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Corbo A, Tzeng JP, Scott S, Cheves E, Cope H, Peay H. Parent perspectives following newborn screening resulting in diagnoses of fragile X syndrome or fragile X premutation. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 148:104719. [PMID: 38507982 DOI: 10.1016/j.ridd.2024.104719] [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: 10/28/2023] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Fragile X syndrome (FXS) is the most common inherited cause of intellectual disability. Early Check, a voluntary newborn screening study, screened 18,833 newborns for FXS over ∼3 years. Exploring parental attitudes and perspectives can provide insight to the potential future acceptability of public health screening. METHODS AND PROCEDURES Mothers of infants who received a screen positive result for FXS (n = 6) or fragile X premutation (FXPM; n = 18) were interviewed about their perceptions and experiences. OUTCOMES AND RESULTS Mothers of children with FXS described utility in receiving information about their child, particularly to monitor for potential developmental issues and intervene early; overall mothers did not regret participating. Mothers reported various reactions to receiving the FXS or FXPM results including (1) stress and worry; (2) guilt; (3) sadness and disappointment; (4) neutrality, relief, and acceptance; and (5) confusion and uncertainty. CONCLUSIONS AND IMPLICATIONS Despite initial reactions such as sadness, stress, and worry, mothers found value in learning of their child's presymptomatic diagnosis of FXS, particularly the anticipated long-term benefits of early diagnosis to their child's health and wellbeing. Our results indicate that professionals returning positive newborn screening results should anticipate and prepare for reactions such as parental shock, guilt, sadness, and uncertainty. Genetic counseling and psychosocial support are critical to supporting families.
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Affiliation(s)
- Allyson Corbo
- Center for Communication and Engagement Research, RTI International, Research Triangle Park, NC, USA
| | - Janice P Tzeng
- Center for Communication and Engagement Research, RTI International, Research Triangle Park, NC, USA
| | - Samantha Scott
- Genomics and Translational Research Center, RTI International, Research Triangle Park, NC, USA
| | - Emily Cheves
- Genomics and Translational Research Center, RTI International, Research Triangle Park, NC, USA
| | - Heidi Cope
- Genomics and Translational Research Center, RTI International, Research Triangle Park, NC, USA
| | - Holly Peay
- Genomics and Translational Research Center, RTI International, Research Triangle Park, NC, USA.
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2
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Weisz ED, Fenton AR, Jongens TA. PGC-1α integrates insulin signaling with mitochondrial physiology and behavior in a Drosophila model of Fragile X Syndrome. NPJ METABOLIC HEALTH AND DISEASE 2024; 2:2. [PMID: 38741938 PMCID: PMC11090494 DOI: 10.1038/s44324-024-00004-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/02/2024] [Indexed: 05/16/2024]
Abstract
Fragile X Syndrome (FXS) is the most prevalent monogenetic form of intellectual disability and autism. Recently, dysregulation of insulin signaling (IS) and aberrations in mitochondrial function have emerged as robust, evolutionarily conserved components of FXS pathophysiology. However, the mechanisms by which altered IS and mitochondrial dysfunction impact behavior in the context of FXS remain elusive. Here, we show that normalization of IS improves mitochondrial volume and function in flies that lack expression of dfmr1, the Drosophila homolog of the causal gene of FXS in humans. Further, we demonstrate that dysregulation of IS underlies diminished expression of the mitochondrial master regulator PGC-1α/Spargel in dfmr1 mutant flies. These results are behaviorally relevant, as we show that pan-neuronal augmentation of PGC-1α/Spargel improves circadian behavior in dfmr1 mutants. Notably, we also show that modulation of PGC-1α/Spargel expression in wild-type flies phenocopies the dfmr1 mutant circadian defect. Taken together, the results presented herein provide a mechanistic link between mitochondrial function and circadian behavior both in FXS pathogenesis as well as more broadly at the interface between metabolism and behavioral output.
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Affiliation(s)
- Eliana D. Weisz
- Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Autism Spectrum Program of Excellence, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Adam R. Fenton
- Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Thomas A. Jongens
- Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Autism Spectrum Program of Excellence, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
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3
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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.
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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
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4
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Abstract
Although autism spectrum disorder (ASD) is the prototypical psychiatric disorder of social impairment, several if not most psychiatric disorders are characterized by prominent impairments in social functioning. A challenge in clinically assessing and describing social impairment is that it has been variably defined and can be difficult to measure. In this article we consider the psychiatric differential diagnosis of social impairment within the DSM-5 framework. We describe the features of social impairment in 13 DSM-5 disorders from a developmental perspective and highlight diagnostic factors that differentiate among the disorders, including the main features of social impairment, verbal communication, nonverbal communication, course of social impairment, social cognition, and key features of accompanying neuropsychiatric symptoms. We conclude by describing an approach for assessing social impairment across the lifespan.
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5
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Long JY, Jiang W, Xia HB, Fu JY, Lu P, Hu F, Feng WC, Sun WW, Gao MM, Yi YH, Long YS. FMRP-absence-induced up-regulation of hypothalamic MAP1B expression decreases AgRP level linking with reduces in food intake and body weight. Neurochem Int 2020; 140:104847. [DOI: 10.1016/j.neuint.2020.104847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 01/22/2023]
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Fitzpatrick SE, Schmitt LM, Adams R, Pedapati EV, Wink LK, Shaffer RC, Sage J, Weber JD, Dominick KC, Erickson CA. Pediatric Quality of Life Inventory (PedsQL) in Fragile X Syndrome. J Autism Dev Disord 2020; 50:1056-1063. [PMID: 31728808 DOI: 10.1007/s10803-019-04292-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To date, health related quality of life (QoL) has not been systematically evaluated in youth with fragile X syndrome (FXS), the most common single gene cause of autism and the most common inherited form of developmental disability. We describe QoL data gathered using the Pediatric Quality of Life Inventory (PedsQL) completed online by 364 parents of youth with FXS. Parents consistently reported across all gender and age groups that their children experienced the highest QoL in Physical functioning and the lowest QoL in Cognitive functioning. Overall, older children with FXS had increase QoL ratings in the domains of School and Cognitive function.
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Affiliation(s)
- Sarah E Fitzpatrick
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA
| | - Lauren M Schmitt
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA
| | - Ryan Adams
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ernest V Pedapati
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Logan K Wink
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rebecca C Shaffer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jessica Sage
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA
| | | | - Kelli C Dominick
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Craig A Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA. .,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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7
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Coll-Tané M, Krebbers A, Castells-Nobau A, Zweier C, Schenck A. Intellectual disability and autism spectrum disorders 'on the fly': insights from Drosophila. Dis Model Mech 2019; 12:dmm039180. [PMID: 31088981 PMCID: PMC6550041 DOI: 10.1242/dmm.039180] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Intellectual disability (ID) and autism spectrum disorders (ASD) are frequently co-occurring neurodevelopmental disorders and affect 2-3% of the population. Rapid advances in exome and genome sequencing have increased the number of known implicated genes by threefold, to more than a thousand. The main challenges in the field are now to understand the various pathomechanisms associated with this bewildering number of genetic disorders, to identify new genes and to establish causality of variants in still-undiagnosed cases, and to work towards causal treatment options that so far are available only for a few metabolic conditions. To meet these challenges, the research community needs highly efficient model systems. With an increasing number of relevant assays and rapidly developing novel methodologies, the fruit fly Drosophila melanogaster is ideally positioned to change gear in ID and ASD research. The aim of this Review is to summarize some of the exciting work that already has drawn attention to Drosophila as a model for these disorders. We highlight well-established ID- and ASD-relevant fly phenotypes at the (sub)cellular, brain and behavioral levels, and discuss strategies of how this extraordinarily efficient and versatile model can contribute to 'next generation' medical genomics and to a better understanding of these disorders.
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Affiliation(s)
- Mireia Coll-Tané
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Alina Krebbers
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Anna Castells-Nobau
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Christiane Zweier
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Annette Schenck
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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Weisz ED, Towheed A, Monyak RE, Toth MS, Wallace DC, Jongens TA. Loss of Drosophila FMRP leads to alterations in energy metabolism and mitochondrial function. Hum Mol Genet 2019; 27:95-106. [PMID: 29106525 PMCID: PMC5886180 DOI: 10.1093/hmg/ddx387] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/25/2017] [Indexed: 11/28/2022] Open
Abstract
Fragile X Syndrome (FXS), the most prevalent form of inherited intellectual disability and the foremost monogenetic cause of autism, is caused by loss of expression of the FMR1 gene . Here, we show that dfmr1 modulates the global metabolome in Drosophila. Despite our previous discovery of increased brain insulin signaling, our results indicate that dfmr1 mutants have reduced carbohydrate and lipid stores and are hypersensitive to starvation stress. The observed metabolic deficits cannot be explained by feeding behavior, as we report that dfmr1 mutants are hyperphagic. Rather, our data identify dfmr1 as a regulator of mitochondrial function. We demonstrate that under supersaturating conditions, dfmr1 mutant mitochondria have significantly increased maximum electron transport system (ETS) capacity. Moreover, electron micrographs of indirect flight muscle reveal striking morphological changes in the dfmr1 mutant mitochondria. Taken together, our results illustrate the importance of dfmr1 for proper maintenance of nutrient homeostasis and mitochondrial function.
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Affiliation(s)
- Eliana D Weisz
- Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Atif Towheed
- Center for Mitochondrial and Epigenomic Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Rachel E Monyak
- Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Meridith S Toth
- Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Douglas C Wallace
- Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.,Center for Mitochondrial and Epigenomic Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.,Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Thomas A Jongens
- Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
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9
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Nash R, Riley C, Paramsothy P, Gilbertson K, Raspa M, Wheeler A, Dziuban EJ, Peacock G. A Description of the Educational Setting Among Individuals With Fragile X Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 124:57-76. [PMID: 30715925 PMCID: PMC6442477 DOI: 10.1352/1944-7558-124.1.57] [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] [Indexed: 06/09/2023]
Abstract
Children with fragile X syndrome (FXS) display wide-ranging intellectual and behavioral abilities that affect daily life. We describe the educational setting of students with FXS and assess the relationships between school setting, co-occurring conditions, and functional ability using a national survey sample ( n = 982). The majority of students with FXS in this sample have formal individualized education plans, spend part of the day outside regular classrooms, and receive modifications when in a regular classroom. Males with FXS and certain co-occurring conditions (autism, aggression, and self-injurious behavior) are more likely to spend the entire day outside regular classrooms, compared to males without these co-occurring conditions. Students who spend more time in regular classrooms are more likely to perform functional tasks without help.
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Affiliation(s)
- Rebecca Nash
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Catharine Riley
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Pangaja Paramsothy
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Kendra Gilbertson
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Melissa Raspa
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Anne Wheeler
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Eric J Dziuban
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Georgina Peacock
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
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10
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Dominick KC, Wink LK, Pedapati EV, Shaffer R, Sweeney JA, Erickson CA. Risperidone Treatment for Irritability in Fragile X Syndrome. J Child Adolesc Psychopharmacol 2018; 28:274-278. [PMID: 29394101 DOI: 10.1089/cap.2017.0057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The goal of this study was to assess the effectiveness of risperidone monoantipsychotic therapy targeting irritability in patients with Fragile X syndrome (FXS) in a naturalistic outpatient clinical setting. METHODS We examined the use of risperidone, predominantly in combination with other nonantipsychotic psychotropic agents, targeting irritability in 21 male patients with FXS with a retrospective analysis of a prospectively collected large developmental disabilities-specific treatment database. Mean age at start of treatment, treatment duration, final dose, body mass index (BMI), and Clinical Global Impressions-Improvement (CGI-I) Scale score at final visit were determined, and changes with treatment were analyzed using paired t-tests. RESULTS Mean age at start of treatment was 14.0 years. The final mean dose of risperidone was 2.5 mg/day. The mean duration of treatment was 22 months. Seven (33.33%) participants were considered treatment responders based on the CGI-I. Change in BMI between initiation and cessation of treatment episode was not significant, however, these data were only available for a subset (n = 11) of patients. CONCLUSIONS Risperidone may be effective in the treatment of irritability in males with FXS. The overall effectiveness of monoantipsychotic treatment with risperidone was limited in this study compared with previous published reports; however, this may be the result of differences in outcome measures as well as a reflection of the level of functioning and severity of irritability in this sample.
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Affiliation(s)
- Kelli C Dominick
- 1 Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Logan K Wink
- 1 Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Ernest V Pedapati
- 1 Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Rebecca Shaffer
- 1 Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - John A Sweeney
- 2 Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati , Cincinnati, Ohio
| | - Craig A Erickson
- 1 Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
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11
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Bailey DB, Ventura LO. The Likely Impact of Congenital Zika Syndrome on Families: Considerations for Family Supports and Services. Pediatrics 2018; 141:S180-S187. [PMID: 29437051 PMCID: PMC5795517 DOI: 10.1542/peds.2017-2038g] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 01/21/2023] Open
Abstract
Congenital Zika virus infection has obvious implications for infants, and considerable research has addressed the nature and consequences of congenital Zika syndrome (CZS). Children with classic CZS meet the criteria for "children with medical complexity," and ongoing research is required to understand the range of needs and optimal treatment options. Far less attention has been given to the consequences of CZS for families, which are both immediate and lifelong. Although families of children with CZS have much in common with families of other children with disabilities, at least 4 features of CZS have special family implications: (1) the severity of the impact on children with obvious abnormalities at birth, coupled with the anticipation of a lifetime of caregiving and economic burdens; (2) uncertainty about the unfolding consequences, both for obviously affected children and for exposed children with no symptoms at birth; (3) a lack of specialized professional knowledge about the course of the disease or treatment options; and (4) social isolation, a lack of social or community supports, and potential stigma. Supporting families will require a family-centered approach to services, extensive care coordination, access to evolving new information, ongoing surveillance, formal and informal supports, and individualized child and family services.
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Affiliation(s)
- Donald B Bailey
- RTI International, Research Triangle Park, North Carolina; and
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12
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Abstract
Fragile X syndrome (FXS) is the leading inherited form of intellectual disability and autism spectrum disorder, and patients can present with severe behavioural alterations, including hyperactivity, impulsivity and anxiety, in addition to poor language development and seizures. FXS is a trinucleotide repeat disorder, in which >200 repeats of the CGG motif in FMR1 leads to silencing of the gene and the consequent loss of its product, fragile X mental retardation 1 protein (FMRP). FMRP has a central role in gene expression and regulates the translation of potentially hundreds of mRNAs, many of which are involved in the development and maintenance of neuronal synaptic connections. Indeed, disturbances in neuroplasticity is a key finding in FXS animal models, and an imbalance in inhibitory and excitatory neuronal circuits is believed to underlie many of the clinical manifestations of this disorder. Our knowledge of the proteins that are regulated by FMRP is rapidly growing, and this has led to the identification of multiple targets for therapeutic intervention, some of which have already moved into clinical trials or clinical practice.
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13
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Ouyang L, Grosse SD, Riley C, Bolen J, Bishop E, Raspa M, Bailey DB. A comparison of family financial and employment impacts of fragile X syndrome, autism spectrum disorders, and intellectual disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1518-27. [PMID: 24755230 PMCID: PMC4491950 DOI: 10.1016/j.ridd.2014.04.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/25/2014] [Accepted: 04/01/2014] [Indexed: 05/17/2023]
Abstract
This study compares the family financial and employment impacts of having a child with fragile X syndrome (FXS), autism spectrum disorder (ASD), or intellectual disabilities (ID). Data from a 2011 national survey of families of children with FXS were matched with data from the National Survey of Children with Special Health Care Needs 2009-2010 to form four analytic groups: children with FXS (n=189), children with special health care needs with ASD only (n=185), ID only (n=177), or both ASD and ID (n=178). Comparable percentages of parents of children with FXS (60%) and parents of children with both ASD and ID (52%) reported that their families experienced a financial burden as a result of the condition, both of which were higher than the percentages of parents of children with ASD only (39%) or ID only (29%). Comparable percentages of parents of children with FXS (40%) and parents of children with both ASD and ID (46%) reported quitting employment because of the condition, both of which were higher than the percentages of parents of children with ID only (25%) or ASD only (25%). In multivariate analyses controlling for co-occurring conditions and functional difficulties and stratified by age, adjusted odds ratios for the FXS group aged 12-17 years were significantly elevated for financial burden (2.73, 95% CI 1.29-5.77), quitting employment (2.58, 95% CI 1.18-5.65) and reduced hours of work (4.34, 95% CI 2.08-9.06) relative to children with ASD only. Among children aged 5-11 years, the adjusted odds ratios for the FXS group were elevated but statistically insignificant for financial burden (1.63, 95% CI 0.85-3.14) and reducing hours of work (1.34, 95% CI 0.68-2.63) relative to children with ASD only. Regardless of condition, co-occurring anxiety or seizures, limits in thinking, reasoning, or learning ability, and more irritability were significantly associated with more caregiver financial and employment impacts. Proper management of anxiety or seizures and functional difficulties of children with FXS or other developmental disabilities may be important in alleviating adverse family caregiver impacts.
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Affiliation(s)
- Lijing Ouyang
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, United States.
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, United States
| | - Catharine Riley
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, United States
| | - Julie Bolen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, United States
| | - Ellen Bishop
- RTI International, Research Triangle Park, NC, United States
| | - Melissa Raspa
- RTI International, Research Triangle Park, NC, United States
| | - Donald B Bailey
- RTI International, Research Triangle Park, NC, United States
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Raspa M, Bailey DB, Bann C, Bishop E. Modeling family adaptation to fragile X syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 119:33-48. [PMID: 24450320 DOI: 10.1352/1944-7558-119.1.33] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Using data from a survey of 1,099 families who have a child with Fragile X syndrome, we examined adaptation across 7 dimensions of family life: parenting knowledge, social support, social life, financial impact, well-being, quality of life, and overall impact. Results illustrate that although families report a high quality of life, they struggle with areas such as social support, social life, and parenting knowledge. Path analysis revealed that child and family factors play a role in adaptation, but family resources and social supports moderated their effect on quality of life, well-being, and overall impact. The interrelationship among multiple aspects of family life should be examined to improve family resiliency.
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Haessler F, Gaese F, Colla M, Huss M, Kretschmar C, Brinkman M, Schieb H, Peters H, Elstner S, Pittrow D. EXPLAIN Fragile-X: an explorative, longitudinal study on the characterization, treatment pathways, and patient-related outcomes of Fragile X Syndrome. BMC Psychiatry 2013; 13:339. [PMID: 24354947 PMCID: PMC3878315 DOI: 10.1186/1471-244x-13-339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 12/16/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Fragile X syndrome (FXS), caused by a mutation of the FMR1 gene on the X chromosome, is the most common inherited form of intellectual disability and autism spectrum disorders. Comprehensive data are lacking, however, on the characteristics and management patients with FXS in Germany. METHODS/DESIGN EXPLAIN is a prospective, observational, longitudinal registry with a non-probability sampling approach. It collects data on patient characteristics, therapeutic interventions, psychosocial parameters (including those of family members and caregivers), quality of life of caregiver and patient, caregiver burden, and health economic parameters, such as hospitalisation time. It is designed to include data from 300 patients in ambulatory care from about 50 centres that employ psychiatrists, paediatricians, neurologists, and other relevant specialists, in Germany. The study was initiated in March, 2013. Patients will be followed for at least two years. DISCUSSION The registry is expected to provide much-needed data on the characteristics and management of patients with FXS in Germany. It will also allow comparisons with other countries, and will enable gap analyses based on current guidelines for management of these patients. TRIAL REGISTRATION The ClinicalTrials.gov identifier is NCT01711606.
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Affiliation(s)
- Frank Haessler
- Zentrum für Nervenheilkunde, Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsmedizin Rostock, Rostock, Germany.
| | - Franziska Gaese
- Abt. Psychiatrische Therapie für Menschen mit Geistiger Behinderung, Isar-Amper-Klinikum gGmbH, Klinikum München-Ost, Haar, Germany
| | - Michael Colla
- Experimental and Clinical Research Center, Charité – Campus Berlin Buch & Department of Psychiatry and Psychotherapy, Charité – Campus Mitte, Berlin, Germany
| | - Michael Huss
- Rheinhessen-Fachklinik Mainz, Kinder- und Jugendpsychiatrie, Mainz, Germany
| | - Christoph Kretschmar
- Städt. Krankenhaus Dresden-Neustadt, Zentrum für Kinder- und Jugendmedizin - Sozialpädiatrisches Zentrum, Dresden, Germany
| | - Marc Brinkman
- Medizinische Abteilung, Novartis Pharma GmbH, Nürnberg, Germany
| | - Heike Schieb
- Medizinische Abteilung, Novartis Pharma GmbH, Nürnberg, Germany
| | - Helmut Peters
- Rheinhessen-Fachklinik Mainz, Kinder- und Jugendpsychiatrie, Mainz, Germany
| | - Samuel Elstner
- Berliner Behandlungszentrum der Abteilung für Psychiatrie, Psychotherapie und Psychosomatik, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany
| | - David Pittrow
- Institut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität Carl Gustav Carus Dresden, Dresden, Germany
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Wheeler A, Raspa M, Bann C, Bishop E, Hessl D, Sacco P, Bailey DB. Anxiety, attention problems, hyperactivity, and the Aberrant Behavior Checklist in fragile X syndrome. Am J Med Genet A 2013; 164A:141-55. [PMID: 24352914 DOI: 10.1002/ajmg.a.36232] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 07/28/2013] [Indexed: 11/07/2022]
Abstract
Behavior problems are a common challenge for individuals with fragile X syndrome (FXS) and constitute the primary clinical outcome domain in trials testing new FXS medications. However, little is known about the relationship between caregiver-reported behavior problems and co-occurring conditions such as anxiety and attention problems. In this study, 350 caregivers, each with at least one son or daughter with full-mutation FXS, rated one of their children with FXS using the Aberrant Behavior Checklist-Community Version (ABC-C); the Anxiety subscale of the Anxiety, Depression, and Mood Scale; and the Attention/Hyperactivity Items from the Symptom Inventories. In addition to examining family consequences of these behaviors, this study also sought to replicate psychometric findings for the ABC-C in FXS, to provide greater confidence for its use in clinical trials with this population. Psychometric properties and baseline ratings of problem behavior were consistent with other recent studies, further establishing the profile of problem behavior in FXS. Cross-sectional analyses suggest that selected dimensions of problem behavior, anxiety, and hyperactivity are age related; thus, age should serve as an important control in any studies of problem behavior in FXS. Measures of anxiety, attention, and hyperactivity were highly associated with behavior problems, suggesting that these factors at least coincide with problem behavior. However, these problems generally did not add substantially to variance in caregiver burden predicted by elevated behavior problems. The results provide further evidence of the incidence of problem behaviors and co-occurring conditions in FXS and the impact of these behaviors on the family.
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Affiliation(s)
- Anne Wheeler
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Martin GE, Ausderau KK, Raspa M, Bishop E, Mallya U, Bailey DB. Therapy service use among individuals with fragile X syndrome: findings from a US parent survey. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2013; 57:837-849. [PMID: 22974130 DOI: 10.1111/j.1365-2788.2012.01608.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Fragile X syndrome (FXS) is known to be associated with a range of developmental challenges, yet the occurrence and intensity of therapy services along with associated factors have not been determined. METHOD In a US national survey, caregivers provided information regarding the therapy services received by their sons (n = 1013) and daughters (n = 283) with FXS (from birth to 63 years; mean = 15.6 years, SD = 10.6). Caregivers reported (1) type, (2) amount, (3) location, and (4) overall satisfaction with services. Associations with other child variables and family income were also examined. RESULTS Key findings included that 72% of males and 47% of females were currently receiving at least one type of therapy service; the most common services for both males and females were speech-language therapy (ST) and occupational therapy (OT). Overall, males were more likely to receive therapy services as well as a greater number of services than females. Autism status was significantly associated with both males and females receiving ST and males receiving OT and behaviour management therapy. Therapies were provided in a variety of locations, and parents were generally satisfied with the amount and quality of therapy services. Age-related declines were evident in the use of services for both males and females, with very few individuals receiving any therapy services after 20 years of age. CONCLUSIONS This study provides a baseline description of the current state of therapy services for children with FXS, laying a foundation for future research and recommendations for service provision and policy.
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Affiliation(s)
- G E Martin
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Cornish K, Cole V, Longhi E, Karmiloff-Smith A, Scerif G. Does attention constrain developmental trajectories in fragile x syndrome? A 3-year prospective longitudinal study. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2012; 117:103-20. [PMID: 22515826 DOI: 10.1352/1944-7558-117.2.103] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Basic attentional processes and their impact on developmental trajectories in fragile X syndrome were assessed in a 3-year prospective study. Although fragile X syndrome is a monogenic X-linked disorder, there is striking variability in outcomes even in young boys with the condition. Attention is a key factor constraining interactions with the environment, so it is a perfect candidate to predict trajectories in cognitive and behavioral outcomes. In this study, 48 boys with fragile X syndrome were assessed 3 times over 24 months. Although nonverbal IQ declined, there were significant improvements in nonverbal growth scores and in cognitive attention. In contrast, behavioral difficulties (i.e., autistic symptomatology, hyperactivity-inattention) remained stable over this time frame. Attentional markers in the visual and auditory modalities predicted intellectual abilities and classroom behavior, whereas auditory markers alone predicted autistic symptomatology.
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Medication utilization for targeted symptoms in children and adults with fragile X syndrome: US survey. J Dev Behav Pediatr 2012; 33:62-9. [PMID: 22064563 DOI: 10.1097/dbp.0b013e318236c0e1] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify the most common neurological and behavioral symptoms treated by medications in individuals with fragile X syndrome (FXS), factors associated with treatment variability, and difficulty in swallowing a pill. METHOD A total of 1019 caregivers provided information about 1064 sons and 299 daughters with FXS in a US national survey. Caregivers reported (a) current use of medications for attention, anxiety, hyperactivity, mood swings, anger, depression, seizures, self-injury, or sleep; (b) perceived efficacy; and (c) difficulty in swallowing a pill. RESULTS Sixty-one percent of males and 38% of females were currently taking medication for at least 1 symptom. The most common symptoms were anxiety, attention, and hyperactivity. Treatments for attention and hyperactivity were common in childhood but declined substantially after the age of 18 years; anxiety treatment remained high in adults. Children perceived to be more impaired and children diagnosed or treated for autism were more likely to be taking medications. Caregivers considered most medications somewhat effective, but less than one-third rated current medication as "a lot" effective. Many children had difficulty swallowing a pill, but only 11% of adult males and 2% of adult females had a lot of difficulty. CONCLUSION Symptom-based medication use is common in FXS, although response is incomplete and there is clearly an unmet need for medications with improved efficacy. The persistent use of medications to treat anxiety, mood, and behavior problems throughout adolescence and into the adult years suggests important outcomes when evaluating the efficacy of new medications.
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Abstract
PURPOSE We sought to determine caregiver perceptions about population screening for fragile X and to examine factors potentially associated with support for screening. METHODS We asked 1,099 caregivers of a child with fragile X syndrome or a fragile X carrier to rate whether free, voluntary screening should be offered preconception, prenatally, neonatally, or when problems occur. Caregivers chose a preferred time for screening, reported whether screening would affect parent-child bonding, indicated preferences for carrier detection, and gave reasons for their choices. RESULTS Caregivers endorsed all forms of screening, but prenatal screening was less strongly endorsed than preconception or postnatal screening. Most (79%) preferred preconception carrier testing, allowing more options when making reproductive decisions. Most thought that screening should also disclose carrier status and believed a positive screen would not negatively affect parent-child bonding. Maternal education, caregiver depression, family impact, and severity of disability were not associated with screening opinions, but parents who only had carrier children were less likely to endorse prenatal screening. CONCLUSION Caregivers of children with fragile X widely endorse screening. However, because different parents will make different choices, screening may need to be offered at multiple times with careful consideration of consent and informed decision-making.
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