The Toddler Period: Behavioral Difficulties

Behavioral difficulties often noted in the second and third years include excessive tantrums, eating problems, and sleeping difficulties. Maintaining consistency in routines, facilitating transitions, avoiding circumstances that are overwhelming in sensory input, and helping a child with calming routines are therapy techniques outlined in chapters 9 and 10. Basic principles of child rearing and discipline, such as reinforcing good behavior and ignoring or timing out negative behavior, can be discussed in detail with parents. Negative behavior cycles can develop at home, which involve negative attention for bad behavior and no reinforcement for appropriate behavior, both of which are counterproductive. If problems develop, early referral to a psychologist who can teach appropriate behavior modification techniques to the parents is essential.

The Toddler Period: Shyness/Social Anxiety

Usually eye contact is good during the first year of life in infants with FXS. However, an increase in sensitivity to eye contact gradually develops by the second to the third year, and it is often associated with initial shyness and social anxiety. Although most boys with FXS warm up to social interaction and are considered friendly, approximately 15-38% will maintain more severe social deficits and will be diagnosed with autism (see chap. 1 for detailed discussion). For these individuals a more intensive preschool program with a focus on treating deficits related to autism is appropriate (Rogers and Lewis 1989; Rogers 2000).

The Toddler Period: Pharmacotherapy

Pharmacotherapy, such as methylphenidate, is typically most helpful for the school-aged child, and it is used for impulsivity and attentional problems and not primarily for behavioral control. However, when episodes of outburst behavior, tantrums, or aggression are severe, clonidine can be cautiously used for the child who is at least three years old, as described below. Dextroamphetamine or methylphenidate in low doses has also been helpful for preschool children with severe symptoms of attention deficit hyperactivity disorder (ADHD). Many families have associated folic acid therapy with improvement in attention, language development, and mood lability during early childhood, as reviewed below. Folic acid therapy may be started during infancy or early childhood, unlike stimulants.

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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References: A, B, C, D, EF, G, H, IJ, K, L, M, NOP, QR, S, T, UVWXYZ

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