1
|
Moser C, Campanelli A, Friedman L, Thurman AJ, Roberts JE, Abbeduto L, Klusek J. Characterising the social interaction style of autism in young adult males with fragile X syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:464-476. [PMID: 38258970 PMCID: PMC11023774 DOI: 10.1111/jir.13121] [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: 07/10/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The characterisation of autism in fragile X syndrome (FXS) has been a source of controversy due to the complexity of disentangling autism traits from common features of the FXS phenotype. Autism in FXS is significantly underdiagnosed in the community, which may be partly due to insufficient clinical description of the social interaction profile of autism within the FXS phenotype. In this study, we applied a classic framework for characterising social interaction styles in autism to a sample of young adult males with FXS and co-occurring autism to enhance understanding of how the social challenges associated with autism manifest within FXS. METHODS Participants were 41 males (M age = 18 years) with FXS and co-occurring autism. Interaction samples were coded for expression of predominately 'active' (characterised by a desire to make social approaches) or 'passive' (characterised by lack of initiation of social approach towards others) interaction profiles. Differences in the expression of phenotypic features of FXS, including anxiety, attention-deficit/hyperactivity disorder, cognitive, adaptive and language impairments and autism symptom severity, were examined across those with passive and active interaction styles. RESULTS Approximately half of the sample was classified as active and half as passive, demonstrating diversity in the social phenotype of autism associated with FXS. The two subtypes did not differ in autism severity, anxiety or attention-deficit/hyperactivity disorder symptoms or in cognitive, adaptive or language abilities. CONCLUSIONS This study enhances understanding of FXS-associated autism by documenting phenotypic variability in the social interaction profile in this group, with active and passive social interaction styles represented. The two social interaction styles were not associated with differential expression of common phenotypic features of FXS, suggesting similar support needs.
Collapse
Affiliation(s)
- Carly Moser
- Department of Communication Sciences and Disorders, University of South Carolina, 1705 College Street, Columbia SC 29208, USA
| | - Alyssa Campanelli
- Department of Communication Sciences and Disorders, University of South Carolina, 1705 College Street, Columbia SC 29208, USA
| | - Laura Friedman
- Department of Communication Sciences and Disorders, University of South Carolina, 1705 College Street, Columbia SC 29208, USA
| | - Angela John Thurman
- Department of Psychiatry and Behavioral Sciences and MIND Institute, University of California Davis Health, 2825 50th Street, Sacramento, CA 95817, USA
| | - Jane E. Roberts
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, South Carolina, 29208, USA
| | - Leonard Abbeduto
- Department of Psychiatry and Behavioral Sciences and MIND Institute, University of California Davis Health, 2825 50th Street, Sacramento, CA 95817, USA
| | - Jessica Klusek
- Department of Communication Sciences and Disorders, University of South Carolina, 1705 College Street, Columbia SC 29208, USA
| |
Collapse
|
2
|
Johnson K, Stanfield AC, Scerif G, McKechanie A, Clarke A, Herring J, Smith K, Crawford H. A holistic approach to fragile X syndrome integrated guidance for person-centred care. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13214. [PMID: 38383947 DOI: 10.1111/jar.13214] [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: 04/28/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND The Fragile X community has expressed a desire for centralised, national guidelines in the form of integrated guidance for Fragile X Syndrome (FXS). METHODS This article draws on existing literature reviews, primary research and clinical trials on FXS, a Fragile X Society conference workshop and first-hand experience of clinicians who have worked with those living with FXS over many years. RESULTS The article scopes proposed integrated guidance over the life course, including appendices of symptoms, comorbidities and referral options for FXS and Fragile X Premutation Associated Conditions. CONCLUSION Integrated guidance would provide an authoritative source for doctors, health professionals, therapists, care workers, social workers, educators, employers, families and those living with FXS, so that a holistic, person-centred approach can be taken across the United Kingdom to garner the best outcomes for those with FXS.
Collapse
Affiliation(s)
- Kirsten Johnson
- The Fragile X Society, Great Dunmow, Essex, UK
- Fragile X International, Brussels, Belgium
| | - Andrew C Stanfield
- The Fragile X Society, Great Dunmow, Essex, UK
- The Patrick Wild Centre, The University of Edinburgh, Edinburgh, UK
| | - Gaia Scerif
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | | | - Angus Clarke
- The Fragile X Society, Great Dunmow, Essex, UK
- Institute of Cancer & Genetics, Cardiff University, Cardiff, UK
| | - Jonathan Herring
- The Fragile X Society, Great Dunmow, Essex, UK
- Law Faculty, University of Oxford, Oxford, UK
| | - Kayla Smith
- Mental Health and Wellbeing Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hayley Crawford
- The Fragile X Society, Great Dunmow, Essex, UK
- Mental Health and Wellbeing Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
3
|
Wall CA, Shic F, Will EA, Wang Q, Roberts JE. Similar Gap-Overlap Profiles in Children with Fragile X Syndrome and IQ-Matched Autism. J Autism Dev Disord 2024:10.1007/s10803-024-06245-1. [PMID: 38246961 DOI: 10.1007/s10803-024-06245-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE Fragile X syndrome (FXS) is a single-gene disorder characterized by moderate to severe cognitive impairment and a high association with autism spectrum disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). Atypical visual attention is a feature of FXS, ASD, and ADHD. Thus, studying early attentional patterns in young children with FXS can offer insight into early emerging neurocognitive processes underlying challenges and contribute to our understanding of common and unique features of ASD and ADHD in FXS. METHODS The present study examined visual attention indexed by the gap-overlap paradigm in children with FXS (n = 39) compared to children with ASD matched on intellectual ability and age (n = 40) and age-matched neurotypical controls (n = 34). The relationship between gap-overlap performance and intellectual ability, ASD, and ADHD across groups was characterized. Saccadic reaction times (RT) were collected across baseline, gap, and overlap conditions. RESULTS Results indicate no group differences in RT for any conditions. However, RT of the ASD and NT groups became slower throughout the experiment whereas RT of the FXS group did not change, suggesting difficulties in habituation for the FXS group. There was no relationship between RT and intellectual ability, ADHD, or ASD symptoms in the FXS and ASD groups. In the NT group, slower RT was related to elevated ADHD symptoms only. CONCLUSION Taken together, findings suggest that the social attention differences documented in FXS and ASD may be due to other cognitive factors, such as reward or motivation, rather than oculomotor control of visual attention.
Collapse
Affiliation(s)
- Carla A Wall
- Duke University Medical Center, Center for Autism and Brain Development, 2424 Erwin Road, Suite 501, Durham, NC, 27705, USA.
| | - Frederick Shic
- Seattle Children's Research Institute, Center for Child Health, Behavior and Development, 1920 Terry Ave CURE-3, Seattle, WA, 98101, USA
- Department of Pediatrics, University of Washington School of Medicine, 1920 Terry Ave CURE-3, Seattle, WA, 98101, USA
| | - Elizabeth A Will
- Department of Communication Sciences and Disorders, University of South Carolina, Arnold School of Public Health, 6311 Garners Ferry Road, Columbia, SC, 29209, USA
| | - Quan Wang
- Key Laboratory of Spectral Imaging Technology, Xi'an Institute of Optics and Precision Mechanics of the Chinese Academy of Sciences, Xi'an, 710119, China
| | - Jane E Roberts
- Department of Psychology, College of Arts and Sciences, University of South Carolina, 6311 Garners Ferry Road, Columbia, SC, 29209, USA
| |
Collapse
|
4
|
Moskowitz L, Will E, Black C, Roberts J. The Effect of Anxiety and Autism Symptom Severity on Restricted and Repetitive Behaviors Over Time in Children with Fragile X Syndrome. RESEARCH SQUARE 2023:rs.3.rs-3353765. [PMID: 37961141 PMCID: PMC10635355 DOI: 10.21203/rs.3.rs-3353765/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Restricted and repetitive behaviors (RRBs) are highly prevalent and reduce function in individuals with fragile X syndrome (FXS). As transdiagnostic features of intellectual disability, elevated rates of RRBs in FXS could represent various underlying known co-occurring conditions in FXS such as anxiety or autism spectrum disorder (ASD), yet this distinction has not been investigated. Further, delineating whether RRBs are more indicative of anxiety or ASD in FXS may clarify phenotypic profiles within FXS and improve differential assessment. Methods We longitudinally examined the potentially independent or multiplicative effect of ASD and anxiety symptom severity on RRBs in 60 children with FXS. Anxiety was measured using the Child Behavior Checklist (CBCL), ASD severity was measured using the Childhood Autism Rating Scale (CARS), and RRBs were measured using The Repetitive Behavior Scale - Revised (RBS-R). We estimated a series of moderated regression models with anxiety and ASD symptoms at the initial assessment (Time 1) as predictors of RRBs at the outcome assessment two years later (Time 2), along with an anxiety-by-ASD interaction term to determine the potential multiplicative effect of these co-occurring conditions on RRBs. Results Results identified a significant interaction between ASD and anxiety symptom severity at the initial assessment that predicted elevated sensory-motor RRBs two years later. Increased sensory-motor RRBs were predicted by elevated ASD symptoms only when anxiety symptom severity was low. Likewise, increased sensory-motor RRBs were predicted by elevated anxiety symptoms only when ASD symptom severity was low. Interestingly, this relationship was isolated to Sensory-Motor RRBs, with evidence that it could also apply to total RRBs. Conclusions Findings suggest that ASD and anxiety exert independent and differential effects on Sensory-Motor RRBs when at high severity levels and a multiplicative effect when at moderate levels.
Collapse
Affiliation(s)
| | | | - Conner Black
- NewYork-Presbyterian Weill Cornell Medical Center
| | | |
Collapse
|
5
|
Crawford H. Social Anxiety in Neurodevelopmental Disorders: The Case of Fragile X Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 128:302-318. [PMID: 37470255 DOI: 10.1352/1944-7558-128.4.302] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 10/04/2022] [Indexed: 07/21/2023]
Abstract
Despite significant advances in understanding and treating social anxiety in the general population, progress in this area lags behind for individuals with intellectual disability. Fragile X syndrome is the most common cause of inherited intellectual disability and is associated with an elevated prevalence rate of social anxiety. The phenotype of fragile X syndrome encompasses multiple clinically significant characteristics that are posed as risk markers for social anxiety in other populations. Here, evidence is reviewed that points to physiological hyperarousal, sensory sensitivity, emotion dysregulation, cognitive inflexibility, and intolerance of uncertainty as primary candidates for underlying mechanisms of heightened social anxiety in fragile X syndrome. A multilevel model is presented that provides a framework for future research to test associations.
Collapse
|
6
|
Hall SS, Britton TC. Differential Effects of a Behavioral Treatment Probe on Social Gaze Behavior in Fragile X Syndrome and Non-Syndromic Autism Spectrum Disorder. J Autism Dev Disord 2023:10.1007/s10803-023-05919-6. [PMID: 37142899 DOI: 10.1007/s10803-023-05919-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 05/06/2023]
Abstract
The purpose of this study was to examine potential differences in social learning between individuals with fragile X syndrome (FXS), the leading known inherited cause of intellectual disability, and individuals with non-syndromic autism spectrum disorder (ASD). Thirty school-aged males with FXS and 26 age and symptom-matched males with non-syndromic ASD, were administered a behavioral treatment probe designed to improve levels of social gaze during interactions with others. The treatment probe was administered by a trained behavior therapist over two days in our laboratory and included reinforcement of social gaze in two alternating training conditions - looking while listening and looking while speaking. Prior to each session, children in each group were taught progressive muscle relaxation and breathing techniques to counteract potential increased hyperarousal. Measures included the rate of learning in each group during treatment, in addition to levels of social gaze and heart rate obtained during administration of a standardized social conversation task administered prior to and following the treatment probe. Results showed that learning rates obtained during administration of the treatment probe were significantly less steep and less variable for males with FXS compared to males with non-syndromic ASD. Significant improvements in social gaze were also observed for males with FXS during the social conversation task. There was no effect of the treatment probe on heart rate in either group. These data reveal important differences in social learning between the two groups and have implications for early interventions in the two conditions.
Collapse
Affiliation(s)
- Scott S Hall
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - Tobias C Britton
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
7
|
Cencelli G, Pacini L, De Luca A, Messia I, Gentile A, Kang Y, Nobile V, Tabolacci E, Jin P, Farace MG, Bagni C. Age-Dependent Dysregulation of APP in Neuronal and Skin Cells from Fragile X Individuals. Cells 2023; 12:758. [PMID: 36899894 PMCID: PMC10000963 DOI: 10.3390/cells12050758] [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: 11/06/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 03/04/2023] Open
Abstract
Fragile X syndrome (FXS) is the most common form of monogenic intellectual disability and autism, caused by the absence of the functional fragile X messenger ribonucleoprotein 1 (FMRP). FXS features include increased and dysregulated protein synthesis, observed in both murine and human cells. Altered processing of the amyloid precursor protein (APP), consisting of an excess of soluble APPα (sAPPα), may contribute to this molecular phenotype in mice and human fibroblasts. Here we show an age-dependent dysregulation of APP processing in fibroblasts from FXS individuals, human neural precursor cells derived from induced pluripotent stem cells (iPSCs), and forebrain organoids. Moreover, FXS fibroblasts treated with a cell-permeable peptide that decreases the generation of sAPPα show restored levels of protein synthesis. Our findings suggest the possibility of using cell-based permeable peptides as a future therapeutic approach for FXS during a defined developmental window.
Collapse
Affiliation(s)
- Giulia Cencelli
- Department of Biomedicine and Prevention, Faculty of Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University, 00168 Rome, Italy
| | - Laura Pacini
- Department of Biomedicine and Prevention, Faculty of Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Faculty of Medicine, UniCamillus, Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Anastasia De Luca
- Department of Biomedicine and Prevention, Faculty of Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Ilenia Messia
- Department of Biomedicine and Prevention, Faculty of Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Antonietta Gentile
- Department of Biomedicine and Prevention, Faculty of Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Roma, 00166 Rome, Italy
| | - Yunhee Kang
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Veronica Nobile
- Institute of Genomic Medicine, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University, 00168 Rome, Italy
| | - Elisabetta Tabolacci
- Institute of Genomic Medicine, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University, 00168 Rome, Italy
| | - Peng Jin
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Maria Giulia Farace
- Department of Biomedicine and Prevention, Faculty of Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Claudia Bagni
- Department of Biomedicine and Prevention, Faculty of Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Department of Fundamental Neurosciences, Faculty of Biology and Medicine, University of Lausanne, 1005 Lausanne, Switzerland
| |
Collapse
|
8
|
Wall CA, Shic F, Varanasi S, Roberts JE. Distinct social attention profiles in preschoolers with autism contrasted to fragile X syndrome. Autism Res 2023; 16:340-354. [PMID: 36408848 PMCID: PMC9957831 DOI: 10.1002/aur.2857] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022]
Abstract
Social attention is a critical skill for learning and development. Social attention difficulties are present in both non-syndromic autism spectrum disorder (nsASD) and fragile X syndrome (FXS), and our understanding of these difficulties is complicated by heterogeneity in both disorders, including co-occurring diagnoses like intellectual disability and social anxiety. Existing research largely utilizes a single index of social attention and rarely includes children with intellectual impairment or uses a cross-syndrome approach. This study investigated whether multi-trait social attention profiles including naturalistic initial eye contact, facial attention, and social scene attention differ in preschool children with nsASD and FXS matched on developmental ability (DQ) and contrasted to neurotypical (NT) controls. The relationship between DQ, ASD severity, and social anxiety and social attention profiles was also examined. Initial eye contact related to social scene attention, implicating that naturalistic social attention is consistent with responses during experimental conditions. Reduced eye contact and lower social scene attention characterized nsASD and FXS. Children with nsASD displayed less facial attention than FXS and NT children, who did not differ. Lower DQ and elevated ASD severity associated with decreased eye contact in nsASD and FXS, and lower DQ was associated with lower social scene attention in FXS. Sex, social anxiety, and age were not associated with social attention. These findings suggest social attention profiles of children with nsASD are highly similar to, yet distinct from, children with FXS. Children with nsASD may present with a global social attention deficit whereas FXS profiles may reflect context-dependent social avoidance.
Collapse
Affiliation(s)
- Carla A. Wall
- Duke University Medical Center, Center for Autism and Brain Development, 2424 Erwin Road, Suite 501, Durham, NC 27705
| | - Frederick Shic
- University of Washington, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA 98101
| | - Sreeja Varanasi
- University of South Carolina, School of Medicine, 6311 Garners Ferry Road, Columbia, SC 29209
| | - Jane E. Roberts
- University of South Carolina, Department of Psychology, 1512 Pendleton Street, Suite #220, Columbia, SC 29208
| |
Collapse
|
9
|
Wall CA, Roberts JE. Negative affect and respiratory sinus arrhythmia are differentially related to social anxiety and autism features in autistic preschoolers contrasted to fragile X syndrome. Front Psychiatry 2023; 14:1151263. [PMID: 37020738 PMCID: PMC10067898 DOI: 10.3389/fpsyt.2023.1151263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction Autism spectrum disorder (ASD) is a highly heterogeneous and complex disorder with co-occurring disorders commonplace. This presents tremendous diagnostic challenges given the phenotypic overlap between autism and other diagnoses, including social anxiety, as well as variance in specific genetic disorders like fragile X syndrome (FXS). Biobehavioral measurement approaches integrate behavioral and biological data, and by so doing have the potential to address diagnostic challenges and shed light on the mechanisms underlying social impairments. Methods The present study utilized a biobehavioral approach to evaluate how biologically based indices of baseline respiratory sinus arrhythmia (RSA) and temperamental negative affect differ and predict autism and anxiety in a sample of 120 preschoolers with non-syndromic autism (nsASD) with co-occurring intellectual impairment, FXS, and neurotypical (NT) development. Results Results indicated that children with nsASD display elevated negative affect compared to both FXS and NT controls which did not differ from each other and females exhibited more negative affect relative to males. Interestingly, elevated negative affect predicted social anxiety, but not ASD in FXS. Baseline RSA did not differ across the groups; however, reduced RSA predicted elevated autism severity for the nsASD group but not those with FXS or NT development. Discussion Taken together, biobehavioral markers differentiated the groups in discrete ways that advance our understanding of autism and promote improved diagnostic clarity using objective measurement.
Collapse
Affiliation(s)
- Carla A. Wall
- Duke Center for Autism and Brain Development, Duke University Medical Center, Durham, NC, United States
- *Correspondence: Carla A. Wall,
| | - Jane E. Roberts
- Department of Psychology, University of South Carolina, Columbia, SC, United States
| |
Collapse
|
10
|
Research Gaps in Fragile X Syndrome: An Updated Literature Review to Inform Clinical and Public Health Practice. J Dev Behav Pediatr 2023; 44:e56-e65. [PMID: 36219479 PMCID: PMC9770151 DOI: 10.1097/dbp.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 08/03/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The phenotypic impact of fragile X syndrome (FXS) has been well-documented since the discovery of the fragile X messenger ribonucleoprotein 1 gene 30 years ago. However, gaps remain in clinical and public health research. The purpose of this literature review was to determine the extent to which these gaps have been addressed and identify targeted areas of future research. METHODS We conducted an electronic search of several scientific databases using a variety of key words. The search focused on 5 areas identified as research gaps by an earlier review: (1) diagnosis, (2) phenotypic presentation, (3) familial impact, (4) interventions and treatments, and (5) life span perspectives. Inclusion criteria included publication between 2014 and 2020, focus on human subjects, and publication in English. A total of 480 articles were identified, 365 were reviewed, and 112 are summarized in this review. RESULTS Results are organized into the following categories: (1) FXS phenotype and subtypes (FXS subtypes, medical profile, cognitive/developmental profile, social and behavioral profile); (2) needs of adults; (3) public health needs (clinical diagnosis and newborn screening, health care needs, and access); (4) treatment (treatment priorities, pharmacological treatments, and behavioral and educational interventions); and (5) families (economic burden and mother-child relationship). CONCLUSION Despite the progress in many areas of FXS research, work remains to address gaps in clinical and public health knowledge. We pose 3 main areas of focused research, including early detection and diagnosis, determinants of health, and development and implementation of targeted interventions.
Collapse
|
11
|
Wilkinson EH, Britton TC, Hall SS. Examining Phenotypic Differences in Gaze Avoidance Between Autism Spectrum Disorder and Fragile X Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:435-454. [PMID: 36306410 PMCID: PMC9667749 DOI: 10.1352/1944-7558-127.6.435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 08/31/2021] [Indexed: 05/22/2023]
Abstract
We examined potential phenotypic differences in eye gaze avoidance exhibited by boys with autism spectrum disorder (ASD) and boys with fragile X syndrome (FXS). In Study 1, the Eye Contact Avoidance Scale (ECAS) was administered to caregivers of boys aged 7-18 years with FXS (n = 148), ASD (n = 168), and mixed developmental disabilities (MDD; n = 128). In Study 2, subsets of boys with FXS (n = 31) and boys with ASD (n = 25) received a brief behavioral treatment probe to improve eye contact. Results showed that boys with FXS obtained significantly higher scores on the ECAS compared to boys with ASD and MDD. Exposure to the brief behavioral treatment probe resulted in significant decreases in scores for boys with FXS, but not for boys with ASD.
Collapse
Affiliation(s)
- Ellen H Wilkinson
- Ellen H. Wilkinson, Tobias C. Britton, and Scott S. Hall, Stanford University School of Medicine
| | - Tobias C Britton
- Ellen H. Wilkinson, Tobias C. Britton, and Scott S. Hall, Stanford University School of Medicine
| | - Scott S Hall
- Ellen H. Wilkinson, Tobias C. Britton, and Scott S. Hall, Stanford University School of Medicine
| |
Collapse
|
12
|
Chen Y, Guo L, Han M, Zhang S, Chen Y, Zou J, Bai S, Cheng G, Zeng Y. Cerebellum Neuropathology and Motor Skill Deficits in Fragile X Syndrome. Int J Dev Neurosci 2022; 82:557-568. [DOI: 10.1002/jdn.10217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yu‐shan Chen
- Brain Science and Advanced Technology Institute, School of Medicine Wuhan University of Science and Technology Wuhan China
| | - Liu Guo
- Brain Science and Advanced Technology Institute, School of Medicine Wuhan University of Science and Technology Wuhan China
| | - Man Han
- Brain Science and Advanced Technology Institute, School of Medicine Wuhan University of Science and Technology Wuhan China
| | - Si‐ming Zhang
- Brain Science and Advanced Technology Institute, School of Medicine Wuhan University of Science and Technology Wuhan China
| | - Yi‐qi Chen
- Brain Science and Advanced Technology Institute, School of Medicine Wuhan University of Science and Technology Wuhan China
| | - Jia Zou
- Brain Science and Advanced Technology Institute, School of Medicine Wuhan University of Science and Technology Wuhan China
| | - Shu‐yuan Bai
- Brain Science and Advanced Technology Institute, School of Medicine Wuhan University of Science and Technology Wuhan China
| | - Gui‐rong Cheng
- Brain Science and Advanced Technology Institute, School of Medicine Wuhan University of Science and Technology Wuhan China
| | - Yan Zeng
- Brain Science and Advanced Technology Institute, School of Medicine Wuhan University of Science and Technology Wuhan China
| |
Collapse
|
13
|
Ridley E, Arnott B, Riby DM, Burt DM, Hanley M, Leekam SR. The Quality of Everyday Eye Contact in Williams Syndrome: Insights From Cross-Syndrome Comparisons. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:293-312. [PMID: 36122327 DOI: 10.1352/1944-7558-127.4.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 08/31/2021] [Indexed: 06/15/2023]
Abstract
Past research shows that individuals with Williams syndrome (WS) have heightened and prolonged eye contact. Using parent report measures, we examined not only the presence of eye contact but also its qualitative features. Study 1 included individuals with WS (n = 22, ages 6.0-36.3). Study 2 included children with different neurodevelopmental (ND) conditions (WS, autism spectrum condition, fragile X syndrome, attention-deficit/hyperactivity disorder) and children with neurotypical development (NT; n = 262, ages 4.0-17.11). Unusual eye contact features, including staring, were found in approximately half of the WS samples. However, other features such as brief glances were frequently found in WS and in all ND conditions, but not NT. Future research in ND conditions should focus on qualitative as well as quantitative features of eye contact.
Collapse
Affiliation(s)
- Ellen Ridley
- Ellen Ridley, Centre for Neurodiversity & Development, Durham University, and Department of Psychology, Durham University, Durham, DH1 3LE, UK
| | - Bronia Arnott
- Bronia Arnott, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Deborah M Riby
- Deborah M. Riby, Centre for Neurodiversity & Development, Durham University, and Department of Psychology, Durham University, Durham, DH1 3LE, UK
| | - D Michael Burt
- D. Michael Burt, Department of Psychology, Durham University, Durham, DH1 3LE, UK
| | - Mary Hanley
- Mary Hanley, Centre for Neurodiversity & Development, Durham University, and Department of Psychology, Durham University, Durham, DH1 3LE, UK
| | - Susan R Leekam
- Susan R. Leekam, Cardiff University Centre for Developmental Science, Cardiff University, Park Place, Cardiff, Wales, CF10 3AT, UK
| |
Collapse
|
14
|
Edwards G, Jones C, Pearson E, Royston R, Oliver C, Tarver J, Crawford H, Shelley L, Waite J. Prevalence of anxiety symptomatology and diagnosis in syndromic intellectual disability: A systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 138:104719. [PMID: 35661754 DOI: 10.1016/j.neubiorev.2022.104719] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/24/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
Individuals with syndromic intellectual disability are at increased risk of experiencing anxiety. Comparing prevalence estimates of anxiety will allow the identification of at-risk groups and inform causal pathways of anxiety. No known study has explored estimates of anxiety symptomatology and diagnosis, including specific anxiety profiles, across groups whilst accounting for methodological quality of studies. This systematic review and meta-analysis aimed to fill this gap. Prior to review completion, methodology and analysis plans were registered and documented in a protocol (CRD42019123561). Data from 83 papers, involving a pooled sample of 13,708 across eight syndromes were synthesised using a random effects model. Anxiety prevalence ranged from 9 % (95 % CI: 4-14) in Down syndrome to 73% in Rett syndrome (95 % CI: 70-77). Anxiety prevalence across syndromic intellectual disability was higher than for intellectual disability of mixed aetiology and general population estimates. Substantial variability between syndromes identified groups at higher risk than others. The identification of high-risk groups is crucial for early intervention, allowing us to refine models of risk and identify divergent profiles.
Collapse
Affiliation(s)
- Georgina Edwards
- The School of Psychology, College of Health and Life Sciences, Aston University, UK.
| | - Chris Jones
- School of Psychology, University of Birmingham, Edgbaston, UK.
| | - Effie Pearson
- The School of Psychology, College of Health and Life Sciences, Aston University, UK.
| | - Rachel Royston
- School of Psychology, University of Birmingham, Edgbaston, UK.
| | - Chris Oliver
- School of Psychology, University of Birmingham, Edgbaston, UK.
| | - Joanne Tarver
- The School of Psychology, College of Health and Life Sciences, Aston University, UK.
| | - Hayley Crawford
- Mental Health and Wellbeing Unit, Warwick Medical School, University of Warwick, UK.
| | - Lauren Shelley
- The School of Psychology, College of Health and Life Sciences, Aston University, UK.
| | - Jane Waite
- The School of Psychology, College of Health and Life Sciences, Aston University, UK.
| |
Collapse
|
15
|
Bülow P, Segal M, Bassell GJ. Mechanisms Driving the Emergence of Neuronal Hyperexcitability in Fragile X Syndrome. Int J Mol Sci 2022; 23:ijms23116315. [PMID: 35682993 PMCID: PMC9181819 DOI: 10.3390/ijms23116315] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023] Open
Abstract
Hyperexcitability is a shared neurophysiological phenotype across various genetic neurodevelopmental disorders, including Fragile X syndrome (FXS). Several patient symptoms are associated with hyperexcitability, but a puzzling feature is that their onset is often delayed until their second and third year of life. It remains unclear how and why hyperexcitability emerges in neurodevelopmental disorders. FXS is caused by the loss of FMRP, an RNA-binding protein which has many critical roles including protein synthesis-dependent and independent regulation of ion channels and receptors, as well as global regulation of protein synthesis. Here, we discussed recent literature uncovering novel mechanisms that may drive the progressive onset of hyperexcitability in the FXS brain. We discussed in detail how recent publications have highlighted defects in homeostatic plasticity, providing new insight on the FXS brain and suggest pharmacotherapeutic strategies in FXS and other neurodevelopmental disorders.
Collapse
Affiliation(s)
- Pernille Bülow
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA 30322, USA
- Correspondence: (P.B.); (G.J.B.)
| | - Menahem Segal
- Department of Brain Science, Weizmann Institute of Science, Rehovot 76100, Israel;
| | - Gary J. Bassell
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA 30322, USA
- Correspondence: (P.B.); (G.J.B.)
| |
Collapse
|
16
|
Klusek J, O'Connor SL, Hickey A, Hills KJ, Abbeduto L, Roberts JE. Attention/Deficit Hyperactivity Disorder in Adolescent and Young Adult Males With Fragile X Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:213-230. [PMID: 35443049 PMCID: PMC9414675 DOI: 10.1352/1944-7558-127.3.213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/26/2021] [Indexed: 05/03/2023]
Abstract
This study characterized the rates of attention-deficit/hyperactivity disorder (ADHD) in adolescent and young adult males with fragile X syndrome (FXS) using a multi-method approach integrating a DSM-based parent interview (Children's Interview for Psychiatric Syndromes; P-ChIPS, Fristad et al., 1998) and a parent rating scale (Child Behavior Checklist; CBCL, Achenbach, 2001). Thirty-one males with FXS, aged 16-24 years, participated. Forty-two percent met DSM-5 criteria for ADHD and 35% exceeded the CBCL cut-offs. Agreement between the two classification methods was fair (κ = 0.38). Autism symptom severity and nonverbal cognitive ability did not predict ADHD diagnoses/symptoms. Results show high rates of ADHD in males with FXS during late adolescence and young adulthood, which are not accounted for by impaired nonverbal cognitive skills or autism symptom severity. DSM-based ADHD-specific scales are recommended over broadband symptom scales to improve accurate identification.
Collapse
Affiliation(s)
- Jessica Klusek
- Jessica Klusek, Shannon L. O'Connor, Alexandra Hickey and Kimberly J. Hills, University of South Carolina
| | - Shannon L O'Connor
- Jessica Klusek, Shannon L. O'Connor, Alexandra Hickey and Kimberly J. Hills, University of South Carolina
| | - Alexandra Hickey
- Jessica Klusek, Shannon L. O'Connor, Alexandra Hickey and Kimberly J. Hills, University of South Carolina
| | - Kimberly J Hills
- Jessica Klusek, Shannon L. O'Connor, Alexandra Hickey and Kimberly J. Hills, University of South Carolina
| | | | | |
Collapse
|
17
|
Chen SY, Yao J, Hu YD, Chen HY, Liu PC, Wang WF, Zeng YH, Zhuang CW, Zeng SX, Li YP, Yang LY, Huang ZX, Huang KQ, Lai ZT, Hu YH, Cai P, Chen L, Wu S. Control of Behavioral Arousal and Defense by a Glutamatergic Midbrain-Amygdala Pathway in Mice. Front Neurosci 2022; 16:850193. [PMID: 35527820 PMCID: PMC9070111 DOI: 10.3389/fnins.2022.850193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
In response to external threatening signals, animals evolve a series of defensive behaviors that depend on heightened arousal. It is believed that arousal and defensive behaviors are coordinately regulated by specific neurocircuits in the central nervous system. The ventral tegmental area (VTA) is a key structure located in the ventral midbrain of mice. The activity of VTA glutamatergic neurons has recently been shown to be closely related to sleep–wake behavior. However, the specific role of VTA glutamatergic neurons in sleep–wake regulation, associated physiological functions, and underlying neural circuits remain unclear. In the current study, using an optogenetic approach and synchronous polysomnographic recording, we demonstrated that selective activation of VTA glutamatergic neurons induced immediate transition from sleep to wakefulness and obviously increased the amount of wakefulness in mice. Furthermore, optogenetic activation of VTA glutamatergic neurons induced multiple defensive behaviors, including burrowing, fleeing, avoidance and hiding. Finally, viral-mediated anterograde activation revealed that projections from the VTA to the central nucleus of the amygdala (CeA) mediated the wake- and defense-promoting effects of VTA glutamatergic neurons. Collectively, our results illustrate that the glutamatergic VTA is a key neural substrate regulating wakefulness and defensive behaviors that controls these behaviors through its projection into the CeA. We further discuss the possibility that the glutamatergic VTA-CeA pathway may be involved in psychiatric diseases featuring with excessive defense.
Collapse
Affiliation(s)
- Shang-Yi Chen
- Department of Epidemiology and Health Statistics, The School of Public Health, Fujian Medical University, Fuzhou, China
| | - Jing Yao
- Fujian Province Key Laboratory of Environment and Health, The School of Public Health, Fujian Medical University, Fuzhou, China
| | - Yu-Duan Hu
- Department of Epidemiology and Health Statistics, The School of Public Health, Fujian Medical University, Fuzhou, China
| | - Hui-Yun Chen
- Fujian Province Key Laboratory of Environment and Health, The School of Public Health, Fujian Medical University, Fuzhou, China
| | - Pei-Chang Liu
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Wen-Feng Wang
- School of Basic Medicine, Fujian Medical University, Fuzhou, China
| | - Yu-Hang Zeng
- School of Basic Medicine, Fujian Medical University, Fuzhou, China
| | - Cong-Wen Zhuang
- School of Basic Medicine, Fujian Medical University, Fuzhou, China
| | - Shun-Xing Zeng
- School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Yue-Ping Li
- School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Liu-Yun Yang
- School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Zi-Xuan Huang
- School of Basic Medicine, Fujian Medical University, Fuzhou, China
| | - Kai-Qi Huang
- School of Basic Medicine, Fujian Medical University, Fuzhou, China
| | - Zhen-Ting Lai
- School of Basic Medicine, Fujian Medical University, Fuzhou, China
| | - Yong-Huai Hu
- School of Basic Medicine, Fujian Medical University, Fuzhou, China
| | - Ping Cai
- Fujian Province Key Laboratory of Environment and Health, The School of Public Health, Fujian Medical University, Fuzhou, China
- *Correspondence: Ping Cai,
| | - Li Chen
- Department of Pharmacology, School of Pharmacy, Fujian Medical University, Fuzhou, China
- Li Chen,
| | - Siying Wu
- Department of Epidemiology and Health Statistics, The School of Public Health, Fujian Medical University, Fuzhou, China
- Siying Wu,
| |
Collapse
|
18
|
Bangert K, Scott KS, Adams C, Kisenwether JS, Giuffre L, Reed J, Thurman AJ, Abbeduto L, Klusek J. Cluttering in the Speech of Young Men With Fragile X Syndrome. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:954-969. [PMID: 35196138 PMCID: PMC9150725 DOI: 10.1044/2021_jslhr-21-00446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/29/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE Cluttering is a fluency disorder that has been noted clinically in individuals with fragile X syndrome (FXS). Yet, cluttering has not been systematically characterized in this population, hindering identification and intervention efforts. This study examined the rates of cluttering in male young adults with FXS using expert clinical opinion, the alignment between expert clinical opinion and objectively quantified features of cluttering from language transcripts, and the association between cluttering and aspects of the FXS phenotype. METHOD Thirty-six men with FXS (aged 18-26 years; M = 22, SD = 2.35) contributed language samples and completed measures of nonverbal cognition, autism symptoms, anxiety, and symptoms of attention-deficit/hyperactivity disorder (ADHD). The presence of cluttering was determined by the consensus of two clinical experts in fluency disorders based on characteristics exhibited in the language sample. Cluttering features (speech rate, disfluencies, etc.) were also objectively quantified from the language transcripts. RESULTS Clinical experts determined that 50% of participants met the criteria for a cluttering diagnosis. Phrase repetitions were the most salient feature that distinguished individuals who cluttered. Although the presence of cluttering was not associated with autism symptoms or mean length of utterance, cluttering was more likely to occur when nonverbal cognitive ability was higher, ADHD symptoms were elevated, and anxiety symptoms were low. CONCLUSIONS Half of the male young adults with FXS exhibited cluttering, which supports FXS as a genetic diagnosis that is highly enriched for risk of cluttering. Cluttering was associated with increased ADHD symptoms and cognitive ability and reduced anxiety symptoms. This study contributes a new description of the clinical presentation of cluttering in men with FXS and may lead to improved understanding of the potential underlying mechanisms of cluttering and eventual refinements to treatment and diagnosis.
Collapse
Affiliation(s)
- Katherine Bangert
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
- Department of Psychology, University of South Carolina, Columbia
| | | | - Charley Adams
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | | | - Lisa Giuffre
- Department of Speech-Language Pathology, Misericordia University, Dallas, PA
| | - Jenna Reed
- Department of Speech-Language Pathology, Misericordia University, Dallas, PA
| | - Angela John Thurman
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento
- MIND Institute, University of California Davis Health, Sacramento
| | - Leonard Abbeduto
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento
- MIND Institute, University of California Davis Health, Sacramento
| | - Jessica Klusek
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| |
Collapse
|
19
|
A glutamatergic basal forebrain to midbrain circuit mediates wakefulness and defensive behavior. Neuropharmacology 2022; 208:108979. [DOI: 10.1016/j.neuropharm.2022.108979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/29/2021] [Accepted: 01/30/2022] [Indexed: 11/24/2022]
|
20
|
He C, Wu C, Yang T, He Y, Yan J, Lin Y, Du Y, He S, Wu S, Cao B. Trajectories and predictors of social avoidance in female patients with breast cancer. Front Psychiatry 2022; 13:1051737. [PMID: 36506424 PMCID: PMC9732026 DOI: 10.3389/fpsyt.2022.1051737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Social avoidance plays an important role in influencing quality of life among patients with breast cancer. Social avoidance behaviors change with treatment periods. However, the trajectory patterns and the predictive factors have not been fully studied. OBJECTIVE This study examined the growth trajectory of social avoidance and its predictors in patients with breast cancer. MATERIALS AND METHODS A total of 176 patients with breast cancer in a university hospital in Shaanxi Province, China, were followed up four times over 6 months following surgery, and data from the final 144 patients were analyzed. The growth mixed model (GMM) was used to identify the trajectory categories, and the predictive factors of the trajectory types were analyzed by logistic regression. RESULTS The best-fit growth mixture modeling revealed three class models: persistent high social avoidance group (Class 1), social avoidance increased first and then decreased group (Class 2), and no social avoidance group (Class 3), accounting for 13.89, 31.94, and 54.17% of patients, respectively. Single-factor analysis showed that family income per capita, residence, and temperament type were related to the social avoidance trajectory. Logistic regression analysis showed that only temperament type was an independent predictor of the social avoidance trajectory, and patients with melancholia were more likely to have persistent high social avoidance. CONCLUSION Our study proved the heterogeneity of social avoidance behaviors and the influencing effect of temperament type on the development of social avoidance behaviors in Chinese patients with breast cancer. Health professionals should pay more attention to patients who are at higher risk of developing a persistent social avoidance pattern and provide target interventions.
Collapse
Affiliation(s)
- Chunyan He
- Department of Nursing, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chao Wu
- Department of Nursing, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Tianqi Yang
- Department of Psychology, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yang He
- Department of Psychology, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jiaran Yan
- Department of Nursing, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yawei Lin
- Department of Nursing, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yanling Du
- Department of Nursing, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shizhe He
- Department of Nursing, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shengjun Wu
- Department of Psychology, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Baohua Cao
- Department of Nursing, Fourth Military Medical University, Xi'an, Shaanxi, China
| |
Collapse
|
21
|
Dominick KC, Andrews HF, Kaufmann WE, Berry-Kravis E, Erickson CA. Psychotropic Drug Treatment Patterns in Persons with Fragile X Syndrome. J Child Adolesc Psychopharmacol 2021; 31:659-669. [PMID: 34818076 DOI: 10.1089/cap.2021.0042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective: Psychiatric comorbidity is common in fragile X syndrome (FXS) and often addressed through pharmacological management. Here we examine data in the Fragile X Online Registry With Accessible Research Database (FORWARD) to characterize specific symptoms being treated with psychotropic medication, patterns of medication use, as well as the influence of gender, intellectual disability (ID), age, and autism spectrum disorder (ASD) diagnosis. Methods: Data were drawn from the 975 participants who have a completed clinician form. We explored the frequency of psychotropic medication use for the following symptom clusters: attention, hyperactivity, anxiety, hypersensitivity, obsessive-compulsive disorder (OCD), mood swings, irritability/agitation, aggression, and self-injury (IAAS). Results: A majority of participants (617 or 63.3%) were taking a psychotropic medication, including investigational drugs. Medications were often targeting multiple symptoms. Psychotropic medication use was more common in males, adolescents, and those with comorbid ID and ASD. Anxiety was the most frequently targeted symptom, followed by attention-deficit/hyperactivity disorder symptoms and IAAS. Selective serotonin reuptake inhibitors (SSRIs) were the most frequently prescribed medication class among all patients (n = 266, 43%), followed by stimulants (n = 235, 38%), each with no gender difference. Antipsychotics were the third most frequently prescribed medication class (n = 205, 33%), and were more frequently prescribed to males and those with ID and ASD. Conclusions: Anxiety, attention and hyperactivity were the most common symptom targets for psychopharmacologic intervention in FXS. Our results support clinical knowledge that males with comorbid ASD and ID have a more severe presentation requiring more intervention including medications. These results highlight the need for examination of symptom overlap and interaction.
Collapse
Affiliation(s)
- Kelli C Dominick
- Department of Psychiatry, University of Cincinnati College of Medicine. Cincinnati, Ohio, USA.,Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Howard F Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Walter E Kaufmann
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elizabeth Berry-Kravis
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurological Sciences, and Rush University Medical Center, Chicago, Illinois, USA.,Department of Biochemistry, Rush University Medical Center, Chicago, Illinois, USA
| | - Craig A Erickson
- Department of Psychiatry, University of Cincinnati College of Medicine. Cincinnati, Ohio, USA.,Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| |
Collapse
|
22
|
Porceddu PF, Ciampoli M, Romeo E, Garrone B, Durando L, Milanese C, Di Giorgio FP, Reggiani A. The novel potent GSK3 inhibitor AF3581 reverts fragile X syndrome phenotype. Hum Mol Genet 2021; 31:839-849. [PMID: 34596681 DOI: 10.1093/hmg/ddab251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/14/2022] Open
Abstract
Glycogen synthase kinase 3 (GSK3) is a kinase mediating phosphorylation on serine and threonine amino acid residues of several target molecules. The enzyme is involved in the regulation of many cellular processes and aberrant activity of GSK3 has been linked to several disease conditions such as Fragile X Syndrome (FXS). Recent evidences demonstrating an increased activity of GSK3 in murine models of FXS, suggest that dysregulation/hyperactivation of the GSK3 path should contribute to FXS development. A likely possibility could be that in FXS there is a functional impairment of the upstream inhibitory input over GSK3 thus making overactive the kinase. Since GSK3 signaling is a central regulatory node for critical neurodevelopmental pathways, understanding the contribution of GSK3 dysregulation to FXS, may provide novel targets for therapeutic interventions for this disease. In this study we used AF3581, a potent GSK3 inhibitor that we recently discovered, in an in vivo FXS mouse model to elucidate the crucial role of GSK3 in specific behavioral patterns (locomotor activity, sensorimotor gating and social behavior) associated with this disease. All the behavioral alterations manifested by Fmr1 knockout mice were reverted after a chronic treatment with our GSK3 inhibitor, confirming the importance of this pathway as a therapeutic target.
Collapse
Affiliation(s)
- Pier Francesca Porceddu
- D3 Validation Research Line, Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - Mariasole Ciampoli
- D3 Validation Research Line, Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - Elisa Romeo
- D3 Validation Research Line, Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | | | - Lucia Durando
- Angelini Pharma S.p.A., Viale Amelia 70, 00181 Rome, Italy
| | | | | | - Angelo Reggiani
- D3 Validation Research Line, Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| |
Collapse
|
23
|
Smith K, Hogan AL, Will E, Roberts JE. Attention Bias and Prodromal Anxiety Symptoms in Toddlers With Fragile X Syndrome and Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:167-181. [PMID: 33651888 PMCID: PMC8108623 DOI: 10.1352/1944-7558-126.2.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/10/2020] [Indexed: 06/12/2023]
Abstract
Early identification of behavioral risk markers for anxiety is essential to optimize long-term outcomes in children with neurodevelopmental disorders. This study analyzed attentional avoidance and its relation to anxiety and autism spectrum disorder (ASD) symptomatology during social and nonsocial fear conditions in toddlers with fragile X syndrome (FXS) and Down syndrome (DS). Toddlers with FXS and DS exhibited increased nonsocial attentional avoidance relative to typically developing (TD) toddlers. Attentional avoidance was not related to anxiety symptom severity in any group; however, higher ASD symptom severity was related to more social attentional avoidance in the FXS and TD groups. Findings suggest that there may be different underlying mechanisms driving attentional avoidance across neurodevelopmental disorders.
Collapse
Affiliation(s)
- Kayla Smith
- Kayla Smith, Abigail L. Hogan, Elizabeth Will, and Jane E. Roberts, University of South Carolina
| | - Abigail L Hogan
- Kayla Smith, Abigail L. Hogan, Elizabeth Will, and Jane E. Roberts, University of South Carolina
| | - Elizabeth Will
- Kayla Smith, Abigail L. Hogan, Elizabeth Will, and Jane E. Roberts, University of South Carolina
| | - Jane E Roberts
- Kayla Smith, Abigail L. Hogan, Elizabeth Will, and Jane E. Roberts, University of South Carolina
| |
Collapse
|
24
|
Abstract
Prospective longitudinal studies of idiopathic autism spectrum disorder (ASD) have provided insights into early symptoms and predictors of ASD during infancy, well before ASD can be diagnosed at age 2-3 years. However, research on the emergence of ASD in disorders with a known genetic etiology, contextualized in a developmental framework, is currently lacking. Using a biobehavioral multimethod approach, we (a) determined the rate of ASD in N = 51 preschoolers with fragile X syndrome (FXS) using a clinical best estimate (CBE) procedure with differential diagnoses of comorbid psychiatric disorders and (b) investigated trajectories of ASD symptoms and physiological arousal across infancy as predictors of ASD in preschoolers with FXS. ASD was not diagnosed if intellectual ability or psychiatric disorders better accounted for the symptoms. Our results determined that 60.7% of preschoolers with FXS met the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (DSM-5) criteria for ASD using the CBE procedure. In addition, 92% of these preschoolers presented with developmental delay and 45.4% also met criteria for psychiatric disorders, either anxiety, ADHD, or both. ASD diagnoses in preschoolers with FXS were predicted by elevated scores on traditional ASD screeners in addition to elevated autonomic arousal and avoidant eye contact from infancy.
Collapse
|
25
|
Moskowitz LJ, Will EA, Black CJ, Roberts JE. Restricted and Repetitive Behaviors in Males and Females with Fragile X Syndrome: Developmental Trajectories in Toddlers Through Young Adults. J Autism Dev Disord 2020; 50:3957-3966. [PMID: 32221748 DOI: 10.1007/s10803-020-04459-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
There is limited research on the trajectory of restricted and repetitive behaviors (RRBs) in fragile X syndrome (FXS), with previous studies only examining males and/or examining RRBs as a unitary construct rather than delineating subtypes of RRBs. Thus, we described the trajectory of five subtypes of RRBs in 153 males and females with FXS (aged 1-18 years) with repeated measurement over time (445 total assessments). Multilevel modeling was used to test age-related differences in RRB subtypes between males and females with FXS, controlling for nonverbal IQ. Results showed that lower-order Sensory-Motor behaviors decreased over time for both males and females, while there was no significant change in the higher-order RRBs. The trajectory between males and females differed for Self-Injury.
Collapse
Affiliation(s)
- Lauren J Moskowitz
- Department of Psychology, St. John's University, 8000 Utopia Parkway, Queens, NY, 11439, USA.
| | - Elizabeth A Will
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Conner J Black
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Jane E Roberts
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
26
|
A Behavioural Assessment of Social Anxiety and Social Motivation in Fragile X, Cornelia de Lange and Rubinstein-Taybi Syndromes. J Autism Dev Disord 2020; 50:127-144. [PMID: 31541420 DOI: 10.1007/s10803-019-04232-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Unique socio-behavioural phenotypes are reported for individuals with different neurodevelopmental disorders. Here, the effects of adult familiarity and nature of interaction on social anxiety and social motivation were investigated in individuals with fragile X (FXS; n = 20), Cornelia de Lange (CdLS; n = 20) and Rubinstein-Taybi (RTS; n = 20) syndromes, compared to individuals with Down syndrome (DS; n = 20). The Social Anxiety and Motivation Rating Scale was employed whilst participants completed four social tasks, each administered separately by a familiar adult, and also by an unfamiliar adult. Compared to participants with DS, those with FXS and RTS exhibited high levels of social anxiety but similar levels of social motivation. Participants with CdLS showed heightened social anxiety and reduced social motivation only during interactions with an unfamiliar adult when active participation was voluntary.
Collapse
|