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Late Adolescence: Aggressive Behavior
Aggressive behavior is a common problem in adolescence and adulthood, and it requires a thorough medical and environmental assessment. Medical problems, such as psychomotor seizures, may precipitate
aggressive behavior, and anticonvulsant therapy is often helpful, as described below. Various environmental stressors may also precipitate an outburst, including overstimulating situations, crowding, transitions, physical
discomfort, staff changes, moves, death of a family member, and family conflict. Possible problems must be assessed and changes made to create an appropriate environment. Often a workplace without excessive stimuli and distractions
or a living situation without disruptive roommates makes a significant difference in the frequency of aggressive outbursts. Additionally, a program of behavior management may include tokens for good behavior and calming techniques
(chaps. 9 and 11). Outbursts may also occur when a male with FXS is around a female staff member or client in whom he is interested sexually, but the feelings may not be mutual. The issue of sexual frustration is probably more
common than we realize, and it is treated most effectively in counseling. Medications, particularly serotonin agents as described in the next section, may work synergistically with behavior and environmental management to help some
patients control aggressive behavior (Stewart et al. 1990). Serotonin agents probably work to improve aggression by decreasing anxiety and irritability. Often, however, a mood stabilizer or an atypical antipsychotic is needed to
treat severe aggression if other medications are not helpful (Ruedrich et al. 1999; Hellings 1999; Hagerman 1999b). Medical studies outside the fragile X field suggest that aggression associated with sexual obsessions, deviant
sexual behavior, or severe paraphilia usually responds to a long-acting analog of gonadotropin-releasing hormone, such as triptorelin, if serotonin agents or other interventions described below are not successful (Rosler and
Witztum 1998). However, there are no controlled studies regarding the treatment of aggression in FXS; actually very little controlled work has been done regarding treatment of any behavioral problem in FXS. Therefore, the
information regarding medications described in the following segment includes studies that have been done in the normal population or in children or adults with developmental disabilities.
Late Adolescence: Physical Examinations
Periodic physical examinations to monitor cardiovascular parameters including blood pressure, growth parameters, weight changes, and neurologic findings that may be influenced by medication are
recommended. Health maintenance also includes an ongoing vigilance for connective tissue problems such as hernias, joint dislocations, scoliosis, and MVP besides behavior and developmental problems (American Academy of Pediatrics
1996; Hagerman 1997).
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This article is not intended to give medical advice for individual cases. Any change in medical treatment
should be done in consultation with appropriate medical personnel. This article is written for medical professionals. Some of the terms will be unfamiliar to those who are not trained in medical fields.
*This article is from the chapter on treatment in the 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research edited
by Randi Jenssen Hagerman, M.D. and Paul Hagerman, M.D., Ph.D., to be published May 2002. It is included with permission from The Johns Hopkins University Press. References to other chapters refer to chapters in
the book which are not included as part of this website.
The complete 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research can be ordered from the National Fragile X Foundation by calling
1-800-688-8765 or from The Johns Hopkins University Press at 1-800-537-5487.
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Medical Follow-up Pharmacotherapy Future Prospects
Outline Medications Medical Conditions
References: A, B, C, D, EF, G, H, IJ, K, L, M, NOP, QR, S, T, UVWXYZ
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