Daily Living Skills in Adolescent and Young Adult Males With Fragile X Syndrome

Systematic Review: Fragile X Syndrome Across the Lifespan with a Focus on Genetics, Neurodevelopmental, Behavioral and Psychiatric Associations

BACKGROUND/OBJECTIVES

Fragile X syndrome (FXS) is one of the most common genetic causes of intellectual developmental disability and autism spectrum disorder (ASD), second only to Down's syndrome and associated with a broad range of neurodevelopmental, behavioral, and psychiatric challenges. FXS may be present in infants or young children with characteristic dysmorphic features, developmental delays, and behavioral challenges. The diagnosis of FXS is confirmed by the molecular genetic testing of the FMR1 gene encoding fragile X messenger RNA-binding protein (FMRP), involved in regulating the translation of multiple mRNAs which play a key role in neuronal development and synaptic plasticity. Understanding the genetic cause, pathophysiology, and natural history of FXS is crucial for identifying commonly associated comorbidities, instituting effective therapeutic interventions, and improving long-term outcomes.

METHODS

This systematic review employed a comprehensive literature search using multiple electronic databases including PubMed, Web of Science, and Scopus with keywords related to fragile X syndrome, lifespan, genetics, neurodevelopmental, behavioral, and psychiatric disorders.

RESULTS

FXS is associated with an increased risk for specific neurodevelopmental, or psychiatric disorders. Symptoms and challenges associated with FXS vary based on multiple factors, including genetic differences, age, sex, comorbid conditions, various environmental influences, the availability of support, and opportunities for therapeutic interventions. Knowledge of these associations helps guide caregivers and clinicians in identifying potentially treatable conditions that can help to improve the lives of affected patients and their families.

CONCLUSIONS

The focus of this article is to explore and describe the genetic underpinnings of FXS, identify associated developmental, behavioral, and psychiatric conditions over the lifespan, and provide a review of clinical features, therapeutic interventions including investigational treatments, and current research updates.

Daily living skills in adolescents with and without (developmental) language disorder, measured using the WHEEL OF INDEPENDENCETM framework

Introduction

Developing daily living skills, such as self-care, cooking and managing money, is a key priority for adolescents with special educational needs. Previous studies investigated the emergence of daily living skills in young people with a range of neurodevelopmental conditions. However, none focused on adolescents with language disorders, including developmental language disorder.

Method

Two groups of 16-year-olds participated in this study: a typically developing group (n = 88) and a (developmental) language disorder group (n = 78), which was subdivided into participants with co-occurring motor difficulties (n = 56) versus typical motor development (n = 22). Data were collected using the WHEEL OF INDEPENDENCE™ framework, a daily living skills measurement tool. Between-group comparisons assessed whether there were significant differences in daily living skills between typically developing and (developmental) language disorder participants and between those with and without motor difficulties within the (developmental) language disorder group.

Results

Findings revealed that typically developing participants had significantly better daily living skills than the (developmental) language disorder group. Within the (developmental) language disorder group, participants with motor difficulties showed marginally significantly lower daily living skills than those without.

Conclusion

Adolescents with (developmental) language disorder experience challenges developing their daily living skills, compared to typically developing peers. This may be compounded if they have co-occurring motor difficulties. Further research could inform understanding of the mechanisms underlying these differences in order to develop tailored and effective interventions.

Description and predictors of self-determination in males and females with fragile X syndrome on the verge of adulthood

BACKGROUND

Self-determination refers to setting goals and making decisions regarding one's own life with support from others as needed. Research on people with intellectual and developmental disabilities has established the importance of self-determination for quality of life outcomes, such as increased independence and life satisfaction. However, self-determination has not been characterised specifically in fragile X syndrome (FXS), the leading inherited cause of intellectual disability. Relative to youth with other forms of intellectual and developmental disabilities, youth with FXS may face exceptional barriers to the development of self-determined behaviour. In addition to intellectual disability, the FXS behavioural profile is characterised by high rates of autism and anxiety that may further limit opportunities for youth with FXS. The heritable nature of the condition can also yield a distinctive family environment, with siblings and parents also living with fragile X or its associated conditions. Considering these unique challenges, the present study examined self-determination in young adult males and females with FXS and explored whether factors such as language skills, adaptive behaviour and autism traits were associated with self-determination capacity and opportunities.

METHODS

The present study included 9 females and 36 males with FXS between the ages of 17 and 25 years. Caregivers (mothers or fathers) completed the American Institute for Research Self-Determination Assessment, which is a questionnaire that yields three scores: self-determination capacity, opportunities for self-determination at home and opportunities for self-determination at school.

RESULTS

Caregivers endorsed a wide range of self-determination capacity and opportunities, with ratings for opportunities at home and school exceeding ratings of capacity. Better adaptive behaviour skills were associated with more self-determination capacity, and the presence of more autism traits was associated with fewer opportunities at school.

CONCLUSIONS

Results from this study contribute to our understanding of avenues to best support young adults with FXS as they transition to adulthood. Our findings also have implications for practice, such that interventions targeting adaptive behaviours and self-determination may be an effective approach for promoting autonomy and independence for young adults with FXS. Additionally, caregivers and educators should continue to provide opportunities to practise self-determination, regardless of their perception of capacity.

Language Skills Influence Transition Planning in Adolescents With Fragile X Syndrome

Individuals with fragile X syndrome (FXS) and their parents have a range of experiences navigating the crucial transition period between adolescence and adulthood. Semistructured interviews of 47 mothers of adolescents with FXS (mean child age = 15.89 years) were analyzed to identify mothers' changing expectations during the adolescent period and parent goals related to work and postsecondary education. Mothers' work and education goals were explored in relation to child factors such as language skills and autism characteristics. Lower language skills were associated with lower likelihood of reporting vocational goals. Results suggest that adolescents with FXS with lower language ability are less likely to have vocational plans for adulthood during this critical period and may need greater transition planning assistance.