1
|
Potter SN, Harvey D, Sterling A, Abbeduto L. Parental Responsivity and Child Communication During Mother-Child and Father-Child Interactions in Fragile X Syndrome. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:939-959. [PMID: 38407074 PMCID: PMC11001423 DOI: 10.1044/2023_jslhr-23-00517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 02/27/2024]
Abstract
PURPOSE Past research shows that parentally responsive behavior toward the child positively influences language development in both neurotypical children and children with intellectual and developmental disabilities, including those with fragile X syndrome (FXS); however, most studies have focused exclusively on the mother-child relationship. The current study examined relationships between parent behavior (i.e., responsivity and behavior management) and child language performance in both mother-child and father-child interactions, as well as relationships between child characteristics and both parent behavior and child language. METHOD Participants were 23 families of young boys with FXS between 3 and 7 years of age. Mothers and fathers independently completed questionnaires assessing child characteristics and separately engaged in 12-min play-based interactions with their child via telehealth. One parent also completed a comprehensive interview assessing child adaptive behavior. Video recordings of the parent-child interactions were transcribed and coded for parent and child behavior, and measures of parent and child language were obtained from the transcripts. RESULTS Mothers and fathers used similar rates of responsive behaviors during parent-child interactions, and parental responsivity was positively associated with some aspects of child language performance (i.e., talkativeness and lexical diversity). Parental behavior, however, was not associated with syntactic complexity. Older children and children with higher levels of adaptive behavior had parents who used higher rates of responsive behaviors. Fathers used higher rates of behavior management strategies compared to mothers, and this type of parent behavior was not associated with child language. CONCLUSION Overall, this study provides evidence that interventions focused on increasing parental responsiveness would be beneficial for families of children with FXS and that these interventions should be delivered early given the association between responsivity and child age. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25229939.
Collapse
Affiliation(s)
- Sarah Nelson Potter
- MIND Institute, UC Davis Health, Sacramento, CA
- Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
| | - Danielle Harvey
- Department of Public Health Sciences, UC Davis Health, Sacramento, CA
| | - Audra Sterling
- Waisman Center, University of Wisconsin–Madison
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
| | - Leonard Abbeduto
- MIND Institute, UC Davis Health, Sacramento, CA
- Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
| |
Collapse
|
2
|
Berry-Kravis E, Abbeduto L, Hagerman R, Coffey CS, Cudkowicz M, Erickson CA, McDuffie A, Hessl D, Ethridge L, Tassone F, Kaufmann WE, Friedmann K, Bullard L, Hoffmann A, Veenstra-VanderWeele J, Staley K, Klements D, Moshinsky M, Harkey B, Long J, Fedler J, Klingner E, Ecklund D, Costigan M, Huff T, Pearson B. Effects of AFQ056 on language learning in fragile X syndrome. J Clin Invest 2023; 134:e171723. [PMID: 37651202 PMCID: PMC10904045 DOI: 10.1172/jci171723] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUNDFXLEARN, the first-ever large multisite trial of effects of disease-targeted pharmacotherapy on learning, was designed to explore a paradigm for measuring effects of mechanism-targeted treatment in fragile X syndrome (FXS). In FXLEARN, the effects of metabotropic glutamate receptor type 5 (mGluR5) negative allosteric modulator (NAM) AFQ056 on language learning were evaluated in 3- to 6-year-old children with FXS, expected to have more learning plasticity than adults, for whom prior trials of mGluR5 NAMs have failed.METHODSAfter a 4-month single-blind placebo lead-in, participants were randomized 1:1 to AFQ056 or placebo, with 2 months of dose optimization to the maximum tolerated dose, then 6 months of treatment during which a language-learning intervention was implemented for both groups. The primary outcome was a centrally scored videotaped communication measure, the Weighted Communication Scale (WCS). Secondary outcomes were objective performance-based and parent-reported cognitive and language measures.RESULTSFXLEARN enrolled 110 participants, randomized 99, and had 91 who completed the placebo-controlled period. Although both groups made language progress and there were no safety issues, the change in WCS score during the placebo-controlled period was not significantly different between the AFQ056 and placebo-treated groups, nor were there any significant between-group differences in change in any secondary measures.CONCLUSIONDespite the large body of evidence supporting use of mGluR5 NAMs in animal models of FXS, this study suggests that this mechanism of action does not translate into benefit for the human FXS population and that better strategies are needed to determine which mechanisms will translate from preclinical models to humans in genetic neurodevelopmental disorders.TRIAL REGISTRATIONClincalTrials.gov NCT02920892.FUNDING SOURCESNeuroNEXT network NIH grants U01NS096767, U24NS107200, U24NS107209, U01NS077323, U24NS107183, U24NS107168, U24NS107128, U24NS107199, U24NS107198, U24NS107166, U10NS077368, U01NS077366, U24NS107205, U01NS077179, and U01NS077352; NIH grant P50HD103526; and Novartis IIT grant AFQ056X2201T for provision of AFQ056.
Collapse
Affiliation(s)
- Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, and Anatomy & Cell Biology, Rush University Medical Center, Chicago, Illinois, USA
| | - Leonard Abbeduto
- MIND Institute and Department of Psychiatry and Behavioral Sciences and
| | - Randi Hagerman
- MIND Institute and Department of Pediatrics, UCD, Sacramento, California, USA
| | | | - Merit Cudkowicz
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Craig A. Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrea McDuffie
- MIND Institute and Department of Psychiatry and Behavioral Sciences and
| | - David Hessl
- MIND Institute and Department of Psychiatry and Behavioral Sciences and
| | - Lauren Ethridge
- Department of Psychology, University of Oklahoma, Norman, Oklahoma, and Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Flora Tassone
- MIND Institute and Department of Biochemistry and Molecular Medicine, UCD, Sacramento, California, USA
| | - Walter E. Kaufmann
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Lauren Bullard
- MIND Institute and Department of Psychiatry and Behavioral Sciences and
| | - Anne Hoffmann
- Departments of Pediatrics and Communication Disorders and Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Jeremy Veenstra-VanderWeele
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, New York, USA
| | - Kevin Staley
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David Klements
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael Moshinsky
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brittney Harkey
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeff Long
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | - Janel Fedler
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | | | - Dixie Ecklund
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | - Michele Costigan
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | - Trevis Huff
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | - Brenda Pearson
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | | |
Collapse
|
3
|
Biggs EE, Arserio AP, Robison SE, Ross ME. Home Literacy Environment and Interventions for Children With Intellectual and Developmental Disabilities: A Scoping Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:2118-2140. [PMID: 37267447 PMCID: PMC10465154 DOI: 10.1044/2023_jslhr-22-00334] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/29/2022] [Accepted: 02/17/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE The aim of this scoping review was to map the research literature published in English and in peer-reviewed journals related to the home literacy environment of children and youth aged 3-21 years with intellectual and developmental disabilities (IDD) who have significant support needs, including children with complex communication needs. METHOD A systematic search was conducted in four databases, along with forward and backward searching. The search yielded 60 studies, which included intervention and nonintervention studies. Data were charted related to participant characteristics, study focus, intervention components, study design and methodological rigor, and study results. RESULTS Findings provided insight into multiple dimensions of the home literacy environment for children with IDD, including the nature of parent views, practices, and interaction styles during shared reading. Findings also revealed gaps in the literature, specifically related to (a) limited representation of subgroups of children and youth with IDD, (b) limited representation of diverse families and caregivers, and (c) concerns about methodological quality. CONCLUSION This review identifies important directions for future research and suggests ways to improve the design and delivery of home literacy interventions for children and youth with IDD and their families, including through family-centered and culturally responsive models. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22704817.
Collapse
Affiliation(s)
| | | | - Sarah E. Robison
- Disability and Psychoeducational Studies, The University of Arizona, Tucson
| | - Madison E. Ross
- Department of Special Education, Vanderbilt University, Nashville, TN
| |
Collapse
|
4
|
Ranjan R, Jha S, Prajjwal P, Chaudhary A, Dudeja P, Vora N, Mateen MA, Yousuf MA, Chaudhary B. Neurological, Psychiatric, and Multisystemic Involvement of Fragile X Syndrome Along With Its Pathophysiology, Methods of Screening, and Current Treatment Modalities. Cureus 2023; 15:e35505. [PMID: 37007359 PMCID: PMC10050793 DOI: 10.7759/cureus.35505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 03/01/2023] Open
Abstract
Fragile X syndrome (FXS) is a hereditary disease that predominantly leads to intellectual disability (ID) in boys. It is the second prominent cause of ID, which manifests as a result of the atypical development of the cytosine-guanine-guanine (CGG) region. This irregular extension of the CGG region gives rise to methylation and silencing of the fragile X mental retardation 1 (FMR1) gene, causing a loss of the fragile X mental retardation 1 protein (FMRP). This reduction or loss of FMRP is the main cause of ID. It has a multisystemic involvement showing neuropsychiatric features such as ID, speech and language delay, autism spectrum disorder, sensory hyperarousal, social anxiety, abnormal eye contact, shyness, and aggressive behaviour. It is also known to cause musculoskeletal symptoms, ocular symptoms, cardiac abnormalities, and gastrointestinal symptoms. The management is challenging, and there is no known cure for the disease; hence an early diagnosis of the condition is needed through prenatal screening offered to couples with familial history of ID before conception. The management rests on non-pharmacological modalities, including applied behaviour analysis, physical therapy, occupational therapy, speech-language therapy, and pharmacologic management through symptomatic treatment of comorbid behaviours and psychiatric problems and some forms of targeted therapy.
Collapse
|
5
|
Research Gaps in Fragile X Syndrome: An Updated Literature Review to Inform Clinical and Public Health Practice. J Dev Behav Pediatr 2023; 44:e56-e65. [PMID: 36219479 PMCID: PMC9770151 DOI: 10.1097/dbp.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 08/03/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The phenotypic impact of fragile X syndrome (FXS) has been well-documented since the discovery of the fragile X messenger ribonucleoprotein 1 gene 30 years ago. However, gaps remain in clinical and public health research. The purpose of this literature review was to determine the extent to which these gaps have been addressed and identify targeted areas of future research. METHODS We conducted an electronic search of several scientific databases using a variety of key words. The search focused on 5 areas identified as research gaps by an earlier review: (1) diagnosis, (2) phenotypic presentation, (3) familial impact, (4) interventions and treatments, and (5) life span perspectives. Inclusion criteria included publication between 2014 and 2020, focus on human subjects, and publication in English. A total of 480 articles were identified, 365 were reviewed, and 112 are summarized in this review. RESULTS Results are organized into the following categories: (1) FXS phenotype and subtypes (FXS subtypes, medical profile, cognitive/developmental profile, social and behavioral profile); (2) needs of adults; (3) public health needs (clinical diagnosis and newborn screening, health care needs, and access); (4) treatment (treatment priorities, pharmacological treatments, and behavioral and educational interventions); and (5) families (economic burden and mother-child relationship). CONCLUSION Despite the progress in many areas of FXS research, work remains to address gaps in clinical and public health knowledge. We pose 3 main areas of focused research, including early detection and diagnosis, determinants of health, and development and implementation of targeted interventions.
Collapse
|
6
|
Hoffmann A. Communication in fragile X syndrome: Patterns and implications for assessment and intervention. Front Psychol 2022; 13:929379. [PMID: 36619013 PMCID: PMC9817301 DOI: 10.3389/fpsyg.2022.929379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Fragile X syndrome (FXS) is the most common cause of inherited intellectual disability and is associated with a high rate of autism diagnosis. Language delays have been noted in the areas of overall communication and the specific areas of receptive, expressive, and pragmatic language, as well as in development of speech sounds and literacy. It has been widely noted that those individuals with a diagnosis of both FXS and autism tend to have more significant intellectual disability and language disorder. In this study, the research exploring the FXS language phenotype is presented, and the roles of cognition, autistic symptomatology, and gender are highlighted as possible. Implications for assessment and intervention approaches based on the strengths and weaknesses of the FXS language phenotype are provided.
Collapse
Affiliation(s)
- Anne Hoffmann
- Department of Communication Disorders and Sciences, Rush University Medical Center, Chicago, IL, United States,Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States,*Correspondence: Anne Hoffmann,
| |
Collapse
|
7
|
Potter SN, Bullard L, Banasik A, Feigles RT, Nguyen V, McDuffie A, Thurman AJ, Hagerman R, Abbeduto L. Family and Caregiver Characteristics Contribute to Caregiver Change in Use of Strategies and Growth in Child Spoken Language in a Parent-Implemented Language Intervention in Fragile X Syndrome. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2022; 7:1630-1644. [PMID: 36778100 PMCID: PMC9910303 DOI: 10.1044/2022_persp-22-00016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Purpose This study examined relationships among family characteristics, caregiver change in use of strategies, and child growth in spoken language over the course of a parent-implemented language intervention (PILI) that was developed to address some of the challenges associated with the fragile X syndrome (FXS) phenotype. Method Participants were 43 parent-child dyads from two different PILI studies, both of which taught parents various language facilitation strategies to support child language. Before starting the intervention, parents reported on their mental health, parenting stress, and parenting competence. This study focused on potential barriers to treatment gains by examining correlations between the measures of parent well-being and (a) parent change in use of intervention strategies taught in the PILI and (b) changes in child language outcomes from preto post-intervention. Results Parents in this study had elevated mental health symptoms across several domains and increased rates of parenting stress. Furthermore, although PILI resulted in treatment gains for both parents and children, a variety of parent mental health symptoms were found to be significantly and negatively associated with change in use of strategies and growth in child language over the course of the intervention. Some inconsistent findings also emerged regarding the relationships between parenting stress and competence and change in parent strategy use and growth in child language. Conclusions This study provides preliminary evidence that parents who are experiencing significant mental health challenges may have a more difficult time participating fully in PILIs and that there may be subsequent effects on child outcomes. Future PILIs could benefit from addressing parent well-being as a substantial part of the intervention program.
Collapse
Affiliation(s)
- Sarah Nelson Potter
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
| | - Lauren Bullard
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
| | - Amy Banasik
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
| | - Robyn Tempero Feigles
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
| | - Vivian Nguyen
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
| | - Andrea McDuffie
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
| | - Angela John Thurman
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
| | - Randi Hagerman
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Pediatrics, UC Davis Health, Sacramento, CA
| | - Leonard Abbeduto
- MIND Institute, UC Davis Health, Sacramento, CA,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA
| |
Collapse
|
8
|
Protic DD, Aishworiya R, Salcedo-Arellano MJ, Tang SJ, Milisavljevic J, Mitrovic F, Hagerman RJ, Budimirovic DB. Fragile X Syndrome: From Molecular Aspect to Clinical Treatment. Int J Mol Sci 2022; 23:ijms23041935. [PMID: 35216055 PMCID: PMC8875233 DOI: 10.3390/ijms23041935] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 02/01/2023] Open
Abstract
Fragile X syndrome (FXS) is a neurodevelopmental disorder caused by the full mutation as well as highly localized methylation of the fragile X mental retardation 1 (FMR1) gene on the long arm of the X chromosome. Children with FXS are commonly co-diagnosed with Autism Spectrum Disorder, attention and learning problems, anxiety, aggressive behavior and sleep disorder, and early interventions have improved many behavior symptoms associated with FXS. In this review, we performed a literature search of original and review articles data of clinical trials and book chapters using MEDLINE (1990-2021) and ClinicalTrials.gov. While we have reviewed the biological importance of the fragile X mental retardation protein (FMRP), the FXS phenotype, and current diagnosis techniques, the emphasis of this review is on clinical interventions. Early non-pharmacological interventions in combination with pharmacotherapy and targeted treatments aiming to reverse dysregulated brain pathways are the mainstream of treatment in FXS. Overall, early diagnosis and interventions are fundamental to achieve optimal clinical outcomes in FXS.
Collapse
Affiliation(s)
- Dragana D. Protic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, 11129 Belgrade, Serbia
- Correspondence: (D.D.P.); (D.B.B.); Tel.: +381-11-36-43-389 (D.D.P.); +1-443-923-2634 (D.B.B.)
| | - Ramkumar Aishworiya
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute UCDH, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA; (R.A.); (M.J.S.-A.); (S.J.T.); (R.J.H.)
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
| | - Maria Jimena Salcedo-Arellano
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute UCDH, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA; (R.A.); (M.J.S.-A.); (S.J.T.); (R.J.H.)
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA 95817, USA
- Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, CA 95817, USA
| | - Si Jie Tang
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute UCDH, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA; (R.A.); (M.J.S.-A.); (S.J.T.); (R.J.H.)
| | - Jelena Milisavljevic
- Faculty of Medicine, University of Belgrade, 11129 Belgrade, Serbia; (J.M.); (F.M.)
| | - Filip Mitrovic
- Faculty of Medicine, University of Belgrade, 11129 Belgrade, Serbia; (J.M.); (F.M.)
| | - Randi J. Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute UCDH, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA; (R.A.); (M.J.S.-A.); (S.J.T.); (R.J.H.)
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA 95817, USA
| | - Dejan B. Budimirovic
- Department of Psychiatry, Fragile X Clinic, Kennedy Krieger Institute, Baltimore, MD 21205, USA
- Department of Psychiatry & Behavioral Sciences-Child Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
- Correspondence: (D.D.P.); (D.B.B.); Tel.: +381-11-36-43-389 (D.D.P.); +1-443-923-2634 (D.B.B.)
| |
Collapse
|
9
|
John Thurman A, Summers Swinehart S, Klusek J, Roberts JE, Bullard L, Marzan JCB, Ted Brown W, Abbeduto L. Daily Living Skills in Adolescent and Young Adult Males With Fragile X Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:64-83. [PMID: 34979036 PMCID: PMC8740615 DOI: 10.1352/1944-7558-127.1.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 04/27/2021] [Indexed: 05/04/2023]
Abstract
By adulthood, most males with fragile X syndrome (FXS) require support to navigate day-to-day settings. The present study cross-sectionally: (1) characterized the profile of daily living skills in males with FXS and (2) examined associated participant characteristics (i.e., fragile X mental retardation protein [FMRP] expression, nonverbal cognition, language, autism symptomatology, and anxiety symptomatology) using the Waisman-Activities of Daily Living questionnaire. Males with FXS (n = 57, ages 15-23 years) needed more help/support in the areas of domestic and community daily livings skills, than in the area of personal daily living skills. Significant associations were observed between reduced daily living skills and lower nonverbal cognition, receptive language, expressive language, and increased autism symptomatology. Receptive language emerged as the strongest unique predictor of daily living skill performance.
Collapse
Affiliation(s)
- Angela John Thurman
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health
- MIND Institute, University of California Davis Health
| | - Stephanie Summers Swinehart
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health
- MIND Institute, University of California Davis Health
| | - Jessica Klusek
- Department of Communication Sciences and Disorders, University of South Carolina
| | | | - Lauren Bullard
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health
- MIND Institute, University of California Davis Health
| | | | - W. Ted Brown
- Department of Psychiatry, University of Sydney
- Department of Human Genetics, NYS Institute for Basic Research
| | - Leonard Abbeduto
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health
- MIND Institute, University of California Davis Health
| |
Collapse
|
10
|
Moser C, Mattie L, Abbeduto L, Klusek J. The FMR1 Premutation Phenotype and Mother-Youth Synchrony in Fragile X Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:443-459. [PMID: 34700350 PMCID: PMC8555425 DOI: 10.1352/1944-7558-126.6.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 01/12/2021] [Indexed: 06/13/2023]
Abstract
A subset of mothers who carry the FMR1 premutation may express a unique phenotype. The relationship between the FMR1 phenotype and mother-child interaction in families with fragile X-associated disorders has not been well characterized, despite the importance of high-quality mother-child interaction for child development. This study examined the association between the FMR1 phenotype and the quality of interactions between mothers and their adolescent/young adult sons with fragile X syndrome. Mother-youth synchrony was coded from a dyadic interaction. Maternal anxiety and depression symptoms, executive function deficits, and pragmatic language difficulties were evaluated. Results indicated that pragmatic language was associated with mother-youth synchrony. These findings highlight the importance of family-centered intervention practices for families with fragile X-associated disorders.
Collapse
Affiliation(s)
- Carly Moser
- University of South Carolina, Columbia, South Carolina, 29208, USA
| | - Laura Mattie
- University of Illinois, Champaign, Illinois, 61820, USA
| | | | - Jessica Klusek
- University of South Carolina, Columbia, South Carolina, 29208, USA
| |
Collapse
|
11
|
Concurrent Associations between Expressive Language Ability and Independence in Adolescents and Adults with Fragile X Syndrome. Brain Sci 2021; 11:brainsci11091179. [PMID: 34573200 PMCID: PMC8465941 DOI: 10.3390/brainsci11091179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Few individuals with fragile X syndrome (FXS) successfully meet adult normative expectations in education, employment, peer relations, and habitation, although there is within-syndrome variability in this regard. The primary goal of this study was to determine whether expressive language skills contribute to the capacity for independent functioning in adulthood even after controlling for nonverbal cognitive ability. METHODS Participants were 18- to 23-year-olds with FXS. Expressive language was assessed using the psychometrically validated Expressive Language Sampling (ELS) conversation and narration procedures. The language produced was transcribed and analyzed to yield measures of expressive vocabulary, syntax, and intelligibility. Parents concurrently completed questionnaires on the independent functioning of the participants with FXS. RESULTS All three ELS measures were significantly corelated with multiple measures of independence. The magnitudes of the correlations were reduced when nonverbal IQ was controlled through partial correlation. Nonetheless, many of the partial correlations were medium to large and several were statistically significant. CONCLUSIONS Expressive language skills appear to contribute uniquely to the capacity for independence, although longitudinal data are needed to evaluate the possibility of a bidirectional relationship between these domains. Thus, language intervention may be a prerequisite for preparing youth with FXS for an independent adult life.
Collapse
|
12
|
Channell MM, Bosley R. Mental State Language Use in Children with Down Syndrome and the Role of Caregivers. Semin Speech Lang 2021; 42:318-329. [PMID: 34311483 DOI: 10.1055/s-0041-1730990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Children with Down syndrome (DS) have both strengths and difficulties in speech, language, and social communication. Mental state language-the ability to discuss others' perspectives such as their thoughts, feelings, and intentions-represents a foundational social communicative skill that is delayed in many children with DS, even into the school-age years. The purpose of this article is to review the evidence base on mental state language development in school-age children with DS, focusing in particular on assessment and intervention. We discuss assessment procedures that are both age appropriate and developmentally appropriate for this population. We also present preliminary data highlighting the role of caregivers in supporting mental state language development in school-age children with DS through shared storytelling. We propose that interventions aimed at supporting mental state language development in DS should include a focus on caregiver-child shared storybook reading, even in the school-age years. Therefore, we discuss key considerations for clinicians when teaching caregivers strategies for supporting mental state language and social communication in children with DS.
Collapse
Affiliation(s)
- Marie Moore Channell
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Rebekah Bosley
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Champaign, Illinois
| |
Collapse
|
13
|
Bangert K, Moser C, Friedman L, Klusek J. Family as a Context for Child Development: Mothers with the FMR1 Premutation and Their Children with Fragile X Syndrome. Semin Speech Lang 2021; 42:277-286. [PMID: 34311480 DOI: 10.1055/s-0041-1730988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Fragile X syndrome (FXS) is a genetic disorder caused by changes of the FMR1 gene that is passed along among families. A range of developmental processes may be impacted with wide variation in abilities across individuals with FXS. Mothers of children with FXS are often carriers of a "premutation" expansion on the FMR1 gene, which is associated with its own clinical phenotype. These maternal features may increase individual and family vulnerabilities, including increased risk for depression and anxiety disorders and difficulties in social and cognitive ability. These characteristics may worsen with age, and potentially interact with a child's challenging behaviors and with family dynamics. Thus, families of children with FXS may experience unique challenges related to genetic risk, manifested across both children and parents, that should be considered in therapeutic planning to optimize outcomes for children and their families. In this article, we review core features of the FMR1 premutation as expressed in mothers and aspects of the family environment that interface with developmental outcomes of children with FXS. Recommendations for family-centered support services are discussed.
Collapse
Affiliation(s)
- Katherine Bangert
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, South Carolina.,Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Carly Moser
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, South Carolina
| | - Laura Friedman
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, South Carolina
| | - Jessica Klusek
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, South Carolina
| |
Collapse
|
14
|
Bullard L, Abbeduto L. Responsive Parenting as a Target for Telehealth Language Interventions in Fragile X Syndrome: Implications for Scalability and Best Practices. Semin Speech Lang 2021; 42:287-300. [PMID: 34311481 DOI: 10.1055/s-0041-1730989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This review highlights the ways in which telehealth procedures can be implemented to help bridge the research-to-practice gap in supporting developmental outcomes for youth with fragile X syndrome (FXS). We review how the literature to date has informed potential treatment targets in the areas of speech and language development with a focus on understanding and supporting the dyadic relationship between the child and their biological mother, who is also impacted biologically. Notably, parental responsivity is an area that is strongly related to child language outcomes, both early and into adolescence, and thus, it is an important treatment target for subsequent interventions. To date, several parent-implemented interventions have been done in FXS across a broad age range (2-17-year-olds) all showing support not only that parents are successful in learning responsive strategies but also that there are subsequent impacts to child language development. Moreover, these interventions were successfully implemented at a distance through telehealth procedures including video teleconferencing and shared recordings of parent-child interactions. This review also addresses potential moderators of treatment gains. Implications for scaling such interventions in the future as well as best practices for incorporating telehealth procedures into future research and intervention programs are also discussed.
Collapse
Affiliation(s)
- Lauren Bullard
- MIND Institute, UC Davis Health, Sacramento, California.,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, California
| | - Leonard Abbeduto
- MIND Institute, UC Davis Health, Sacramento, California.,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, California
| |
Collapse
|
15
|
Bush L, Martin GE, Landau E, Losh M. A Longitudinal Study of Parent-Child Interactions and Language Outcomes in Fragile X Syndrome and Other Neurodevelopmental Disorders. Front Psychiatry 2021; 12:718572. [PMID: 34819882 PMCID: PMC8606641 DOI: 10.3389/fpsyt.2021.718572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022] Open
Abstract
Difficulties with pragmatic language (i.e., language in social contexts, such as conversational ability) are a noted characteristic of the language profiles of both fragile X syndrome (FXS) and autism spectrum disorder (ASD), conditions which show significant phenotypic overlap. Understanding the origins and developmental course of pragmatic language problems in FXS and other developmental conditions associated with language impairment is a critical step for the development of targeted interventions to promote communicative competence across the lifespan. This study examined pragmatic language in the context of parent-child interactions in school-age children with FXS (who did and did not meet ASD criteria on the ADOS; n = 85), idiopathic ASD (n = 32), Down syndrome (DS; n = 38), and typical development (TD; n = 39), and their parents. Parent-child communicative interactions were examined across multiple contexts, across groups, and in relationship to pragmatic language outcomes assessed 2 years later. Results showed both overlapping and divergent patterns across the FXS-ASD and idiopathic ASD child and parent groups, and also highlighted key differences in pragmatic profiles based on situational context, with more pragmatic language difficulties occurring for both ASD groups in less structured interactions. Differences in parental language styles during parent-child interactions were associated with child language outcomes, likely reflecting the complex interplay of discourse style inherent to a parent, with the inevitable influence of child characteristics on parent language as well. Together, findings help delineate the dynamic and multifactorial nature of impaired pragmatic skills among children with FXS and other neurodevelopmental disorders associated with language impairment, with potential implications for the development of targeted interventions for pragmatic communication skills.
Collapse
Affiliation(s)
- Lauren Bush
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States.,Department of Psychiatry and Behavioral Sciences, Autism Assessment, Research, Treatment, and Services Center, Rush University Medical Center, Chicago, IL, United States
| | - Gary E Martin
- Department of Communication Sciences and Disorders, St. John's University, Staten Island, NY, United States
| | - Emily Landau
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Molly Losh
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| |
Collapse
|
16
|
Abbeduto L. Presidential Address, 2020-Using Technology to Deliver Services and Supports in Homes, Neighborhoods, and Communities: Evidence and Promise. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 58:525-531. [PMID: 33290532 PMCID: PMC7773138 DOI: 10.1352/1934-9556-58.6.525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Indexed: 06/12/2023]
|
17
|
Liao CY, Ganz JB, Vannest KJ, Wattanawongwan S, Pierson LM, Yllades V, Li YF. Caregiver Involvement in Communication Skills for Individuals with ASD and IDD: a Meta-analytic Review of Single-Case Research on the English, Chinese, and Japanese Literature. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020. [DOI: 10.1007/s40489-020-00223-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
18
|
Lindly O, Crossman M, Eaves M, Philpotts L, Kuhlthau K. Health Literacy and Health Outcomes Among Children With Developmental Disabilities: A Systematic Review. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 125:389-407. [PMID: 32936893 DOI: 10.1352/1944-7558-125.5.389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 12/07/2019] [Indexed: 06/11/2023]
Abstract
Developmental disabilities (DDs) are prevalent and associated with health disparities among children. Family health literacy of parents and/or children is one modifiable factor associated with child health; however, little is known about family health literacy for children with DDs. This systematic review was conducted to determine evidence on associations of health literacy with health outcomes among children with DDs. Medline, CINAHL, Embase, ERIC, PsycInfo, and Web of Science were searched through August 2018. Of 2,768 unique records, 53 full text articles were reviewed and four articles were included. Associations of family health literacy with health outcomes among children with DDs were mixed. Future research should include more diverse samples, greater breadth in health outcomes assessed, and increased methodological rigor.
Collapse
Affiliation(s)
| | | | | | | | - Karen Kuhlthau
- Karen Kuhlthau, Massachusetts General Hospital & Harvard Medical School
| |
Collapse
|
19
|
Thurman AJ, Potter LA, Kim K, Tassone F, Banasik A, Potter SN, Bullard L, Nguyen V, McDuffie A, Hagerman R, Abbeduto L. Controlled trial of lovastatin combined with an open-label treatment of a parent-implemented language intervention in youth with fragile X syndrome. J Neurodev Disord 2020; 12:12. [PMID: 32316911 PMCID: PMC7175541 DOI: 10.1186/s11689-020-09315-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/27/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The purpose of this study was to conduct a 20-week controlled trial of lovastatin (10 to 40 mg/day) in youth with fragile X syndrome (FXS) ages 10 to 17 years, combined with an open-label treatment of a parent-implemented language intervention (PILI), delivered via distance video teleconferencing to both treatment groups, lovastatin and placebo. METHOD A randomized, double-blind trial was conducted at one site in the Sacramento, California, metropolitan area. Fourteen participants were assigned to the lovastatin group; two participants terminated early from the study. Sixteen participants were assigned to the placebo group. Lovastatin or placebo was administered orally in a capsule form, starting at 10 mg and increasing weekly or as tolerated by 10 mg increments, up to a maximum dose of 40 mg daily. A PILI was delivered to both groups for 12 weeks, with 4 activities per week, through video teleconferencing by an American Speech-Language Association-certified Speech-Language Pathologist, in collaboration with a Board-Certified Behavior Analyst. Parents were taught to use a set of language facilitation strategies while interacting with their children during a shared storytelling activity. The main outcome measures included absolute change from baseline to final visit in the means for youth total number of story-related utterances, youth number of different word roots, and parent total number of story-related utterances. RESULTS Significant increases in all primary outcome measures were observed in both treatment groups. Significant improvements were also observed in parent reports of the severity of spoken language and social impairments in both treatment groups. In all cases, the amount of change observed did not differ across the two treatment groups. Although gains in parental use of the PILI-targeted intervention strategies were observed in both treatment groups, parental use of the PILI strategies was correlated with youth gains in the placebo group and not in the lovastatin group. CONCLUSION Participants in both groups demonstrated significant changes in the primary outcome measures. The magnitude of change observed across the two groups was comparable, providing additional support for the efficacy of the use of PILI in youth with FXS. TRIAL REGISTRATION US National Institutes of Health (ClinicalTrials.gov), NCT02642653. Registered 12/30/2015.
Collapse
Affiliation(s)
- Angela John Thurman
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA. .,Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, USA.
| | - Laura A Potter
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Pediatrics, University of California Davis Health, Sacramento, USA
| | - Kyoungmi Kim
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Public Health Sciences, University of California Davis Health, Sacramento, USA
| | - Flora Tassone
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Biochemistry and Molecular Medicine, University of California Davis Health, Sacramento, USA
| | - Amy Banasik
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, USA
| | - Sarah Nelson Potter
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Human Ecology, University of California Davis, Davis, USA
| | - Lauren Bullard
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Human Ecology, University of California Davis, Davis, USA
| | - Vivian Nguyen
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, USA
| | - Andrea McDuffie
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, USA
| | - Randi Hagerman
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Pediatrics, University of California Davis Health, Sacramento, USA
| | - Leonard Abbeduto
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, USA
| |
Collapse
|
20
|
Peter B, Dougherty MJ, Reed EK, Edelman E, Hanson K. Perceived Gaps in Genetics Training Among Audiologists and Speech-Language Pathologists: Lessons From a National Survey. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:408-423. [PMID: 31091132 DOI: 10.1044/2018_ajslp-18-0069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The aim of this study was to assess knowledge, self-rated confidence, and perceived relevance of genetics in the clinical practice of audiologists and speech-language pathologists (SLPs) toward a better understanding of the need for genetics education, given that genetics plays a growing role in the diagnosis of hearing impairment and communication disorders. Method A survey consisting of 8 demographic items and 16 content questions was returned by 233 audiologists and 283 SLPs. Knowledge of applied genetics was queried with clinical scenarios in a multiple-choice format. Self-assessment of clinical confidence and perceived relevance of genetics in one's field was queried with questions and statements rated on 5-point Likert scales. The benefit of additional training in genetics was rated with a yes/no question, and if answered with yes, suggested topics were entered. Results A large significant gap between confidence in one's own genetics skills and the perceived relevance of genetics was evident, regardless of professional group. Over one third of the audiologists and over two thirds of the SLPs indicated low or somewhat low confidence in their own ability to implement principles of genetics, whereas over two thirds of both groups agreed that genetics is relevant for their field. Regardless of group, confidence scores were significantly and positively associated with relevance scores. Over 80% of respondents in both groups indicated that they would benefit from additional training in genetics. Most commonly suggested topics included genetic causes, general information about genetics, and making referrals. Conclusion Both audiologists and SLPs felt that genetics is relevant for their fields and that additional training in genetics would be beneficial. Future studies should evaluate the effect of genetics training on patient outcomes and the need for incorporating genetics more extensively into audiology and speech-language pathology training programs.
Collapse
Affiliation(s)
- Beate Peter
- Department of Speech and Hearing Science, Arizona State University, Tempe
- Department of Communication Sciences and Disorders, Saint Louis University, MO
| | - Michael J Dougherty
- American Society of Human Genetics, Bethesda, MD
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | | | | | - Karen Hanson
- American Society of Human Genetics, Bethesda, MD
| |
Collapse
|
21
|
Abbeduto L, Thurman AJ, McDuffie A, Klusek J, Feigles RT, Ted Brown W, Harvey DJ, Adayev T, LaFauci G, Dobkins C, Roberts JE. ASD Comorbidity in Fragile X Syndrome: Symptom Profile and Predictors of Symptom Severity in Adolescent and Young Adult Males. J Autism Dev Disord 2019; 49:960-977. [PMID: 30382442 DOI: 10.1007/s10803-018-3796-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Many males with FXS meet criteria for ASD. This study was designed to (1) describe ASD symptoms in adolescent and young adult males with FXS (n = 44) and (2) evaluate the contributions to ASD severity of cognitive, language, and psychiatric factors, as well as FMRP (the protein deficient in FXS). A few ASD symptoms on the ADOS-2 were universal in the sample. There was less impairment in restricted and repetitive behaviors (RRB) than in the social affective (SA) domain. The best predictor of overall ASD severity and SA severity was expressive syntactic ability. RRB severity was best predicted by the psychiatric factors. Implications for clinical practice and for understanding the ASD comorbidity in FXS are discussed.
Collapse
Affiliation(s)
- Leonard Abbeduto
- University of California, Davis, USA. .,UC Davis MIND Institute, 2825 50th St, Sacramento, CA, 95817, USA.
| | | | | | | | | | - W Ted Brown
- New York State Institute for Basic Research in Developmental Disabilities, New York, USA
| | | | - Tatyana Adayev
- New York State Institute for Basic Research in Developmental Disabilities, New York, USA
| | - Giuseppe LaFauci
- New York State Institute for Basic Research in Developmental Disabilities, New York, USA
| | - Carl Dobkins
- New York State Institute for Basic Research in Developmental Disabilities, New York, USA
| | | |
Collapse
|
22
|
Vismara LA, McCormick CEB, Shields R, Hessl D. Extending the Parent-Delivered Early Start Denver Model to Young Children with Fragile X Syndrome. J Autism Dev Disord 2018; 49:1250-1266. [DOI: 10.1007/s10803-018-3833-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
23
|
Nelson S, McDuffie A, Banasik A, Tempero Feigles R, Thurman AJ, Abbeduto L. Inferential language use by school-aged boys with fragile X syndrome: Effects of a parent-implemented spoken language intervention. JOURNAL OF COMMUNICATION DISORDERS 2018; 72:64-76. [PMID: 29494850 PMCID: PMC5860999 DOI: 10.1016/j.jcomdis.2018.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 02/07/2018] [Accepted: 02/09/2018] [Indexed: 05/30/2023]
Abstract
This study examined the impact of a distance-delivered parent-implemented narrative language intervention on the use of inferential language during shared storytelling by school-aged boys with fragile X syndrome, an inherited neurodevelopmental disorder. Nineteen school-aged boys with FXS and their biological mothers participated. Dyads were randomly assigned to an intervention or a treatment-as-usual comparison group. Transcripts from all pre- and post-intervention sessions were coded for child use of prompted and spontaneous inferential language coded into various categories. Children in the intervention group used more utterances that contained inferential language than the comparison group at post-intervention. Furthermore, children in the intervention group used more prompted inferential language than the comparison group at post-intervention, but there were no differences between the groups in their spontaneous use of inferential language. Additionally, children in the intervention group demonstrated increases from pre- to post-intervention in their use of most categories of inferential language. This study provides initial support for the utility of a parent-implemented language intervention for increasing the use of inferential language by school aged boys with FXS, but also suggests the need for additional treatment to encourage spontaneous use.
Collapse
Affiliation(s)
- Sarah Nelson
- MIND Institute and Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, 2825 50th Street, Sacramento, CA 95811, USA; Human Development Graduate Group, Department of Human Ecology, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA.
| | - Andrea McDuffie
- MIND Institute and Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, 2825 50th Street, Sacramento, CA 95811, USA
| | - Amy Banasik
- MIND Institute and Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, 2825 50th Street, Sacramento, CA 95811, USA
| | - Robyn Tempero Feigles
- MIND Institute and Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, 2825 50th Street, Sacramento, CA 95811, USA
| | - Angela John Thurman
- MIND Institute and Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, 2825 50th Street, Sacramento, CA 95811, USA
| | - Leonard Abbeduto
- MIND Institute and Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, 2825 50th Street, Sacramento, CA 95811, USA; Human Development Graduate Group, Department of Human Ecology, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA
| |
Collapse
|
24
|
McDuffie A, Banasik A, Bullard L, Nelson S, Feigles RT, Hagerman R, Abbeduto L. Distance delivery of a spoken language intervention for school-aged and adolescent boys with fragile X syndrome. Dev Neurorehabil 2018; 21:48-63. [PMID: 28956679 PMCID: PMC5986725 DOI: 10.1080/17518423.2017.1369189] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A small randomized group design (N = 20) was used to examine a parent-implemented intervention designed to improve the spoken language skills of school-aged and adolescent boys with FXS, the leading cause of inherited intellectual disability. The intervention was implemented by speech-language pathologists who used distance video-teleconferencing to deliver the intervention. The intervention taught mothers to use a set of language facilitation strategies while interacting with their children in the context of shared story-telling. Treatment group mothers significantly improved their use of the targeted intervention strategies. Children in the treatment group increased the duration of engagement in the shared story-telling activity as well as use of utterances that maintained the topic of the story. Children also showed increases in lexical diversity, but not in grammatical complexity.
Collapse
Affiliation(s)
- Andrea McDuffie
- MIND Institute, University of California, Sacramento, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, CA, USA
| | - Amy Banasik
- MIND Institute, University of California, Sacramento, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, CA, USA
| | - Lauren Bullard
- MIND Institute, University of California, Sacramento, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, CA, USA
| | - Sarah Nelson
- MIND Institute, University of California, Sacramento, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, CA, USA
| | - Robyn Tempero Feigles
- MIND Institute, University of California, Sacramento, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, CA, USA
| | - Randi Hagerman
- MIND Institute, University of California, Sacramento, CA, USA,Department of Pediatrics, University of California, Sacramento CA, USA
| | - Leonard Abbeduto
- MIND Institute, University of California, Sacramento, CA, USA,Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, CA, USA
| |
Collapse
|
25
|
Drug development for neurodevelopmental disorders: lessons learned from fragile X syndrome. Nat Rev Drug Discov 2017; 17:280-299. [PMID: 29217836 DOI: 10.1038/nrd.2017.221] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neurodevelopmental disorders such as fragile X syndrome (FXS) result in lifelong cognitive and behavioural deficits and represent a major public health burden. FXS is the most frequent monogenic form of intellectual disability and autism, and the underlying pathophysiology linked to its causal gene, FMR1, has been the focus of intense research. Key alterations in synaptic function thought to underlie this neurodevelopmental disorder have been characterized and rescued in animal models of FXS using genetic and pharmacological approaches. These robust preclinical findings have led to the implementation of the most comprehensive drug development programme undertaken thus far for a genetically defined neurodevelopmental disorder, including phase IIb trials of metabotropic glutamate receptor 5 (mGluR5) antagonists and a phase III trial of a GABAB receptor agonist. However, none of the trials has been able to unambiguously demonstrate efficacy, and they have also highlighted the extent of the knowledge gaps in drug development for FXS and other neurodevelopmental disorders. In this Review, we examine potential issues in the previous studies and future directions for preclinical and clinical trials. FXS is at the forefront of efforts to develop drugs for neurodevelopmental disorders, and lessons learned in the process will also be important for such disorders.
Collapse
|
26
|
Ashby SA, Channell MM, Abbeduto L. Inferential language use by youth with Down syndrome during narration. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 71:98-108. [PMID: 29032290 PMCID: PMC5675781 DOI: 10.1016/j.ridd.2017.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/22/2017] [Accepted: 10/03/2017] [Indexed: 05/23/2023]
Abstract
We examined inferential language use by youth with Down syndrome (DS) in the context of narrative storytelling relative to younger typically developing (TD) children and same-aged peers with fragile X syndrome (FXS) matched on nonverbal cognitive ability level. Participants' narratives were coded for the use of different types of inferential language. Participants with DS used proportionately less inferential language overall relative to their counterparts with TD or FXS, although mean length of utterance accounted for group differences observed for the DS-TD group comparison only. Patterns of inferential language use varied across inferential subtypes and across participant groups, with mean length of utterance playing a significant role in group differences. These findings suggest potential syndrome specificity to the DS phenotype regarding impairments in inferential language use that can be partially explained by level of expressive syntactic ability and should be considered in future research. Clinical interventions within the DS population, therefore, should target to some extent the use of inferential language and complex sentence structure.
Collapse
Affiliation(s)
- Shealyn A Ashby
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, 901 S. Sixth Street, Champaign, IL, 61820, USA.
| | - Marie Moore Channell
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, 901 S. Sixth Street, Champaign, IL, 61820, USA.
| | - Leonard Abbeduto
- MIND Institute, University of California, Davis, 2825 50th Street, Sacramento, CA, 95817, USA.
| |
Collapse
|
27
|
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.
Collapse
|
28
|
Thurman AJ, McDuffie A, Hagerman RJ, Josol CK, Abbeduto L. Language Skills of Males with Fragile X Syndrome or Nonsyndromic Autism Spectrum Disorder. J Autism Dev Disord 2017; 47:728-743. [PMID: 28074353 DOI: 10.1007/s10803-016-3003-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite the similarities observed between the fragile X syndrome (FXS) and autism spectrum disorder (ASD) phenotypes, few studies have compared their behavioral profiles outside of ASD symptomatology. In the present study, we sought to compare lexical and grammatical abilities in these two conditions. Comparisons of language abilities in both of these conditions are particularly interesting because both conditions are characterized by difficulties navigating social interactions. Results suggest that although both FXS and ASD are associated with language difficulties, there are important differences between the two conditions in terms of the language profiles observed and the factors influencing language when considering children of similar developmental levels. Theoretical implications are discussed.
Collapse
Affiliation(s)
- Angela John Thurman
- MIND Institute, University of California Davis, 2825 50th Street, Room 2101, Davis, CA, 95817, USA.
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, USA.
| | - Andrea McDuffie
- MIND Institute, University of California Davis, 2825 50th Street, Room 2101, Davis, CA, 95817, USA
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, USA
| | - Randi J Hagerman
- MIND Institute, University of California Davis, 2825 50th Street, Room 2101, Davis, CA, 95817, USA
- Department of Pediatrics, University of California Davis, Davis, USA
| | - Cynde K Josol
- MIND Institute, University of California Davis, 2825 50th Street, Room 2101, Davis, CA, 95817, USA
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, USA
| | - Leonard Abbeduto
- MIND Institute, University of California Davis, 2825 50th Street, Room 2101, Davis, CA, 95817, USA
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, USA
| |
Collapse
|
29
|
Budimirovic DB, Berry-Kravis E, Erickson CA, Hall SS, Hessl D, Reiss AL, King MK, Abbeduto L, Kaufmann WE. Updated report on tools to measure outcomes of clinical trials in fragile X syndrome. J Neurodev Disord 2017; 9:14. [PMID: 28616097 PMCID: PMC5467057 DOI: 10.1186/s11689-017-9193-x] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 02/22/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Fragile X syndrome (FXS) has been the neurodevelopmental disorder with the most active translation of preclinical breakthroughs into clinical trials. This process has led to a critical assessment of outcome measures, which resulted in a comprehensive review published in 2013. Nevertheless, the disappointing outcome of several recent phase III drug trials in FXS, and parallel efforts at evaluating behavioral endpoints for trials in autism spectrum disorder (ASD), has emphasized the need for re-assessing outcome measures and revising recommendations for FXS. METHODS After performing an extensive database search (PubMed, Food and Drug Administration (FDA)/National Institutes of Health (NIH)'s www.ClinicalTrials.gov, etc.) to determine progress since 2013, members of the Working Groups who published the 2013 Report evaluated the available outcome measures for FXS and related neurodevelopmental disorders using the COSMIN grading system of levels of evidence. The latter has also been applied to a British survey of endpoints for ASD. In addition, we also generated an informal classification of outcome measures for use in FXS intervention studies as instruments appropriate to detect shorter- or longer-term changes. RESULTS To date, a total of 22 double-blind controlled clinical trials in FXS have been identified through www.ClinicalTrials.gov and an extensive literature search. The vast majority of these FDA/NIH-registered clinical trials has been completed between 2008 and 2015 and has targeted the core excitatory/inhibitory imbalance present in FXS and other neurodevelopmental disorders. Limited data exist on reliability and validity for most tools used to measure cognitive, behavioral, and other problems in FXS in these trials and other studies. Overall, evidence for most tools supports a moderate tool quality grading. Data on sensitivity to treatment, currently under evaluation, could improve ratings for some cognitive and behavioral tools. Some progress has also been made at identifying promising biomarkers, mainly on blood-based and neurophysiological measures. CONCLUSION Despite the tangible progress in implementing clinical trials in FXS, the increasing data on measurement properties of endpoints, and the ongoing process of new tool development, the vast majority of outcome measures are at the moderate quality level with limited information on reliability, validity, and sensitivity to treatment. This situation is not unique to FXS, since reviews of endpoints for ASD have arrived at similar conclusions. These findings, in conjunction with the predominance of parent-based measures particularly in the behavioral domain, indicate that endpoint development in FXS needs to continue with an emphasis on more objective measures (observational, direct testing, biomarkers) that reflect meaningful improvements in quality of life. A major continuous challenge is the development of measurement tools concurrently with testing drug safety and efficacy in clinical trials.
Collapse
Affiliation(s)
- Dejan B. Budimirovic
- Departments of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute and Child Psychiatry, Johns Hopkins University School of Medicine, 716 N. Broadway, Baltimore, MD 21205 USA
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, Biochemistry, Rush University Medical Center, 1725 West Harrison, Suite 718, Chicago, IL 60612 USA
| | - Craig A. Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 4002, Cincinnati, OH 45229 USA
| | - Scott S. Hall
- Division of Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305 USA
| | - David Hessl
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, 2825 50th Street, Sacramento, CA 95817 USA
| | - Allan L. Reiss
- Division of Interdisciplinary Brain Sciences, Departments of Psychiatry and Behavioral Sciences, Radiology and Pediatrics, Stanford University, 401 Quarry Road, Stanford, CA 94305 USA
| | - Margaret K. King
- Autism & Developmental Medicine Institute, Geisinger Health System, Present address: Novartis Pharmaceuticals Corporation, US Medical, One Health Plaza, East Hanover, NJ 07936 USA
| | - Leonard Abbeduto
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, 2825 50th Street, Sacramento, CA 95817 USA
| | - Walter E. Kaufmann
- Center for Translational Research, Greenwood Genetic Center, 113 Gregor Mendel Circle, Greenwood, SC 29646 USA
- Department of Neurology, Boston Children’s Hospital, Boston, MA 02115 USA
| |
Collapse
|
30
|
Bullard L, McDuffie A, Abbeduto L. Distance delivery of a parent-implemented language intervention for young boys with fragile X syndrome. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2017; 2:10.1177/2396941517728690. [PMID: 30417116 PMCID: PMC6223638 DOI: 10.1177/2396941517728690] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND In addition to significant cognitive delays, boys with fragile X syndrome display phenotypic characteristics that include delays in language, inattention, social anxiety, and escape-maintained challenging behaviors. Despite these challenges, families affected by fragile X syndrome often have limited access to center-based intervention programs. METHODS The present study utilized a multiple baseline design across participants to examine the preliminary effectiveness of a 12-week, parent-implemented spoken language intervention for three 5- to 7-year-old boys with fragile X syndrome. The goal of the intervention was to teach the biological mothers of each boy to use a set of verbally responsive language support strategies while participating in shared book reading activities with her child. All aspects of the intervention, including pre- and post-treatment measures, were delivered into the family's home via distance video teleconferencing. RESULTS Results from this study provide preliminary support for the efficacy of this parent-implemented language intervention approach by demonstrating generalized improvements in both targeted maternal strategy use and measures of child spoken language. CONCLUSIONS The present study expands upon prior language intervention research utilizing distance delivery of services for families affected by fragile X syndrome. Additionally, the study provides early support for the feasibility of collecting pre- and post-treatment assessments at a distance.
Collapse
|