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Early Adolescence: Attention Problems/Aggressive Behavior
Often hyperactivity decreases before or during puberty, but attention problems usually persist into adulthood in boys with FXS (Einfeld et al. 1999). Aggressive behavior may be a problem for some boys,
and episodic violent outbursts are particularly common during and after puberty, perhaps related to the increase in testosterone during puberty (Constantino 1995; Einfeld et al. 1999). Aggression can be associated with CNS
dysfunction in the hypothalamus, orbital prefrontal cortex, and amygdaloid complex (Weiger and Bear 1988; Habib et al. 2000), and all of these brain areas are affected by the absence of the FMR1 protein (FMRP) (Binstock 1995; Reiss
et al. 1995; chap. 1). Treatment involves many of the same interventions mentioned at earlier ages, including calming techniques and individual counseling, as well as behavior management and perhaps use of visual imagery to calm
behavior (Brown et al. 1991; Brown 1995; chap. 9). Bregman (1991) summarized the goals of counseling in individuals with developmental disabilities. The goals and treatment issues include increasing self-esteem, helping with
emancipation from parents or caregivers, finding adaptive ways to cope with anger or social stigmatization, understanding one's cognitive limitations, and planning for independent or semi-independent living when possible.
Monitoring the environment to avoid overwhelming stimuli and facilitating transitions are also helpful (chap. 10). Medical intervention with pharmacotherapy (as described below) may work synergistically with these other
interventions (chap. 9).
Early Adolescence: Continued
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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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