly associated with a subset of the comorbid conditions analyzed. Importantly, depression or anxiety were also significantly associated with many of the comorbid health conditions. This work highlights some of the modifiable factors associated with complex health profiles among women with an FMR1 PM.
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Affiliation(s)
- Emily Graves Allen
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States
| | - Krista Charen
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States
| | - Heather S. Hipp
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Lisa Shubeck
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States
| | - Ashima Amin
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States
| | - Weiya He
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States
| | - Jessica Ezzell Hunter
- Genomics, Ethics, and Translational Research Program, RTI International, Triangle Park, NC, United States
| | - Katharine E. Shelly
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States
| | - Stephanie L. Sherman
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States
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Waldrop J, Baker M, Salomon R, Moreton E. Parenting Interventions and Secondary Outcomes Related to Maternal Mental Health: A Systematic Review. Matern Child Health J 2021; 25:870-880. [PMID: 33905064 PMCID: PMC10916505 DOI: 10.1007/s10995-021-03130-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Perinatal mood and anxiety disorders can have far reaching negative impact on both maternal mental health and child growth and development. Multimodal group parenting programs have been shown to improve maternal mental health symptoms however, they are often costly to provide and not accessible to many mothers, especially those mothers suffering from mental health symptoms. Therefore, the authors sought to answer the following question by undertaking a systematic review of the literature: are parenting interventions aimed at improving maternal-child interaction also a way to address mental health symptoms (i.e. depression, anxiety, stress) in mothers? METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. An online platform that supports the systematic review process and quality assessment according to Cochrane guidelines, Covidence, was used in conjunction with an adapted extraction tool to identify relevant studies and extract data for analysis. RESULTS 11 articles were included in the qualitative synthesis. There was great heterogeneity between study interventions and measurement of outcomes for maternal mental health symptoms which precluded meta-analysis. CONCLUSION Studies reviewed did not demonstrate consistent evidence to recommend that parenting interventions leads to improvement in maternal mental health symptoms for depression, anxiety or stress. However, there was evidence that participating in parenting programs does not worsen these symptoms and some encouraging evidence that alternative delivery methods, beyond face to face, could, with more research, lead to more financially feasible and sustainable models of delivery of these types of interventions in the future.
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Affiliation(s)
- Julee Waldrop
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Maureen Baker
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca Salomon
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth Moreton
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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10
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Bizzego A, Lim M, Schiavon G, Setoh P, Gabrieli G, Dimitriou D, Esposito G. Child disability and caregiving in low and middle income countries: Big data approach on open data. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 107:103795. [PMID: 33142260 DOI: 10.1016/j.ridd.2020.103795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 09/28/2020] [Accepted: 10/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The presence of child disabilities might affect the amount of caregiving attention the child receives, with potential ramifications on the development of the child and increasing the likelihood of developing a more severe condition. Little is known about the association between child disabilities and caregiving practices in less developed countries, penalized by both lack of data and a research bias toward western societies. METHOD In this study, we apply data mining methods on a large (N = 29,525) dataset from UNICEF to investigate the association between caregiving practices and developmental disabilities of the children, and highlight the differences between intellectual and other disabilities. RESULTS Our results highlight that, compared to other types of disabilities, intellectual disabilities increased the risk of being neglected by the caregiver in those activities oriented to the cognitive development. The education of the caregiver and the socioeconomical development of the country are actively involved in the moderation of the risk. CONCLUSION We demonstrated that educational policies of parental training, such as psychoeducation regarding intellectual disabilities and destigmatization campaigns, are needed to benefit parental practices in low- and middle-income countries.
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Affiliation(s)
- Andrea Bizzego
- Department of Psychology and Cognitive Science, University of Trento, Italy
| | - Mengyu Lim
- School of Social Sciences, Nanyang Technological University, Singapore
| | - Greta Schiavon
- Department of Psychology and Cognitive Science, University of Trento, Italy
| | - Peipei Setoh
- School of Social Sciences, Nanyang Technological University, Singapore
| | - Giulio Gabrieli
- School of Social Sciences, Nanyang Technological University, Singapore
| | - Dagmara Dimitriou
- UCL Institute of Education, University College London, London, United Kingdom
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, Italy; School of Social Sciences, Nanyang Technological University, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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11
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Bizzego A, Lim M, Schiavon G, Esposito G. Children with Developmental Disabilities in Low- and Middle-Income Countries: More Neglected and Physically Punished. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7009. [PMID: 32992729 PMCID: PMC7579206 DOI: 10.3390/ijerph17197009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022]
Abstract
Little is known about parenting in the context of developmental disabilities in low- and middle-income countries (LMIC), penalized by both lack of data and a research bias toward western societies. In this study, we apply data mining methods on a large (N = 25,048) dataset from UNICEF to highlight patterns of association between developmental disabilities of children and parental involvement. We focus on the co-presence of multiple disabilities and the quality of childcare in three parenting domains: discipline, caregiving, and education. Our results show that, in LMIC, children with more severe developmental conditions are also more likely to receive low-quality parental care. Specific policies of parental training are needed to improve parental practices in LMIC.
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Affiliation(s)
- Andrea Bizzego
- Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy; (A.B.); (G.S.)
| | - Mengyu Lim
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore 636921, Singapore;
| | - Greta Schiavon
- Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy; (A.B.); (G.S.)
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy; (A.B.); (G.S.)
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore 636921, Singapore;
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 636921, Singapore
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12
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Hunter JE, Jenkins CL, Grim V, Leung S, Charen KH, Hamilton DR, Allen EG, Sherman SL. Feasibility of an app-based mindfulness intervention among women with an FMR1 premutation experiencing maternal stress. RESEARCH IN DEVELOPMENTAL DISABILITIES 2019; 89:76-82. [PMID: 30959430 DOI: 10.1016/j.ridd.2019.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/23/2019] [Accepted: 03/20/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Women who carry an FMR1 premutation (PM) allele and are mothers of children with fragile X syndrome (FXS) experience elevated maternal stress. In-person mindfulness sessions have been shown to be effective in alleviating maternal stress-related outcomes among mothers of children with intellectual and developmental disabilities. Our prior studies indicate women with a PM are at risk of social anxiety, a potential barrier to in-person mindfulness sessions. AIM The main goals of this pilot study were to assess feasibility and adherence of an app-based mindfulness training program among mothers of children with FXS and to explore stress, social outcomes, and potential barriers to social support. METHODS Participants (n = 18) completed questionnaires to assess stress and social anxiety, an app-based mindfulness program, and a semi-structured follow-up interview. RESULTS Thirteen out of 18 (72%) participants completed the mindfulness program; of those, 10 (77%) found it helpful. Eight out of 18 (44%) participants met criteria for social anxiety and 11 (61%) reported having difficulties reaching out for help when needed. Women with social anxiety and those experiencing barriers to social support were more likely to find the program helpful. CONCLUSIONS This study provides guidance for future mindfulness-based interventions to alleviate maternal stress in mothers of children with FXS.
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Affiliation(s)
- Jessica Ezzell Hunter
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, 97227, United States.
| | - Charisma L Jenkins
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, 97227, United States
| | - Valerie Grim
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, 97227, United States
| | - Sue Leung
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, 97227, United States
| | - Krista H Charen
- Department of Human Genetics, Emory University, Atlanta, GA, 30322, United States
| | - Debra R Hamilton
- Department of Human Genetics, Emory University, Atlanta, GA, 30322, United States
| | - Emily G Allen
- Department of Human Genetics, Emory University, Atlanta, GA, 30322, United States
| | - Stephanie L Sherman
- Department of Human Genetics, Emory University, Atlanta, GA, 30322, United States
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Del Hoyo Soriano L, Thurman AJ, Harvey DJ, Ted Brown W, Abbeduto L. Genetic and maternal predictors of cognitive and behavioral trajectories in females with fragile X syndrome. J Neurodev Disord 2018; 10:22. [PMID: 29925305 PMCID: PMC6011256 DOI: 10.1186/s11689-018-9240-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/11/2018] [Indexed: 02/02/2023] Open
Abstract
Background Fragile X syndrome (FXS) is caused by a mutation in the FMR1 gene on the X chromosome, leading to decreased levels of FMR1 protein (FMRP), which causes the array of neuropsychological impairments that define FXS. Because FXS is an X-linked condition, fewer females display FXS and females with FXS are more mildly affected than males, on average. However, there is a considerable variability in terms of severity of affectedness among females with FXS. The current study was designed to investigate potential genetic (FMRP level and ratio of affected to total chromosomes) and environmental factors (maternal psychological distress and closeness in the mother–child relationship) influencing the cognitive (fluid and crystallized intelligence) and behavioral (anxiety and withdrawal) phenotype of females with FXS. Methods We conducted a prospective 3-year longitudinal study of 16 females with FXS (with up to four assessments, each separated by a year) using an accelerated longitudinal design so that we had coverage of the age range of 10–15 years at study start and 13–18 at study end. We focused on both the level of functioning related to chronological age expectations (standard scores) and absolute change in skill (raw scores) over the 3-year period. Results At a cross-sectional level, fluid intelligence and crystallized intelligence were both predicted by a closer mother–child relationship and lower maternal psychological distress. However, only fluid intelligence was predicted by a lower ratio of affected to total chromosomes. Anxiety and withdrawal were predicted by a higher ratio of affected to total chromosomes. Withdrawal was also predicted by lower closeness in the mother–child relationship and higher maternal distress. In terms of longitudinal change, gains were observed in fluid and crystallized intelligence, whereas anxious and withdrawn behaviors remained stable over visits. Gains in fluid intelligence were solely predicted by FXS biomarkers (higher FMRP level and lower ratio of affected to total chromosomes), while gains in crystallized intelligence were not predicted by any of the biological and environmental variables. Conclusions Our results show that FXS biomarkers and maternal variables contribute differentially to the cognitive and behavioral features of the adolescent female with FXS. These findings can help in the design of treatment studies aimed at enhancing cognitive and behavioral abilities in the FXS population.
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Affiliation(s)
- Laura Del Hoyo Soriano
- MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA. .,Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, USA.
| | - Angela John Thurman
- MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA.,Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, USA
| | - Danielle Jenine Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - W Ted Brown
- NY Institute for Basic Research on Developmental Disabilities, Staten Island, NY, USA
| | - Leonard Abbeduto
- MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA.,Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, USA
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Qian X. Differences in teachers verbal responsiveness to groups of children with ASD who vary in cognitive and language abilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:557-568. [PMID: 29732730 DOI: 10.1111/jir.12495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/16/2018] [Accepted: 04/01/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND This study aimed to examine whether verbal responsiveness in special education teachers varied among subgroups of children with autism spectrum disorder (n = 112) who differed in cognitive and language abilities. METHODS Participants were divided into clusters using cluster analysis based on standardised cognitive and language tests using k-mean clustering. For each child, a 15-min video of free play in school setting was collected. Three types of responsive utterances were coded: follow-in directives for behaviour, follow-in directives for language and follow-in comments. RESULTS Results showed that the three groups did not differ in overall verbal responsiveness after controlling for engagement, classroom type, age and gender. However, groups differ in follow-in directives for language, but not in follow-in directives for behaviours or follow-in comments. Compared with children with autism spectrum disorder who had higher cognitive and language ability, children with more severe impairments received fewer follow-in directives for language. Moreover, children with more cognitive and language impairments produced fewer amount of vocal/verbal acts, which results in receiving fewer verbal responses from their teachers. Additionally, teachers from the three groups did not differ in their responses to the child's verbal/vocal acts when the number of the child's verbal/vocal acts were controlled for. CONCLUSION Findings suggest child characteristics are related to the type of teachers' verbal responses in preschools. This difference in follow-in directives for questions may be related to language or other outcomes that warrant further investigations.
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Affiliation(s)
- X Qian
- Institute on Community Integration, University of Minnesota, Minneapolis, MN, USA
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15
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Beeber LS, Meltzer-Brody S, Martinez M, Matsuda Y, Wheeler AC, Mandel M, LaForett D, Waldrop J. Recognizing Maternal Depressive Symptoms: An Opportunity to Improve Outcomes in Early Intervention Programs. Matern Child Health J 2018; 21:883-892. [PMID: 27730388 DOI: 10.1007/s10995-016-2189-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective A higher rate of depressive symptoms is found among mothers of children with disabilities compared to other parents. However, there is a lack of study of mothers with children <3 years of age participating in Early Intervention (EI) programs. This study aims to more fully describe the extent of mood disorders in these mothers including estimated prevalence, severity and factors associated with maternal mental health, using gold standard clinical diagnostic and symptom measures, and test models associating depressive symptoms with contextual factors and child behavior. Methods A cross-sectional study was conducted with 106 women who had at least one child enrolled in EI. Mothers were interviewed and completed reliable, valid measures to evaluate mental health, health status, family conflict, parent-child interaction, self-efficacy, social support, child behavioral problems, hardship, endangerment, and child disability. Descriptive statistics and multivariate analyses were performed. Results We found 8 % of participants met all criteria for a Major Depressive Episode (MDE) with 44 % of the sample reporting a past episode and 43 % endorsing recurrent episodes. Using the CES-D to assess depressive symptom severity approximately 34 % of mothers screened in a clinically significant range. Using linear regression to predict severity of current depressive symptoms demonstrated that current depression severity was primarily predicted by poorer maternal health status, lower self-efficacy and past MDE (p < 0.05). Conclusions for practice A brief assessment of maternal mood, health and self-efficacy are important factors to assess when evaluating how to support mothers of children in EI.
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Affiliation(s)
- Linda S Beeber
- University of North Carolina at Chapel Hill School of Nursing, CB 7460, Chapel Hill, NC, 27599-7460, USA.
| | - Samantha Meltzer-Brody
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, 27599, USA
| | - Maria Martinez
- University of North Carolina at Chapel Hill Cecil G. Sheps Center, Chapel Hill, NC, 27599, USA
| | - Yui Matsuda
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, 33124, USA
| | - Anne C Wheeler
- RTI International, Research Triangle Park, Durham, NC, 27709-2194, USA
| | - Marcia Mandel
- N.C. Department of Health and Human Services, Children's Developmental Services Agency Director, Durham Children's Developmental Services Agency, Early Intervention Branch, Durham, NC, 27701, USA
| | - Dore LaForett
- University of North Carolina at Chapel Hill Frank Porter Graham Child Development Institute, Chapel Hill, NC, 27599, USA
| | - Julee Waldrop
- University of North Carolina at Chapel Hill School of Nursing, CB 7460, Chapel Hill, NC, 27599-7460, USA
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16
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Wheeler A, Raspa M, Hagerman R, Mailick M, Riley C. Implications of the FMR1 Premutation for Children, Adolescents, Adults, and Their Families. Pediatrics 2017; 139:S172-S182. [PMID: 28814538 PMCID: PMC5621635 DOI: 10.1542/peds.2016-1159d] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Given the nature of FMR1 gene expansions, most biological mothers, and often multiple other family members of children with fragile X syndrome (FXS), will have a premutation, which may increase individual and family vulnerabilities. This article summarizes important gaps in knowledge and notes potential implications for pediatric providers with regard to developmental and medical risks for children and adolescents with an FMR1 premutation, including possible implications into adulthood. METHODS A structured electronic literature search was conducted on FMR1 pre- and full mutations, yielding a total of 306 articles examined. Of these, 116 focused primarily on the premutation and are included in this review. RESULTS Based on the literature review, 5 topic areas are discussed: genetics and epidemiology; phenotypic characteristics of individuals with the premutation; implications for carrier parents of children with FXS; implications for the extended family; and implications for pediatricians. CONCLUSIONS Although the premutation phenotype is typically less severe in clinical presentation than in FXS, premutation carriers are much more common and are therefore more likely to be seen in a typical pediatric practice. In addition, there is a wide range of medical, cognitive/developmental, and psychiatric associated features that individuals with a premutation are at increased risk for having, which underscores the importance of awareness on the part of pediatricians in identifying and monitoring premutation carriers and recognizing the impact this identification may have on family members.
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Affiliation(s)
- Anne Wheeler
- RTI International, Research Triangle Park, North Carolina;
| | - Melissa Raspa
- RTI International, Research Triangle Park, North Carolina
| | - Randi Hagerman
- MIND Institute, University of California at Davis, Sacramento, California
| | - Marsha Mailick
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin; and
| | - Catharine Riley
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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17
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Abstract
OBJECTIVES The purpose of this systematic literature review is to describe what is known about fragile X syndrome (FXS) and to identify research gaps. The results can be used to help inform future public health research and provide pediatricians with up-to-date information about the implications of the condition for individuals and their families. METHODS An electronic literature search was conducted, guided by a variety of key words. The search focused on 4 areas of both clinical and public health importance: (1) the full mutation phenotype, (2) developmental trajectories across the life span, (3) available interventions and treatments, and (4) impact on the family. A total of 661 articles were examined and 203 were included in the review. RESULTS The information is presented in the following categories: developmental profile (cognition, language, functional skills, and transition to adulthood), social-emotional profile (cooccurring psychiatric conditions and behavior problems), medical profile (physical features, seizures, sleep, health problems, and physiologic features), treatment and interventions (educational/behavioral, allied health services, and pharmacologic), and impact on the family (family environment and financial impact). Research gaps also are presented. CONCLUSIONS The identification and treatment of FXS remains an important public health and clinical concern. The information presented in this article provides a more robust understanding of FXS and the impact of this complex condition for pediatricians. Despite a wealth of information about the condition, much work remains to fully support affected individuals and their families.
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Affiliation(s)
- Melissa Raspa
- RTI International, Research Triangle Park, North Carolina; and
| | - Anne C Wheeler
- RTI International, Research Triangle Park, North Carolina; and
| | - Catharine Riley
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Riley C, Mailick M, Berry-Kravis E, Bolen J. The Future of Fragile X Syndrome: CDC Stakeholder Meeting Summary. Pediatrics 2017; 139:S147-S152. [PMID: 28814536 PMCID: PMC5592737 DOI: 10.1542/peds.2016-1159b] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Catharine Riley
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marsha Mailick
- Waisman Center, University of Wisconsin, Madison, Wisconsin
| | - Elizabeth Berry-Kravis
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois,Department of Biochemistry, Rush University Medical Center, Chicago, Illinois
| | - Julie Bolen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia;
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19
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Gilkerson J, Richards JA, Warren SF, Montgomery JK, Greenwood CR, Kimbrough Oller D, Hansen JHL, Paul TD. Mapping the Early Language Environment Using All-Day Recordings and Automated Analysis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:248-265. [PMID: 28418456 PMCID: PMC6195063 DOI: 10.1044/2016_ajslp-15-0169] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 04/05/2016] [Accepted: 10/31/2016] [Indexed: 05/24/2023]
Abstract
PURPOSE This research provided a first-generation standardization of automated language environment estimates, validated these estimates against standard language assessments, and extended on previous research reporting language behavior differences across socioeconomic groups. METHOD Typically developing children between 2 to 48 months of age completed monthly, daylong recordings in their natural language environments over a span of approximately 6-38 months. The resulting data set contained 3,213 12-hr recordings automatically analyzed by using the Language Environment Analysis (LENA) System to generate estimates of (a) the number of adult words in the child's environment, (b) the amount of caregiver-child interaction, and (c) the frequency of child vocal output. RESULTS Child vocalization frequency and turn-taking increased with age, whereas adult word counts were age independent after early infancy. Child vocalization and conversational turn estimates predicted 7%-16% of the variance observed in child language assessment scores. Lower socioeconomic status (SES) children produced fewer vocalizations, engaged in fewer adult-child interactions, and were exposed to fewer daily adult words compared with their higher socioeconomic status peers, but within-group variability was high. CONCLUSIONS The results offer new insight into the landscape of the early language environment, with clinical implications for identification of children at-risk for impoverished language environments.
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Affiliation(s)
| | | | | | - Judith K. Montgomery
- Department of Communication Sciences and Disorders, Chapman University, Orange, CA
| | | | - D. Kimbrough Oller
- School of Communication Sciences and Disorders and Institute for Intelligent Systems, University of Memphis, TN
- Konrad Lorenz Institute for Evolution and Cognition Research, Klosterneuburg, Austria
| | - John H. L. Hansen
- School of Engineering and Computer Science, University of Texas at Dallas
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20
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Klusek J, LaFauci G, Adayev T, Brown WT, Tassone F, Roberts JE. Reduced vagal tone in women with the FMR1 premutation is associated with FMR1 mRNA but not depression or anxiety. J Neurodev Disord 2017; 9:16. [PMID: 28469730 PMCID: PMC5414146 DOI: 10.1186/s11689-017-9197-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 04/21/2017] [Indexed: 12/12/2022] Open
Abstract
Background Autonomic dysfunction is implicated in a range of psychological conditions, including depression and anxiety. The fragile X mental retardation-1 (FMR1) premutation is a common genetic mutation that affects ~1:150 women and is associated with psychological vulnerability. This study examined cardiac indicators of autonomic function among women with the FMR1 premutation and control women as potential biomarkers for psychological risk that may be linked to FMR1. Methods Baseline inter-beat interval and respiratory sinus arrhythmia (a measure of parasympathetic vagal tone) were measured in 35 women with the FMR1 premutation and 28 controls. The women completed anxiety and depression questionnaires. FMR1 genetic indices (i.e., CGG repeat, quantitative FMRP, FMR1 mRNA, activation ratio) were obtained for the premutation group. Results Respiratory sinus arrhythmia was reduced in the FMR1 premutation group relative to controls. While depression symptoms were associated with reduced respiratory sinus arrhythmia among control women, these variables were unrelated in the FMR1 premutation. Elevated FMR1 mRNA was associated with higher respiratory sinus arrhythmia. Conclusions Women with the FMR1 premutation demonstrated autonomic dysregulation characterized by reduced vagal tone. Unlike patterns observed in the general population and in study controls, vagal activity and depression symptoms were decoupled in women with the FMR1 premutation, suggesting independence between autonomic regulation and psychopathological symptoms that is atypical and potentially specific to the FMR1 premutation. The association between vagal tone and mRNA suggests that molecular variation associated with FMR1 plays a role in autonomic regulation.
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Affiliation(s)
- Jessica Klusek
- Department of Communication Sciences and Disorders, University of South Carolina, Keenan Building, Suite 300, Columbia, SC 29208 USA
| | - Giuseppe LaFauci
- Department of Developmental Biochemistry, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island, NY 10314 USA
| | - Tatyana Adayev
- Department of Developmental Biochemistry, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island, NY 10314 USA
| | - W Ted Brown
- Department of Human Genetics, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island, NY 10314 USA
| | - Flora Tassone
- UC Davis MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817 USA
| | - Jane E Roberts
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, SC 29208 USA
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21
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Gossett A, Sansone S, Schneider A, Johnston C, Hagerman R, Tassone F, Rivera SM, Seritan AL, Hessl D. Psychiatric disorders among women with the fragile X premutation without children affected by fragile X syndrome. Am J Med Genet B Neuropsychiatr Genet 2016; 171:1139-1147. [PMID: 27615674 PMCID: PMC6907071 DOI: 10.1002/ajmg.b.32496] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/19/2016] [Indexed: 11/07/2022]
Abstract
Several studies have demonstrated increased rates of anxiety and depressive disorders among female carriers of the fragile X premutation. However, the majority of these studies focused on mothers of children with fragile X syndrome, who experience higher rates of parenting stress that may contribute to the emergence of these disorders. The present study compared psychiatric symptom presentation (utilizing measures of current symptoms and lifetime DSM-IV Axis I disorders) in 24 female carriers without affected children (mean age = 32.1 years) to 26 non-carrier women from the community (mean age = 30.5 years). We also examined the association between CGG repeat size (adjusted for X activation ratio) and mRNA, with severity of psychiatric symptoms. Women with the premutation reported significantly elevated symptoms of anxiety, depression, interpersonal sensitivity, obsessive-compulsiveness, and somatization relative to controls during the past week. Carriers had significantly higher rates of lifetime social phobia (42.3%) compared to controls (12.5%); however, this comparison did not remain significant after multiple comparison adjustment. Rates of other psychiatric disorders were not significantly elevated relative to controls, though it should be noted that lifetime rates among controls were much higher than previously published population estimates. Although the sample is relatively small, the study of this unique cohort suggests the premutation confers risk for mood and anxiety disorders independent of the stress of parenting children with FXS. Screening for psychiatric disorders in women with the premutation, even before they become parents, is important and highly encouraged. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Amy Gossett
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Psychology, California School of Professional Psychology, Alliant International University, Sacramento, California
| | - Stephanie Sansone
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California
| | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California
| | - Cindy Johnston
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California
| | - Randi Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California
| | - Flora Tassone
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Biochemistry and Molecular Medicine, University of California Davis, Davis, California
| | - Susan M. Rivera
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Psychology, University of California Davis, Davis, California
- Center for Mind and Brain, University of California Davis, Davis, California
| | - Andreea L. Seritan
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California
| | - David Hessl
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California
- Correspondence to: David Hessl, Ph.D., Department of Psychiatry and Behavioral Sciences, MIND Institute, UC Davis, 2825 50th St., Sacramento, CA 95817.
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22
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Raspa M, Sacco P, Candrilli SD, Bishop E, Petrillo J. Validity of a condition specific outcome measure for fragile X syndrome: the Aberrant Behaviour Checklist-utility index. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:844-855. [PMID: 26929037 DOI: 10.1111/jir.12264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 12/07/2015] [Accepted: 01/20/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND The purpose of this study was to assess the construct validity of the Aberrant Behaviour Checklist-utility index (ABC-UI) by examining the relationship between healthcare resource utilisation by patients with fragile X syndrome (FXS) as well as burden experienced by their caregivers. METHOD In 2011, a total of 350 US caregivers of individuals with FXS completed a questionnaire that captured information on FXS-related burden as well as the ABC-Community. Using the ABC-UI, a condition-specific outcome measure derived from the ABC-Community, five utility index categories were created: very low (0.00-0.33); low (0.34-0.66); moderate (0.67-0.77); high (0.78-0.89); and very high (0.90-1.00). Multivariable regression models examined the association between the utility value and nine burden-related outcomes. RESULTS Approximately 2% of individuals with FXS were in the very low utility index category, 31% low, 27% moderate, 38% high and 3% very high. The median utility value was 0.74. Women with FXS and adults 18 years and older had higher values. Regression results indicate that individuals with higher utility values were more likely to have fewer specialist visits, use fewer prescription medications, need fewer hours of unpaid caregiving, inflict fewer caregiver injuries and have caregivers with fewer mental health provider visits. CONCLUSIONS The ABC-UI appears to function well as condition-specific outcome measure, and as an indicator of health-related quality-of-life and economic burden in individuals with FXS. Among patients with FXS in the US and their caregivers, significant differences in health care resource utilisation and burden exist across health state utility categories.
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Affiliation(s)
- M Raspa
- RTI International, Research Triangle Park, Durham, NC, USA
| | - P Sacco
- Novartis Pharmaceuticals, East Hanover, NJ, USA
| | - S D Candrilli
- RTI Health Solutions, Research Triangle Park, Durham, NC, USA
| | - E Bishop
- RTI International, Research Triangle Park, Durham, NC, USA
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23
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Weber CL. Understanding fragile X syndrome from a mother's perspective: Challenges and resilience. Int J Qual Stud Health Well-being 2016; 11:29512. [PMID: 27104339 PMCID: PMC4841094 DOI: 10.3402/qhw.v11.29512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2016] [Indexed: 11/14/2022] Open
Abstract
The purpose of this study is to communicate findings from a case study on a South African mother with three children diagnosed with full mutation fragile X syndrome (FXS). The participant is an unaffected carrier of FXS. Research has shown that mothers of children with FXS often experience high levels of parenting stress and low levels of psychological well-being. However, observations made have piqued curiosity about their positivity and determination to carry on each day raising children diagnosed with FXS. The aim is to develop a better understanding of the manner in which a mother of children with FXS make sense of her situation, to gain further insight into the specific resilience processes she acquired. A qualitative case study approach was followed, gathering data through semi-structured interviews based on open-ended questions. The findings offer new insights into a South African mother's life raising children with FXS. Even though there is very limited support and little awareness of FXS in South Africa, she still found ways to seek help, and find solutions to every day challenges. The study conclusions discourage blind stereotyping of mothers of children with FXS as vulnerable only. Future research should concentrate on promoting awareness, education, advocacy, and support for individuals with FXS in South Africa.
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Affiliation(s)
- Chantel Lynette Weber
- Department of Psychology of Education, University of South Africa, Pretoria, South Africa;
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Klusek J, McGrath SE, Abbeduto L, Roberts JE. Pragmatic Language Features of Mothers With the FMR1 Premutation Are Associated With the Language Outcomes of Adolescents and Young Adults With Fragile X Syndrome. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2016; 59:49-61. [PMID: 26895548 PMCID: PMC4867932 DOI: 10.1044/2015_jslhr-l-15-0102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/26/2015] [Accepted: 07/09/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Pragmatic language difficulties have been documented as part of the FMR1 premutation phenotype, yet the interplay between these features in mothers and the language outcomes of their children with fragile X syndrome is unknown. This study aimed to determine whether pragmatic language difficulties in mothers with the FMR1 premutation are related to the language development of their children. METHOD Twenty-seven mothers with the FMR1 premutation and their adolescent/young adult sons with fragile X syndrome participated. Maternal pragmatic language violations were rated from conversational samples using the Pragmatic Rating Scale (Landa et al., 1992). Children completed standardized assessments of vocabulary, syntax, and reading. RESULTS Maternal pragmatic language difficulties were significantly associated with poorer child receptive vocabulary and expressive syntax skills, with medium effect sizes. CONCLUSIONS This work contributes to knowledge of the FMR1 premutation phenotype and its consequences at the family level, with the goal of identifying modifiable aspects of the child's language-learning environment that may promote the selection of treatments targeting the specific needs of families affected by fragile X. Findings contribute to our understanding of the multifaceted environment in which children with fragile X syndrome learn language and highlight the importance of family-centered intervention practices for this group.
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Guralnick MJ. Early Intervention for Children with Intellectual Disabilities: An Update. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:211-229. [DOI: 10.1111/jar.12233] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Michael J. Guralnick
- Center on Human Development and Disability; University of Washington; Seattle WA USA
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Hudson S, Levickis P, Down K, Nicholls R, Wake M. Maternal responsiveness predicts child language at ages 3 and 4 in a community-based sample of slow-to-talk toddlers. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2015; 50:136-42. [PMID: 25208649 DOI: 10.1111/1460-6984.12129] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 07/16/2014] [Indexed: 05/24/2023]
Abstract
BACKGROUND Maternal responsiveness has been shown to predict child language outcomes in clinical samples of children with language delay and non-representative samples of typically developing children. An effective and timely measure of maternal responsiveness for use at the population level has not yet been established. AIMS To determine whether a global rating of maternal responsiveness at age 2 years predicts language outcomes at ages 3 and 4 in a community sample of slow-to-talk toddlers. METHODS & PROCEDURES In an Australian population-based study, at child age 1:6 years, 301 slow-to-talk toddlers (scoring ≤20th percentile on a parent-reported expressive vocabulary checklist) were invited to take part in a 15-min free-play video of mother-child interaction at 2:0 years. Each free-play video was rated for maternal responsiveness using a five-point global rating scale, where 1 is 'very low' responsiveness and 5 is 'very high' responsiveness. Language skills were measured at 3:0 years using PLS-4 and at 4:0 years using the CELF-P2. OUTCOMES & RESULTS In adjusted linear regression models (potential confounders: gender, maternal education, socioeconomic status) maternal responsiveness strongly predicted receptive, expressive and total language standard scores at ages 3 (coefficient = 5.9, p < 0.001; coefficient = 5.4, p < 0.001; coefficient = 6.2, p < 0.001, respectively) and 4 years (coefficient = 4.6, p < 0.001; coefficient = 3.1, p = 0.004; coefficient = 4.0, p < 0.001, respectively). CONCLUSIONS & IMPLICATIONS Slow-to-talk toddlers of mothers with higher global ratings of responsiveness have higher language scores at 3 and 4 years of age. This global measure of maternal responsiveness could be further developed as a clinical tool for identifying which slow-to-talk toddlers are most in need of early intervention.
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Affiliation(s)
- Sophie Hudson
- Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, VIC, Australia
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Hauser CT, Kover ST, Abbeduto L. Maternal well-being and child behavior in families with fragile X syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:2477-86. [PMID: 24984053 PMCID: PMC4135714 DOI: 10.1016/j.ridd.2014.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 06/08/2014] [Accepted: 06/12/2014] [Indexed: 05/18/2023]
Abstract
The purpose of this study was to examine the bidirectional relationships relationship between maternal mental health status, maternal stress, family environment and behavioral functioning of children with fragile X syndrome (FXS), the leading cause of inherited intellectual disability. Children with FXS commonly demonstrate challenging behavior related to anxiety, attention, and aggression, whereas mothers of children with FXS have been identified as susceptible to mental health challenges due to their status as genetic carriers of the FXS premutation, as well as the environmental stressors of raising children with special needs. The longitudinal design of this study builds upon prior work that established a concurrent relationship among these factors in families of children with other intellectual disorders. Findings indicated that maternal mental health status was not significantly related to changes in levels of child challenging behavior, heightened child challenging behavior was related to improvements in maternal depression over time, and heightened levels of child challenging behavior was related to increased feelings of maternal closeness toward the child over time. The unexpected nature of the results regarding maternal depression and closeness provides new and more complex hypotheses about how mothers of special needs children demonstrate adaptation and resilience. The findings have implications for maternal and familial mental health treatment as well as future research.
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Affiliation(s)
- Claire T Hauser
- Waisman Center, University of Wisconsin-Madison, United States
| | - Sara T Kover
- Waisman Center, University of Wisconsin-Madison, United States
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Weber AM, Harrison TM. Maternal behavior and infant physiology during feeding in premature and term infants over the first year of life. Res Nurs Health 2014; 37:478-89. [PMID: 25223730 DOI: 10.1002/nur.21618] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2014] [Indexed: 11/12/2022]
Abstract
Little is known about the relationship between maternal behavior and the stability of premature infants' physiologic responses during feeding. In a secondary data analysis, we examined relationships between quality of maternal behavior and cardiorespiratory physiology during feeding in 61 premature and 53 term infants at four times over the first year of life. Measures included heart rate (HR), respiratory rate (RR), and oxygen saturation; Child Feeding Skills Checklist; and Parent-Child Early Relational Assessment. Birthweight, gestational age, and neurodevelopmental risk were covariates. Quality of maternal behavior did not predict infants' physiologic response to feeding. However, birthweight was related to infant feeding physiology among all infants over the first year of life. Stress during fetal life, which may lead to impaired intrauterine growth and low birthweight, may have longitudinal effects on cardiorespiratory functioning of premature infants. Research is needed to further investigate the biological pathways by which maternal-infant interaction supports behavioral and physiologic feeding outcomes of premature infants.
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Affiliation(s)
- Ashley M Weber
- Doctoral Candidate, The Ohio State University College of Nursing, Columbus, Ohio
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Tonnsen B, Cornish KM, Wheeler AC, Roberts JE. Maternal predictors of anxiety risk in young males with fragile X. Am J Med Genet B Neuropsychiatr Genet 2014; 165B:399-409. [PMID: 24832235 PMCID: PMC4681279 DOI: 10.1002/ajmg.b.32244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 04/23/2014] [Indexed: 12/11/2022]
Abstract
Children with fragile X syndrome (FXS) demonstrate high rates of anxiety disorders, with 65-83% meeting diagnostic criteria. The severity of anxiety symptoms in FXS has been shown to be partially predicted by elevated negative affect across early childhood [Tonnsen et al. (2013a); J Abnorm Child Psychol 41:267-280]. This association suggests that biologically driven vulnerability emerges early in development, as is reported in non-clinical populations. However, anxiety emergence is likely moderated by multifaceted genetic, biological and environmental risk and protective factors. Mothers with the FMR1 premutation have been shown to exhibit elevated parenting stress and internalizing symptoms, which have each been associated with child behavior problems [Bailey et al. (2008a); Am J Med Genet Part A 146A:2060-2069 and Bailey et al. (2008b) Am J Med Genet Part A 146A:720-729]. Despite these findings, it is unclear whether maternal factors directly relate to anxiety vulnerability in high-risk children with FXS, a question essential to informing targeted, family-sensitive treatment. The present study examines how maternal protective and risk factors relate to child inhibition reflected in (1) child anxiety symptoms, (2) child trajectories of negative affect, and (3) the association between child anxiety and negative affect. Primary predictors include maternal parenting stress, indicators of mental health risk (anxiety and depressive symptoms), and maternal optimism. We also examine genetic correlates in mothers (CGG repeats, activation ratio, mRNA). Our findings suggest that behavioral inhibition in young children with FXS is associated with higher parenting stress and lower optimism, and higher parenting stress is associated with lower maternal X-activation ratio. These findings underscore the need for family-sensitive treatment strategies for anxiety disorders in children with FXS.
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Affiliation(s)
- Bridgette Tonnsen
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Kim M. Cornish
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | | | - Jane E. Roberts
- Department of Psychology, University of South Carolina, Columbia, South Carolina
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Raspa M, Bailey DB, Bann C, Bishop E. Modeling family adaptation to fragile X syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 119:33-48. [PMID: 24450320 DOI: 10.1352/1944-7558-119.1.33] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Using data from a survey of 1,099 families who have a child with Fragile X syndrome, we examined adaptation across 7 dimensions of family life: parenting knowledge, social support, social life, financial impact, well-being, quality of life, and overall impact. Results illustrate that although families report a high quality of life, they struggle with areas such as social support, social life, and parenting knowledge. Path analysis revealed that child and family factors play a role in adaptation, but family resources and social supports moderated their effect on quality of life, well-being, and overall impact. The interrelationship among multiple aspects of family life should be examined to improve family resiliency.
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Kenna HA, Tartter M, Hall SS, Lightbody AA, Nguyen Q, de los Angeles CP, Reiss AL, Rasgon NL. High rates of comorbid depressive and anxiety disorders among women with premutation of the FMR1 gene. Am J Med Genet B Neuropsychiatr Genet 2013; 162B:872-8. [PMID: 24003006 PMCID: PMC5756731 DOI: 10.1002/ajmg.b.32196] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 08/02/2013] [Indexed: 11/09/2022]
Abstract
Phenotypic variations are emerging from investigations of carriers of the fragile X mental retardation 1 (FMR1) premutation gene (55 to 200 CGG repeats). Initial studies suggest elevated psychiatric and reproductive system dysfunction, but have largely used self-reports for assessment of psychiatric history. The present study used diagnostic psychiatric interviews and assessed reproductive and menstrual history in women with FMR1 premutation. History of psychiatric diagnoses and data on reproductive functioning were collected in 46 women with FMR1 premutation who were mothers of at least one child with the fragile X full mutation. Results showed a significantly earlier age of menopause (mean age = 45.6 years) relative to the national average age of menopause (mean age = 51 years) and a high rate (76%) of lifetime depressive or anxiety history, with 43% of the overall sample reporting a comorbid history of both diagnoses. Compared to those free of psychiatric history, significantly longer premutation length was observed among women with psychiatric history after adjusting for age, with comorbid women having the highest number of CGG repeats (mean = 95.8) compared to women free of psychiatric history (mean = 79.9). Psychiatric history did not appear significantly related to reproductive system dysfunction, though results may have been obscured by the high rates of psychiatric dysfunction in the sample. These data add to the growing evidence base that women with the FMR1 premutation have an increased risk of psychiatric illness and risk for early menopause. Future investigations may benefit from inclusion of biochemical reproductive markers and longitudinal assessment of psychiatric and reproductive functioning.
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Affiliation(s)
| | | | | | | | | | | | | | - Natalie L. Rasgon
- Correspondence to: Natalie Rasgon, M.D., Ph.D., Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5723.
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Finucane B, Haas-Givler B, Simon EW. Knowledge and perceptions about fragile X syndrome: implications for diagnosis, intervention, and research. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2013; 51:226-236. [PMID: 23909584 DOI: 10.1352/1934-9556-51.4.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We surveyed 439 professionals in the field of autism to assess their knowledge and perceptions about fragile X syndrome (FXS) and related issues. Almost half had worked with at least one child diagnosed with FXS, yet most lacked basic knowledge about the condition, underestimated its significance in the etiology of autism spectrum disorders, and rarely accessed fragile X-specific resources. A majority perceived etiology to be an important variable in therapeutic response while three quarters felt that professionals in the field of autism should play an active role in referring children for etiological evaluation. Despite these opinions, most respondents either rarely or never inquired about etiology when working with a new client. The survey results underscore the need for training and education so that autism professionals can become effective partners in diagnostic genetic referral and in research and implementation of syndrome-specific interventions.
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Affiliation(s)
- Brenda Finucane
- Autism & Developmental Medicine Institute, Geisinger Health System, 250 Reitz Blvd., Lewisburg, PA 17837, USA.
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Sterling AM, Warren SF, Brady N, Fleming K. Influences on maternal responsivity in mothers of children with fragile X syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2013; 118:310-26. [PMID: 23937372 PMCID: PMC4088940 DOI: 10.1352/1944-7558-188.4.310] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
This study investigated the influence of maternal and child variables on the maternal responsivity of 55 mothers with young children with fragile X syndrome. Data included video observations of mother-child interactions in four different contexts, standardized assessments with the children, and standardized questionnaires for the mothers. The video observations were coded for child communication acts; maternal responsivity was coded at two levels: a more general measure and a behavior-by-behavior measure. Results indicated that child developmental level and language ability strongly influenced behavior-by-behavior responsivity, while maternal IQ was the strongest predictor of both general and behavior-by-behavior responsivity, after controlling for child developmental level.
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Baker JK, Seltzer MM, Greenberg JS. Behaviour problems, maternal internalising symptoms and family relations in families of adolescents and adults with fragile X syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:984-95. [PMID: 22676314 PMCID: PMC3443295 DOI: 10.1111/j.1365-2788.2012.01580.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Studies have linked the behaviour problems of children with fragile X syndrome (FXS) to maternal well-being, but less is known about how behaviour problems relate to important family factors such as marital satisfaction and family cohesion. METHODS Married mothers of 115 adolescents and adults with FXS completed questionnaires and interviews, and maternal CGG repeat length was obtained by medical/laboratory records or by blood analysis. RESULTS Indirect effects were present between behaviour problems and family variables in that behaviour problems were positively related to maternal internalising symptoms which were, in turn, negatively associated with both family cohesion and marital satisfaction. Direct associations between behaviour problems and family relationship variables were not significant. CONCLUSIONS Findings suggest the importance of intervening with behaviour problems in individuals with FXS and identify maternal mental health as a potentially powerful conduit for the effects of child behaviour on relationships within these families. Implications for targeted interventions are discussed.
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Affiliation(s)
- Jason K. Baker
- California State University, Fullerton, 800 N. State College Blvd., Fullerton, CA 92831; 657-278-7966
| | - Marsha Mailick Seltzer
- Waisman Center, University of Wisconsin-Madison; 1500 Highland Ave, Madison, WI 53705, USA; 608- 263-5940
| | - Jan S. Greenberg
- Waisman Center, University of Wisconsin-Madison; 1500 Highland Ave, Madison, WI 53705, USA; 608- 263-0532
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Greenberg JS, Seltzer MM, Baker JK, Smith LE, Warren SF, Brady N, Hong J. Family environment and behavior problems in children, adolescents, and adults with fragile X syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2012; 117:331-46. [PMID: 22809078 PMCID: PMC3482941 DOI: 10.1352/1944-7558-117.4.331] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
We examine how the family environment is associated with aspects of the Fragile X syndrome phenotype during childhood, adolescence, and adulthood. Mothers of children (n = 48), adolescents (n = 85), and adults (n = 34) with Fragile X syndrome participated in a multisite study. For children and adults with Fragile X syndrome, the presence of warmth and positivity and the absence of criticism were associated with fewer behavior problems. Although a higher level of criticism was significantly associated with greater behavior problems, there were only trend-level associations between levels of warmth and positivity and behavior problems during the adolescent years. The provision of family psychoeducation programs, which can reduce parental criticism, would likely benefit both the individual with Fragile X syndrome and the family.
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Affiliation(s)
- Jan S. Greenberg
- University of Wisconsin-Madison, Waisman Center, 1500 Highland Ave., Madison, WI 53705, USA
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Leigh P, Nievar MA, Nathans L. Maternal Sensitivity and Language in Early Childhood: A Test of the Transactional Model. Percept Mot Skills 2011; 113:281-99. [DOI: 10.2466/10.17.21.28.pms.113.4.281-299] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the relation between mothers' sensitive responsiveness to their children and the children's expressive language skills during early childhood. Reciprocal effects were tested with dyads of mothers and their children participating in the National Institute of Health and Human Development Study of Early Child Care and Youth Development. Sensitive maternal interactions positively affected children's later expressive language in the second and third years of life. Although maternal sensitivity predicted later language skills in children, children's language did not affect later maternal sensitivity as indicated in a structural equation model. These results do not support the 1975 transactional model of child development of Sameroff and Chandler. A consistent pattern of sensitivity throughout infancy and early childhood indicates the importance of fostering maternal sensitivity in infancy for prevention or remediation of expressive language problems in young children.
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[Perceived quality of life in mothers of young boys with fragile X syndrome]. Prax Kinderpsychol Kinderpsychiatr 2010; 59:389-403. [PMID: 20545297 DOI: 10.13109/prkk.2010.59.5.389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Quality of life has been conceptualized as a subjective view of one's feeling of well-being. There is evidence for restraints caused by parenting stress as well as resilience in mothers of children with an intellectual handicap. Specifically, we report on an investigation using the family-related life quality questionnaire (FLQ) in mothers of 26 young boys with Fragile X syndrome. Quality of life is affected by parenting stress as well as individual and social coping resources (hope as a personal trait and quality of family relationships). Child-related variables (age, adaptive competence) had no significant effect on perceived quality of life, child temperament and atypical behavior is related indirectly to maternal life satisfaction as a factor determining the degree of parenting stress.
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Lachiewicz A, Dawson D, Spiridigliozzi G, Cuccaro M, Lachiewicz M, McConkie-Rosell A. Indicators of anxiety and depression in women with the fragile X premutation: assessment of a clinical sample. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2010; 54:597-610. [PMID: 20629912 DOI: 10.1111/j.1365-2788.2010.01290.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Current research suggests that depression and anxiety may be common problems in women with the fragile X (FMR1) premutation. METHODS To learn more about this in a clinical setting, we asked 33 women with the FMR1 premutation and 20 women without the FMR1 premutation to complete the Brief Carroll Depression Scale (Brief CDS) and the Multidimensional Anxiety Questionnaire (MAQ) and to provide information about mental health medication use. Questionnaire findings were compared between groups and with normative samples. Trinucleotide (CGG) repeat counts were also correlated to checklist findings. RESULTS Both women with the FMR1 premutation and the comparison group had high current mental health medication use (33% vs. 35%). Approximately 1/3 of the women from both groups had high Brief CDS Total T-scores (33% vs. 30%). More women with the FMR1 premutation had at least one elevated MAQ Total or sub-scale T-score than the comparison group (39% vs. 10%, P = 0.03). Twenty-one per cent of women with the FMR1 premutation had all three of the indicators of distress targeted in this study vs. none of the women in the comparison samples (P < 0.05). There was no statistically significant correlation between CGG repeat size and abnormal checklist findings using the Spearman rank correlation, although a higher percentage of women with >100 CGG repeats (57%) had an elevated Brief CDS Total T-score than women with <or=100 CGG repeats (16%) (P = 0.02). More women with >100 CGG repeats also had all three indicators of anxiety and depression (P = 0.03). CONCLUSIONS Women with the FMR1 premutation appear to have a high incidence of depression and increased symptoms of anxiety. Screening tools like the Brief CDS and the MAQ may be useful to identify these women in the clinic setting. Positive identification could lead to increased mental health care and treatment.
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Affiliation(s)
- Ave Lachiewicz
- Duke University Medical Center, Pediatrics, Durham, North Carolina, USA.
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Wheeler AC, Hatton D, Holloway VT, Sideris J, Neebe EC, Roberts JE, Reznick JS. Maternal responses to child frustration and requests for help in dyads with fragile X syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2010; 54:501-515. [PMID: 20426796 DOI: 10.1111/j.1365-2788.2010.01269.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Variability in behaviour displayed by children with fragile X syndrome (FXS) may be partially attributable to environmental factors such as maternal responsivity. The purpose of this study was to explore variables associated with maternal behaviour during a task designed to elicit frustration in their children with FXS. METHODS Forty-six mother-child dyads, in which the child had full-mutation FXS, were observed in their homes during a task designed to elicit frustration in the child. Each child was given a wrong set of keys and asked to open a box to retrieve a desired toy. Mothers were provided with the correct set of keys and instructed to intervene when they perceived their child was getting too frustrated. Child-expressed frustration and requests for help and maternal behaviours (comforting, negative control, and encouraging/directing) were observed and coded. Maternal variables (e.g. depression, stress, education levels), child variables (e.g. autistic behaviours, age, medication use) and child behaviours (frustration, requests for help) were explored as predictors of maternal behaviour. RESULTS Almost all mothers intervened to help their children and most used encouraging/directing behaviours, whereas very few used comforting or negative control. Child age and child behaviours during the frustrating event were significant predictors of encouraging/directing behaviours in the mothers. Children whose mothers reported higher depressive symptomology used fewer requests for help, and mothers of children with more autistic behaviours used more negative control. CONCLUSIONS The results of this study suggest that child age and immediate behaviours are more strongly related to maternal responsivity than maternal traits such as depression and stress.
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Affiliation(s)
- A C Wheeler
- University of North Carolina at Chapel Hill, Center for Development and Learning, Chapel Hill, NC 27599-7255, USA.
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The serotonin1A receptor gene as a genetic and prenatal maternal environmental factor in anxiety. Proc Natl Acad Sci U S A 2010; 107:7592-7. [PMID: 20368423 DOI: 10.1073/pnas.0914805107] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Low serotonin(1A) receptor (5-HT(1A)R) binding is a risk factor for anxiety and depression, and deletion of the 5-HT(1A)R results in anxiety-like behavior in mice. Here we show that anxiety-like behavior in mice also can be caused, independently of the offspring's own 5-HT(1A)R genotype, by a receptor deficit in the mother: a nongenetic transmission of a genetic defect. Some of the nongenetically transmitted anxiety manifestations were acquired prenatally and linked to a delay in dentate gyrus maturation in the ventral hippocampus of the offspring. Both the developmental delay and the anxiety-like phenotype were phenocopied by the genetic inactivation of p16(ink4a) encoding a cyclin-dependent kinase inhibitor implicated in neuronal precursor differentiation. No maternal 5-HT(1A)R genotype-dependent anxiety developed when the strain background was switched from Swiss Webster to C57BL/6, consistent with the increased resilience of this strain to early adverse environment. Instead, all anxiety manifestations were caused by the offspring's own receptor deficiency, indicating that the genetic and nongenetic effects converge to common anxiety manifestations. We propose that 5-HT(1A)R deficit represents a dual risk for anxiety and that vulnerability to anxiety associated with genetic 5-HT(1A)R deficiency can be transmitted by both genetic and nongenetic mechanisms in a population. Thus, the overall effect of risk alleles can be higher than estimated by traditional genetic assays and may contribute to the relatively high heritability of anxiety and psychiatric disorders in general.
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Larson E. Identifying indicators of well-being for caregivers of children with disabilities. Occup Ther Int 2009; 17:29-39. [DOI: 10.1002/oti.284] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Zupan B, Toth M. Wild-type male offspring of fmr-1+/- mothers exhibit characteristics of the fragile X phenotype. Neuropsychopharmacology 2008; 33:2667-75. [PMID: 18172434 PMCID: PMC2904748 DOI: 10.1038/sj.npp.1301651] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Fragile X syndrome is an X-linked disorder caused by the inactivation of the FMR-1 gene with symptoms ranging from impaired cognitive functions to seizures, anxiety, sensory abnormalities, and hyperactivity. Males are more severely affected than heterozygote (H) females, who, as carriers, have a 50% chance of transmitting the mutated allele in each pregnancy. fmr-1 knockout (KO) mice reproduce fragile X symptoms, including hyperactivity, seizures, and abnormal sensory processing. In contrast to the expectation that wild-type (WT) males born to H (fmr-1(+/-)) mothers (H>WT) are behaviorally normal and indistinguishable from WT males born to WT mothers (WT>WT); here, we show that H>WT offspring are more active than WT>WT offspring and that their hyperactivity is similar to male KO mice born to H or KO (fmr-1(-/-)) mothers (H>KO/KO>KO). H>WT mice, however, do not exhibit seizures or abnormal sensory processing. Consistent with their hyperactivity, the effect of the D2 agonist quinpirole is reduced in H>WT as well as in H>KO and KO>KO mice compared to WT>WT offspring, suggesting a diminished feedback inhibition of dopamine release. Our data indicate that some aspects of hyperactivity and associated dopaminergic changes in 'fragile X' mice are a maternal fmr-1 genotype rather than an offspring fmr-1 genotype effect.
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Affiliation(s)
- Bojana Zupan
- Department of Pharmacology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Miklos Toth
- Department of Pharmacology, Weill Cornell Medical College, Cornell University, New York, NY, USA,Correspondence: Professor M Toth, Department of Pharmacology, Weill Cornell Medical College, Cornell University, 1300 York Avenue, LC 522, New York, NY 10021, USA, Tel: + 1 212 746 6245, Fax: + 1 212 746 8835,
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Zupan B, Toth M. Inactivation of the maternal fragile X gene results in sensitization of GABAB receptor function in the offspring. J Pharmacol Exp Ther 2008; 327:820-6. [PMID: 18812493 DOI: 10.1124/jpet.108.143990] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Fragile X syndrome is an X-linked disorder caused by the inactivation of the FMR1 gene, with symptoms ranging from impaired cognitive functions to seizures, anxiety, sensory abnormalities, and hyperactivity. Although fragile X syndrome is considered a typical Mendelian disorder, we have recently reported that the environment, specifically the fmr1(+/-) or fmr1(-/-) [H or knockout (KO)] maternal environment, elicits on its own a partial fragile X-like phenotype and can contribute to the overall phenotype of fmr1(-/0) (KO) male offspring. Genetically fmr1(+/0) (WT) males born to H females (H(maternal) > WT(offspring)), similar to KO male offspring born to H and KO mothers (H > KO and KO > KO), exhibit locomotor hyperactivity. These mice also showed reduced D(2) autoreceptor function, indicating a possible diminished feedback inhibition of dopamine (DA) release in the nigrostriatal and mesolimbic systems. The GABAergic system also regulates DA release, in part via presynaptic GABA(B) receptors (Rs) located on midbrain dopaminergic neurons. Here, we show that the locomotor inhibitory effect of the GABA(B)R agonist baclofen [4-amino-3-(4-chlorophenyl)-butanoic acid] is enhanced in all progeny of mutant mothers (H > WT, H > KO, and KO > KO) compared with WT > WT mice, irrespective of their own genotype. However, increased sensitivity to baclofen was selective and limited to the locomotor response because the muscle-relaxant and sedative effects of the drug were not altered by the maternal environment. These data show that GABA(B)R sensitization, traditionally induced pharmacologically, can also be elicited by the fmr1-deficient maternal environment.
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Affiliation(s)
- Bojana Zupan
- Weill Cornell Graduate School of Medical Sciences, Cornell University, Neuroscience Program, New York, New York, USA
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The role of maternal responsivity in the development of children with intellectual disabilities. ACTA ACUST UNITED AC 2008; 13:330-8. [PMID: 17979201 DOI: 10.1002/mrdd.20177] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is growing evidence that cumulative exposure to highly responsive parenting styles throughout the early childhood period may provide a variety of important child benefits in terms of language, cognitive, social, and emotional development. We view maternal responsivity as a dynamic construct of central importance to the development of children with intellectual disabilities just as it is for typically developing children. In this study, we selectively review the theoretical and conceptual evidence for the effects of responsivity on development, discuss factors known to influence responsivity including the nature of a child's disability, and review intervention approaches intended to enhance maternal responsivity. We conclude with a set of recommendations for future research.
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Chapter Eight Understanding Individual Differences in Adaptation in Parents of Children with Intellectual Disabilities. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s0074-7750(08)00008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Turk J. Behavioural phenotypes: their applicability to children and young people who have learning disabilities. ACTA ACUST UNITED AC 2007. [DOI: 10.1108/17530180200700025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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