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Sandoval GM, Shim S, Hong DS, Garrett AS, Quintin EM, Marzelli MJ, Patnaik S, Lightbody AA, Reiss AL. Neuroanatomical abnormalities in fragile X syndrome during the adolescent and young adult years. J Psychiatr Res 2018; 107:138-144. [PMID: 30408626 PMCID: PMC6249038 DOI: 10.1016/j.jpsychires.2018.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/01/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
Abstract
Abnormal brain development and cognitive dysfunction have been reported both in children and in adults with fragile X syndrome (FXS). However, few studies have examined neuroanatomical abnormalities in FXS during adolescence. In this study we focus on adolescent subjects with FXS (N = 54) as compared to age- and sex-matched subjects with idiopathic intellectual disability (Comparison Group) (N = 32), to examine neuroanatomical differences during this developmental period. Brain structure was assessed with voxel-based morphometry and independent groups t-test in SPM8 software. Results showed that the FXS group, relative to the comparison group, had significantly larger gray matter volume (GMV) in only one region: the bilateral caudate nucleus, but have smaller GMV in several regions including bilateral medial frontal, pregenual cingulate, gyrus rectus, insula, and superior temporal gyrus. Group differences also were noted in white matter regions. Within the FXS group, lower FMRP levels were associated with less GMV in several regions including cerebellum and gyrus rectus, and less white matter volume (WMV) in pregenual cingulate, middle frontal gyrus, and other regions. Lower full scale IQ within the FXS group was associated with larger right caudate nucleus GMV. In conclusion, adolescents and young adults with FXS demonstrate neuroanatomical abnormalities consistent with those previously reported in children and adults with FXS. These brain variations likely result from reduced FMRP during early neurodevelopment and mediate downstream deleterious effects on cognitive function.
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Warren SF, Brady N, Fleming KK, Hahn LJ. The Longitudinal Effects of Parenting on Adaptive Behavior in Children with Fragile X Syndrome. J Autism Dev Disord 2017; 47:768-784. [PMID: 28074357 DOI: 10.1007/s10803-016-2999-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Several studies have reported declines in adaptive behavior amongst children with fragile X syndrome (FXS) starting in middle childhood. We examined the effects of maternal responsivity on adaptive behavior in 55 children with FXS visited 5-6 times in their homes from early through middle childhood. Our analyses indicated that sustained maternal responsivity had a significant positive impact on the trajectories of communication and to a lesser extent other adaptive behavior domains through middle childhood with many effects remaining significant after controlling for autism symptoms and developmental level. For children who showed declines in adaptive behavior during middle childhood, sustained high levels of maternal responsivity minimized the amount of decline observed in the communication, socialization, and daily living domains.
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Affiliation(s)
- Steven F Warren
- Dole Human Development Center, Department of Speech-Language-Hearing: Sciences and Disorders, The Schiefelbusch Institute for Life Span Studies, The University of Kansas, 1000 Sunnyside Avenue, #3045, Lawrence, KS, 66045-7555, USA.
| | - Nancy Brady
- Department of Speech-Language-Hearing: Sciences and Disorders, The Schiefelbusch Institute for Life Span Studies, The University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS, 66045-7555, USA
| | - Kandace K Fleming
- Schiefelbusch Institute for Life Spans Studies, The University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS, 66045-7555, USA
| | - Laura J Hahn
- Schiefelbusch Institute for Life Spans Studies, The University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS, 66045-7555, USA
- Department of Speech and Hearing Science, University of Illinois, 901S. Sixth St., Champaign, IL, 61820, USA
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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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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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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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Wheeler AC, Bailey DB, Berry-Kravis E, Greenberg J, Losh M, Mailick M, Milà M, Olichney JM, Rodriguez-Revenga L, Sherman S, Smith L, Summers S, Yang JC, Hagerman R. Associated features in females with an FMR1 premutation. J Neurodev Disord 2014; 6:30. [PMID: 25097672 PMCID: PMC4121434 DOI: 10.1186/1866-1955-6-30] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 03/19/2014] [Indexed: 12/31/2022] Open
Abstract
Changes in the fragile X mental retardation 1 gene (FMR1) have been associated with specific phenotypes, most specifically those of fragile X syndrome (FXS), fragile X tremor/ataxia syndrome (FXTAS), and fragile X primary ovarian insufficiency (FXPOI). Evidence of increased risk for additional medical, psychiatric, and cognitive features and conditions is now known to exist for individuals with a premutation, although some features have been more thoroughly studied than others. This review highlights the literature on medical, reproductive, cognitive, and psychiatric features, primarily in females, that have been suggested to be associated with changes in the FMR1 gene. Based on this review, each feature is evaluated with regard to the strength of evidence of association with the premutation. Areas of need for additional focused research and possible intervention strategies are suggested.
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Affiliation(s)
- Anne C Wheeler
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA ; Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Donald B Bailey
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | | | - Jan Greenberg
- Waisman Center, University of Wisconsin, 1500 Highland Avenue, Madison, WI 53705, USA
| | - Molly Losh
- Northwestern University, 2240 Campus Drive, Evanston, IL 60208-3507, USA
| | - Marsha Mailick
- Waisman Center, University of Wisconsin, 1500 Highland Avenue, Madison, WI 53705, USA
| | - Montserrat Milà
- Biochemistry and Molecular Genetics Department, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain
| | - John M Olichney
- Center for Mind and Brain, University of California-Davis, 1 Shields Avenue, Davis, CA 95616, USA ; MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA
| | - Laia Rodriguez-Revenga
- Biochemistry and Molecular Genetics Department, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain
| | | | - Leann Smith
- Waisman Center, University of Wisconsin, 1500 Highland Avenue, Madison, WI 53705, USA
| | - Scott Summers
- Center for Mind and Brain, University of California-Davis, 1 Shields Avenue, Davis, CA 95616, USA ; MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA
| | - Jin-Chen Yang
- Center for Mind and Brain, University of California-Davis, 1 Shields Avenue, Davis, CA 95616, USA ; MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA
| | - Randi Hagerman
- Center for Mind and Brain, University of California-Davis, 1 Shields Avenue, Davis, CA 95616, USA ; MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA
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Brady N, Warren SF, Fleming K, Keller J, Sterling A. Effect of sustained maternal responsivity on later vocabulary development in children with fragile X syndrome. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2014; 57:212-26. [PMID: 24023370 PMCID: PMC3864610 DOI: 10.1044/1092-4388(2013/12-0341)] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
PURPOSE This research explored whether sustained maternal responsivity (a parent–child interaction style characterized by warmth, nurturance, and stability as well as specific behaviors, such as contingent positive responses to child initiations) was a significant variable predicting vocabulary development of children with fragile X syndrome through age 9 years. METHOD Fifty-five mother–child dyads were followed longitudinally when children were between 2 and 10 years of age. Measures of maternal responsivity and child vocabulary were obtained at regular intervals starting at age 2.9 years. Sustained responsivity was indicated by the average responsivity measured over Observations 2–5. Responsivity at the 1st time period, autism symptoms, and cognitive development were used as control variables. RESULTS After controlling for development and autism symptoms, the authors found significant effects for sustained responsivity on receptive vocabulary, expressive vocabulary, and the rate of different words children produced through age 9. CONCLUSIONS Maternal responsivity, which is typically a variable of interest during early childhood, continues to be a significant variable, predicting vocabulary development through the middle childhood period. Thus, responsivity is a potential target for language interventions through this age period.
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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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Losh M, Martin GE, Klusek J, Hogan-Brown AL. Pragmatic Language in autism and fragile X syndrome: Genetic and clinical applications. PERSPECTIVES ON LANGUAGE LEARNING AND EDUCATION 2012; 19:48-55. [PMID: 24660047 PMCID: PMC3961489 DOI: 10.1044/lle19.2.48] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Evidence suggests a strong genetic basis to autism. Our research program focuses on identifying genetically meaningful phenotypes in autism, through family-genetic and cross-population methods, with a particular focus on language and social phenotypes that have been shown to aggregate in families of individuals with autism. In this article, we discuss recent findings from family study research implicating particular language and personality features as markers for genetic liability to autism and fragile X syndrome and FMR1-related variation in relatives. We conclude with consideration of the clinical implications of such findings.
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Affiliation(s)
- Molly Losh
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
| | - Gary E. Martin
- FPG Child Development Institute, University of North Carolina at Chapel Hill
- Division of Speech and Hearing Sciences, Allied Health Sciences, University of North Carolina at Chapel Hill
| | - Jessica Klusek
- FPG Child Development Institute, University of North Carolina at Chapel Hill
- Division of Speech and Hearing Sciences, Allied Health Sciences, University of North Carolina at Chapel Hill
| | - Abigail L. Hogan-Brown
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University
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Bourgeois JA, Seritan AL, Casillas EM, Hessl D, Schneider A, Yang Y, Kaur I, Cogswell JB, Nguyen DV, Hagerman RJ. Lifetime prevalence of mood and anxiety disorders in fragile X premutation carriers. J Clin Psychiatry 2011; 72:175-82. [PMID: 20816038 PMCID: PMC4038118 DOI: 10.4088/jcp.09m05407blu] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 08/25/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The authors studied the lifetime prevalence of DSM-IV-TR psychiatric disorders in a population of adults with the fragile X premutation. METHOD The Structured Clinical Interview for DSM-IV was conducted, from 2007-2008, in 85 individuals with the fragile X premutation, 47 with the fragile X-associated tremor/ataxia syndrome (FXTAS; 33 male, 14 female; mean age = 66 years) and 38 without FXTAS (16 male, 22 female; mean age = 52 years). Lifetime prevalence for mood and anxiety disorders among carriers with and without FXTAS was compared to available age-specific population estimates from the National Comorbidity Survey Replication (NCS-R). RESULTS Among participants with FXTAS, 30 (65%) met lifetime DSM-IV-TR criteria for a mood disorder; 24 (52%) met lifetime DSM-IV-TR criteria for an anxiety disorder. Among the non-FXTAS participants, there were 15 instances of lifetime mood disorder (42%) and 18 of lifetime anxiety disorder (47%). When compared to age-specific NCS-R data, the lifetime prevalences of any mood disorder (P < .0001), major depressive disorder (P < .0001), any anxiety disorder (P < .0001), panic disorder (P = .006), specific phobia (P = .0003), and posttraumatic stress disorder (P = .004) were significantly higher in participants with FXTAS. The lifetime rates of social phobia in individuals with the premutation without FXTAS were significantly higher than NCS-R data (P = .001). CONCLUSIONS This sample of carriers of the fragile X premutation had a notably high lifetime risk of mood and anxiety disorders. Mood and anxiety disorders may be part of the clinical phenotype of the fragile X premutation conditions, especially in carriers with FXTAS. Clinicians encountering these patients are advised to consider FXTAS as a neuropsychiatric syndrome as well as a neurologic disorder.
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Affiliation(s)
- James A. Bourgeois
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, Sacramento, CA
| | - Andreea L. Seritan
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, Sacramento, CA
| | - E. Melina Casillas
- M.I.N.D. Institute, University of California, Davis Medical Center,Department of Pediatrics, University of California, Davis Medical Center
| | - David Hessl
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, Sacramento, CA,M.I.N.D. Institute, University of California, Davis Medical Center
| | - Andrea Schneider
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, Sacramento, CA,M.I.N.D. Institute, University of California, Davis Medical Center
| | - Ying Yang
- Department of Public Health Sciences, University of California, Davis, Davis CA
| | - Inderjeet Kaur
- M.I.N.D. Institute, University of California, Davis Medical Center
| | - Jennifer B. Cogswell
- M.I.N.D. Institute, University of California, Davis Medical Center,Department of Pediatrics, University of California, Davis Medical Center
| | - Danh V. Nguyen
- Department of Public Health Sciences, University of California, Davis, Davis CA
| | - Randi J. Hagerman
- M.I.N.D. Institute, University of California, Davis Medical Center,Department of Pediatrics, University of California, Davis Medical Center
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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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Warren SF, Brady N, Sterling A, Fleming K, Marquis J. Maternal responsivity predicts language development in young children with fragile X syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2010; 115:54-75. [PMID: 20025359 PMCID: PMC3045825 DOI: 10.1352/1944-7558-115.1.54] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Accepted: 09/01/2009] [Indexed: 05/04/2023]
Abstract
The relationship between early maternal responsivity and later child communication outcomes in young children with fragile X syndrome was investigated. Data were obtained from 55 mother-child dyads over a 36-month period. Performance data were obtained at each measurement point from video observations of four different contexts. These were coded for (a) child communication behaviors, (b) parent responsivity, and (c) behavior management behaviors. Results indicate that early maternal responsivity predicts the level of four important child language outcomes at 36 months of age after controlling for child developmental level and autism symptomology.
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Affiliation(s)
- Steven F Warren
- Institute for Life Span Studies, University of Kansas, Lawrence, KS 66045-2930, USA.
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Bourgeois J, Coffey S, Rivera SM, Hessl D, Gane LW, Tassone F, Greco C, Finucane B, Nelson L, Berry-Kravis E, Grigsby J, Hagerman PJ, Hagerman RJ. A review of fragile X premutation disorders: expanding the psychiatric perspective. J Clin Psychiatry 2009; 70:852-62. [PMID: 19422761 PMCID: PMC2705685 DOI: 10.4088/jcp.08m04476] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 11/11/2008] [Indexed: 01/28/2023]
Abstract
CONTEXT Fragile X premutation conditions are associated with a significant degree of psychopathology and thus are of interest to the psychiatrist. Remarkable advances at the molecular level have enhanced our understanding of fragile X premutation disorders. OBJECTIVE The authors review the genetic, molecular, neuroimaging, and clinical (systemic, neurologic, and psychiatric) manifestations of the premutation carrier state (55-200 CGG repeats) of the fragile X mental retardation 1 (FMR1) gene. DATA SOURCES The search for the psychiatric clinical manifestations of fragile X-associated conditions was accomplished by PubMed for clinical papers published between 1970 and 2008 with the following search terms: Fragile X syndrome, depression, psychosis, anxiety, and dementia. STUDY SELECTION Articles addressing psychiatric symptoms in premutation carriers based on review of the abstracts were reviewed. As the majority of the literature on this topic is based on case reports and small case series, these were included in the database. RESULTS Reported clinical manifestations of psychiatric illness in premutation carriers include an apparently significant rate of cognitive, mood, anxiety, and other psychiatric disorders. Fragile X premutation-associated conditions are part of the clinical differential diagnosis of several psychiatric syndromes, particularly in pedigrees with known fragile X syndrome cases. CONCLUSIONS Fragile X-associated psychiatric manifestations serve as a useful model for a molecular genesis of neuropsychiatric illness. Because of the multigenerational expression of fragile X-associated neuropsychiatric illness, there is a prominent role for genetic testing and genetic counseling of patients and their relatives. Genetic testing is confirmatory of the FMR1 premutation and is an essential component of the clinical evaluation. Psychopharmacologic and psychotherapeutic treatment of fragile X-associated psychiatric illnesses may improve patient function and assist in adaptation to the burden of a genetic neuropsychiatric illness.
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Affiliation(s)
- James Bourgeois
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, Sacramento, CA
| | - Sarah Coffey
- M.I.N.D. Institute, University of California, Davis Medical Center, Sacramento, CA., Department of Pediatrics, University of California, Davis Medical Center, Sacramento, CA
| | - Susan M. Rivera
- M.I.N.D. Institute, University of California, Davis Medical Center, Sacramento, CA., Department of Psychology, University of California, Davis
| | - David Hessl
- M.I.N.D. Institute, University of California, Davis Medical Center, Sacramento, CA., Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA
| | - Louise W. Gane
- M.I.N.D. Institute, University of California, Davis Medical Center, Sacramento, CA
| | - Flora Tassone
- M.I.N.D. Institute, University of California, Davis Medical Center, Sacramento, CA., Department of Biochemistry and Molecular Medicine, University of California, Davis, School of Medicine, Sacramento, CA
| | - Claudia Greco
- Department of Pathology, University of California, Davis Medical Center, School of Medicine, Sacramento, CA
| | - Brenda Finucane
- Genetic Services, Elwyn, Inc., 111 Elwyn Road, Elwyn, Pennsylvania
| | - Lawrence Nelson
- Integrative Reproductive Medicine Unit, Intramural Research Program on Reproductive and Adult Endocrinology, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, and Biochemistry, RUSH University Medical Center, Chicago, IL
| | - Jim Grigsby
- Department of Medicine, University of Colorado at Denver and Health Sciences Center, Denver, CO
| | - Paul J. Hagerman
- Department of Biochemistry and Molecular Medicine, University of California, Davis, School of Medicine, Sacramento, CA
| | - Randi J. Hagerman
- M.I.N.D. Institute, University of California, Davis Medical Center, Sacramento, CA., Department of Pediatrics, University of California, Davis Medical Center, Sacramento, CA
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14
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Roberts JE, Bailey DB, Mankowski J, Ford A, Sideris J, Weisenfeld LA, Heath TM, Golden RN. Mood and anxiety disorders in females with the FMR1 premutation. Am J Med Genet B Neuropsychiatr Genet 2009; 150B:130-9. [PMID: 18553360 DOI: 10.1002/ajmg.b.30786] [Citation(s) in RCA: 198] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Fragile X syndrome (FXS) is a model for studying the relative contributions of genetic and environmental factors to psychiatric disorders in mothers of children with disabilities. Here, we examine the frequency and predictors of mood and anxiety disorders in mothers with the FMR1 premutation. Ninety-three females with the FMR1 premutation were in the study and were compared to 2,159 women from the National Comorbidity Survey Replication (NCS-R) dataset. Mood and anxiety disorders were assessed using the SCID-I. Our data reflect elevated lifetime major depressive disorder (MDD), lifetime panic disorder without agoraphobia and current agoraphobia without panic disorder in the FMR1 premutation sample. Also, we found a low frequency of lifetime social phobia, specific phobia, and post-traumatic stress disorders and current specific phobia in the FMR1 premutation sample. The profile of MDD in the FMR1 premutation sample was not episodic or comorbid with an anxiety disorder, as in the NCS-R dataset. Never having been married and smaller CGG repeat length were associated with increased likelihood of MDD while increased children with FXS in the family and greater child problem behaviors were associated with increased likelihood of an anxiety disorder in the FMR 1 premutation group. Major depression in females with the FMR1 premutation may not be characterized as an episodically chronic recurrent disorder as it is in community samples and may have a genetic basis given the relationship with CGG repeat length and lack of association with all child and most demographic factors.
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Affiliation(s)
- Jane E Roberts
- FPG Child Development Institute, The University of North Carolina at Chapel Hill, North Carolina, USA.
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15
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Aberrant neural function during emotion attribution in female subjects with fragile X syndrome. J Am Acad Child Adolesc Psychiatry 2008; 47:1443-354. [PMID: 18981933 PMCID: PMC4820328 DOI: 10.1097/chi.0b013e3181886e92] [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: 12/30/2022]
Abstract
OBJECTIVE Fragile X (FraX) syndrome is caused by mutations of the FraX mental retardation-1 gene-a gene responsible for producing FraX mental retardation protein. The neurocognitive phenotype associated with FraX in female subjects includes increased risk for emotional disorders including social anxiety, depression, and attention deficit. Here, the authors investigated the neurobiological systems underlying emotion attribution in female subjects with FraX syndrome. METHOD While undergoing functional magnetic resonance imaging, 10 high-functioning female subjects with FraX syndrome and 10 typically developing (TD) female subjects were presented with photographs of happy, sad, and neutral faces and instructed to determine the facial emotion. RESULTS No significant group differences were found for the recognition of happy faces, although the FraX group showed a trend toward a significant difference for the recognition of sad faces and significantly poorer recognition of neutral faces. Controlling for between-group differences in IQ and performance accuracy, the TD group had greater activation than the FraX group in the anterior cingulate cortex (ACC) for neutral faces compared with scrambled faces and the caudate for sad faces compared with scrambled faces (but not for sad faces compared with neutral faces). In the FraX group, FraX mental retardation protein levels positively correlated with activation in the dorsal ACC for neutral, happy, and sad faces when independently compared with scrambled faces. Significantly greater negative correlation between IQ and insula activation for neutral faces relative to scrambled faces was observed in the FraX group compared with the TD group. Significantly greater positive correlation between IQ and ACC activation for neutral faces relative to scrambled faces was observed in the TD group compared with the FraX group. CONCLUSIONS Although emotion recognition is generally spared in FraX syndrome, the emotion circuit (i.e., ACC, caudate, insula) that modulates emotional responses to facial stimuli may be disrupted.
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16
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Bailey DB, Sideris J, Roberts J, Hatton D. Child and genetic variables associated with maternal adaptation to fragile X syndrome: A multidimensional analysis. Am J Med Genet A 2008; 146A:720-9. [DOI: 10.1002/ajmg.a.32240] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Abstract
Fragile X syndrome (FraX) is the most common known cause of inherited mental impairment. FMR1 gene mutations, the cause of FraX, lead to reduced expression of FMR1 protein and an increased risk for a particular profile of cognitive, behavioral, and emotional dysfunction. The study of individuals with FraX provides a unique window of understanding into important disorders such as autism, social phobia, cognitive disability, and depression. This review highlights the typical phenotypic features of individuals with FraX, discussing the apparent strengths and weaknesses in intellectual functioning, as evidenced from longitudinal follow-up studies. It also discusses recent neuroanatomic findings that may pave the way for more focused disease-specific pharmacologic and behavioral interventions. This article describes the results of recent medication trials designed to target symptoms associated with FraX. It also describes some recent behavioral interventions that were conducted in our laboratory.
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Affiliation(s)
- Allan L Reiss
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305-5975, USA
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18
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Wheeler A, Hatton D, Reichardt A, Bailey D. Correlates of maternal behaviours in mothers of children with fragile X syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2007; 51:447-62. [PMID: 17493028 DOI: 10.1111/j.1365-2788.2006.00896.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND The behaviours of 24 mothers of children with fragile X syndrome (FXS) with their affected children were examined during planned observations in their homes. The goal of this study was to describe concurrent maternal interactive behaviour and the factors that influence the type and frequency of these behaviours within this group. METHODS The frequency of maintaining, directive and scaffolding behaviours and the extent to which the mothers displayed warm sensitivity and restrictions were examined within a 60-min naturalistic observation and a 10-min toy play observation. Rating scales and parent questionnaires were used to assess selected maternal mental health factors, including depression, anxiety, stress and social support. The cognitive status of mothers and developmental and behavioural abilities of children were also examined. RESULTS The women in this study used primarily maintaining behaviours in interactions with their children. Maintaining behaviours and warm sensitivity were consistent across structured and unstructured settings, while directive, scaffolding and restricting were not correlated across the two settings. Child receptive language skills were related to higher rates of maintaining and scaffolding behaviours. The women reported clinically significant levels of stress, depression and anxiety at a prevalence rate higher than that of the general public. Child behaviour problems contributed to maternal stress, and mothers with higher stress engaged in fewer interactions with their children. CONCLUSIONS The relations between maternal stress, child problem behaviour and number of interactive behaviours exhibited by the mothers in this study provide information that can inform interventions and provide direction for future research exploring environmental influences on the development of children with fragile X syndrome.
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Affiliation(s)
- Anne Wheeler
- FPG Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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19
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Bailey DB, Golden RN, Roberts J, Ford A. Maternal depression and developmental disability: Research critique. ACTA ACUST UNITED AC 2007; 13:321-9. [DOI: 10.1002/mrdd.20172] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Abstract
A quantitative examination was made of the association of parental mood and anxiety disorders with severity of disability within a large sample of young children with Pervasive Developmental Disorder (PDD). Maternal recurrent mood disorders were associated with elevated cognitive and adaptive functioning in their affected children, parent reports of increased behavior problems and teacher reports of an internalizing behavioral style. Maternal histories of anxiety disorders and paternal depression or anxiety disorders were not associated with levels of adaptive/cognitive functioning or levels of maladaptive behaviors in the children. Various genetic models are discussed. It is hypothesized that genes associated with recurrent depression in women may exert a "protective" effect on cognition and adaptive functioning in children with PDD.
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Affiliation(s)
- Ira L Cohen
- Dept. of Psychology and George A. Jervis Clinic, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island, NY 10314, USA.
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21
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22
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Lachiewicz AM, Dawson DV, Spiridigliozzi GA, McConkie-Rosell A. Arithmetic difficulties in females with the fragile X premutation. Am J Med Genet A 2006; 140:665-72. [PMID: 16508954 DOI: 10.1002/ajmg.a.31082] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Females with the fragile X full mutation have been reported to have difficulty learning mathematics. Women with the fragile X premutation often give a history of mathematics difficulties in themselves especially with higher level math. In order to evaluate whether women with the premutation have difficulty with math, we asked women with both the fragile X premutation and full mutation to complete the Wide Range Achievement Test-3. For the group of 39 women with the fragile X premutation, the median standard score on the Arithmetic portion was 93, which was significantly lower (P = 0.001) than the median of the standardized norm of 100. Only nine of the women had Arithmetic scores at or above the 50th centile, while over half of the women had standard scores at or above the 50th centile in Reading and Spelling. The eight women with the full mutation also had lower Arithmetic scores than Reading and Spelling scores. These data suggest that mathematics may be an area of relative weakness for the women with the premutation as well as the full mutation. This possibility should be evaluated further by using other measures. This information is important both for counseling purposes and to understand whether a mathematics deficit is evidence of low expression of the FMR1 gene in the premutation state.
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Affiliation(s)
- Ave M Lachiewicz
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710, USA.
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23
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Abstract
The present French-German investigation of fragile-X syndrome (fra-X) was undertaken to disentangle genetic from environmental effects on cognitive performance as assessed with the following measures: Wechsler Adult Intelligence Scale-Revised (WAIS-R), Wisconsin Card Sorting Test, Trail-Making Test, Tower of Hanai, Verbal Fluency Test, Stroop Test, short-term and consolidation memory, and the d2 task. Groups with different genotypes (n = 11 mothers with a full mutation in the FMR-1 gene of fra-X children; n = 65 mothers with a premutation in the FMR-1 gene of fra-X children; n = 18 siblings of these mothers with normal CGG repeats) and with different psychosocial stressors from fra-X families (n = 14 siblings with a premutation but without affected children of their own) were examined. A group of mothers of non-fra-X autistic children (n = 39) formed an external control group. Previous findings were replicated concerning cognitive performance of FMR-1 full-mutation carrier mothers, who were characterized by lower overall IQ and poorer performance than the group of mothers with the FMR-1 premutation in verbal and performance subtests of the WAIS-R, tests of executive-frontal lobe functioning, and tests of sustained attention. Carriers of the FMR-1 premutation, whether they were mothers of affected children or not,performed in a similar way on all neuropsychological tasks to the intrafamilial control group without CGG amplification. On the basis of these results, it is concluded that there is no neuropsychological evidence of reduced cognitive performance of FMR-1 premutation carriers compared with performance of two control groups with normal CGG repeats. Furthermore, the psychosocial burden of raising fra-X children does not exert an environmental effect on neuropsychological test performance.
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Franke P, Leboyer M, Gänsicke M, Weiffenbach O, Biancalana V, Cornillet-Lefebre P, Croquette MF, Froster U, Schwab SG, Poustka F, Hautzinger M, Maier W. Genotype-phenotype relationship in female carriers of the premutation and full mutation of FMR-1. Psychiatry Res 1998; 80:113-27. [PMID: 9754690 DOI: 10.1016/s0165-1781(98)00055-9] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The present French-German cooperative study focuses on the genotype-phenotype relationship of mutations of the FMR-1 gene and psychiatric conditions in mothers with a full mutation in the FMR-1 gene of fra-X children (n=13), mothers with a premutation in the FMR-1 gene of fra-X children (n=61), as well as premutated siblings of these mothers without affected children (n=17) and two non-mutated control groups: (1) siblings of these mothers with normal CGG repeat (n=18); and (2) mothers of non-fra-X autistic children (n=42). Mothers with a full mutation in the FMR-1 gene and mothers with a premutation in the FMR-1 gene did not differ in the frequency of any axis I disorder; however, both groups were diagnosed with social phobia more often than the control group of mothers of autistic children. Moreover, mothers with a premutation in the FMR-1 gene of fra-X children and their siblings with the premutation (without affected offspring) revealed a similar frequency of social phobia. Furthermore avoidant personality disorder was more common in groups of carriers of the full premutation than in siblings without mutation or than the control group of mothers with autistic children. On the basis of our data, we therefore suggest that social avoidance (expressed as social phobia or avoidant personality disorder) has been underestimated in previous studies of carriers with the FMR-1 full mutation or premutation. Comorbidity of axis I and axis II psychiatric diagnoses was mainly restricted to the group of carriers of the full mutation and carriers of the premutation of FMR-1. Correlations between size of CGG repeat and IQ as well as CGG and age of onset of axis I diagnosis were non-significant. IQ of subjects had no impact on presence or absence of axis I and/or axis II diagnoses.
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Affiliation(s)
- P Franke
- Department of Psychiatry, University of Bonn, Germany.
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25
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McClure E, Rogeness GA, Thompson NM. Characteristics of adolescent girls with depressive symptoms in a so-called "normal' sample. J Affect Disord 1997; 42:187-97. [PMID: 9105960 DOI: 10.1016/s0165-0327(96)01412-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Forty-four percent of adolescent girls who had been screened for absence of psychiatric disorder reported depressive symptoms on a structured interview. Girls reporting symptoms were assigned to a depression group and compared to those who were free of depressive symptoms on behavioral and neuropsychological measures to determine if there were meaningful differences in cognition, behavior and motivation/self-perception between groups. METHOD Adolescent girls were randomly selected from local schools to participate in a study of neuropsychological development in adolescence. Those who volunteered and whose parents reported them to be free of psychiatric disorders were enrolled and completed a battery of behavioral, neuropsychological and motivation/self-perception measures. RESULTS The depressed group showed more behavioral problems, evaluated themselves as less competent, showed more extrinsic motivational orientation, had lower IQ and differed on a measure of visual spatial perception. CONCLUSION The frequency of subclinical depression is high in adolescent girls, even when parents report no psychiatric/emotional problems. The increase in problem behaviors and extrinsic motivation, as well as the decrease in feelings of self-worth suggest that this group may benefit from intervention. Poorer performance on a measure of visual spatial perception needs further investigation to confirm its association with depression and understand its relationship to depressive symptoms.
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Affiliation(s)
- E McClure
- Department of Psychiatry, University of Texas Health Science Center, San Antonio 78284-7792, USA
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