The School-Age Period: Attentional Problems and Hyperactivity

The assessment and treatment of attentional problems and hyperactivity are important components of the educational program for the young school-aged child. Successful treatment is multimodal, including behavior management, structure in the classroom, and individual therapy (Dykens et al. 1994; Keogh 1992; Wilson et al. 1994; chap. 9). In addition, medication to improve attention and reduce impulsivity and hyperactivity is often helpful in patients with ADHD, with or without FXS (MTA 1999a, 1999b; Hagerman et al. 1988). For evaluation of possible ADHD, a detailed history should be taken and questionnaires, such as the Conners (Conners 1973), can be given to the parent and teacher (Murphy and Hagerman 1992). For a thorough list and a review of a variety of ADHD behavior checklists, see Barkley (1995, 1997, 1998). In the clinical assessment of the child, behavior can be monitored during play and during tasks that require concentration (Hagerman 1984).

The School-Age Period: Connective Tissue Dysplasia

Further signs of connective tissue dysplasia may be evident at this age, including scoliosis, flat feet, hernias, and a cardiac murmur. Mitral valve prolapse (MVP) may be manifested by a click or an early systolic murmur and occurs in approximately 50% of adult males with FXS. On rare occasions, the MVP may be severe and a holosystolic murmur secondary to mitral regurgitation is heard. If evidence of MVP is detected on physical examination (a click or a murmur), further evaluation by a cardiologist, including an echocardiogram, is necessary. If the MVP is confirmed, prophylaxis for subacute bacterial endocarditis (SBE) is recommended for dental procedures or surgery that may be contaminated by endogenous bacteria (Durack 1995). If scoliosis is present, baseline films of the total spine should be performed with careful follow-up. Referral to an orthopedist is important because progression of the scoliosis may require treatment such as bracing well before puberty.

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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