Trajectories and predictors of the development of very young boys with fragile X syndrome

OBJECTIVE

To describe the development of young boys with fragile X syndrome (FXS).

METHODS

Fifty-five boys (aged 8-48 months at study entry) with the full mutation FXS received multiple developmental assessments.

RESULTS

As expected, the boys' rate of development was significantly lower than chronological age expectations. No evidence of slowing in the rate of development was found. Autistic behavior was negatively associated with development, but maternal IQ was not. Developmental delays were evident in some domains as early as 9 months; however, initial detection of delays is complicated by measures and criteria used. Developmental age scores at 31 months of age were related to scores obtained at 61 months of age only in the global composite and visual reception domain.

CONCLUSIONS

Developmental delays are evident in some infants with FXS as young as 9 months of age. Pediatric psychologists need to be informed about the developmental profiles in young children with FXS to accurately diagnose, treat, and support these children and their families.

Video analysis of sensory-motor features in infants with fragile X syndrome at 9-12 months of age

This study utilized retrospective video analysis to distinguish sensory-motor patterns in infants with fragile X syndrome (FXS) (n = 11) from other infants [i.e., autism (n = 11), other developmental delay (n = 10), typical (n = 11)] at 9-12 months of age. Measures of development, autistic features, and FMRP were assessed at the time of entry into the study. Home videos collected from families were edited and coded with previously validated procedures. Findings revealed a pattern of sensory-motor features (e.g., repetitive leg movements, posturing, less sophistication/repetitive use of objects) associated with FXS, and suggest these infants were most similar to the group of infants with other developmental delays, irrespective of co-existing autistic symptoms later in life. Infant sensory-motor features in the FXS group were more predictive of an early developmental milestone (i.e., age walking) than later, more broad, developmental outcomes, or FMRP. Implications for early identification and differential diagnosis are discussed.

Developmental screening and detection of developmental delays in infants and toddlers with fragile X syndrome

Three developmental screening tests (the Denver-II, Battelle Developmental Inventory Screening Test, and Early Language Milestone Scale-2) were administered to 18 infants and toddlers (13 boys and 5 girls) with confirmed diagnoses of fragile X syndrome as part of a comprehensive developmental assessment at 9, 12, and 18 months of age. The Denver-II identified delays for 10 of 11 boys at 9 months of age and the Denver-II and the Early Language Milestone Scale-2 identified delays in 100% of the boys at 12 and 18 months. The Battelle Developmental Inventory Screening Test identified delays in 75% of the children at 12 and 18 months. When compared with more comprehensive developmental tests (Mullen Scales of Early Learning and Receptive-Expressive Emergent Language Scale-2), the screening tests concurred at least 76% of the time at the 12- and 18-month assessments. These results indicate that developmental delays could be detected in most children with fragile X syndrome through routine developmental screening by the age of 9 to 12 months.

Early Intervention Practices and Communication Intervention Strategies for Young Males With Fragile X Syndrome

Purpose: This study describes speech-language pathologists’ impressions of the communication difficulties of young males with fragile X syndrome (FXS) and the need for both syndrome-specific and individualized interventions. The findings of a regional study that identified speech-language pathologists’ impressions of the speech, language, and behavioral difficulties experienced by males with FXS and an array of interventions used by speech-language pathologists to improve communication skills for these children are reported.

Methods: Fifty-one speech-language pathologists providing intervention for males with FXS ranging in age from 2 to 9 years (mean age=6;3 [years;months]) were interviewed.

Results: The majority of the speech-language pathologists reported that boys with FXS exhibit a visually based, experiential or wholistic learning preference. They emphasized the necessity of making environmental accommodations for limited attention span, difficulties with topic and activity transitions, sensory deficits, and low threshold for anxiety. They reported that speech goals focused on slowing rate and increasing precision for verbal children and both low and high levels of assistive technology for nonverbal or minimally verbal children. Language goals focused on listening, auditory comprehension, and narrative/conversation skills. Pragmatic goals emphasized social dialogue, role playing, and topic maintenance.

Clinical Implications: This study suggests that young males with FXS present the clinician with a constellation of behaviors and communication impairments that are both syndrome specific and symptom familiar. The specific communication strengths and deficits described by clinicians working with these children are common to many children with speech and language impairments compounded by cognitive deficits. Intervention programs for young boys with FXS should also attend closely to the specific behavioral (e.g., increased anxiety, attention deficits) and sensory "overload" problems they often exhibit before designing a tailored intervention program.

Videofluoroscopic assessment of dysphagia in children with severe spastic cerebral palsy

Very little has been published about the characteristics and sequelae of dysphagia in children with neurological impairment. The swallowing difficulties encountered by children with spastic cerebral palsy are particularly debilitating and potentially lethal. However, aggressive evaluation and management of their feeding is typically deferred until they are medically or nutritionally compromised. Reports of the use of videofluoroscopy to analyze the swallowing patterns and presence or absence of aspiration in such children are rare. This paper describes the histories and analyzes the videofluorographic swallow studies of 22 patients with the primary diagnosis of severe spastic cerebral palsy. The ages of the subjects ranged from 7 months to 19 years. All had severe dysphagia and were slow, inefficient eaters. Fifteen patients (68.2%) demonstrated significant silent aspiration during their swallow study. Analysis of specific features of their swallowing patterns indicated that decreased or poorly coordinated pharyngeal motility was predictive of silent aspiration. Moderately to severely impaired oral-motor coordination was indicative of severity of feeding complications. Our data suggest that early diagnostic workup, including baseline and comparative videofluoroscopic swallow studies, could be helpful in managing the feeding difficulties in these children and preventing chronic aspiration, malnutrition, and unpleasant lengthy mealtimes.