Autism & Developmental

Fragile X syndrome: genetic predisposition to psychopathology.

Bregman et al. (1988) · Journal of autism and developmental disorders 1988
★ The Verdict

In Fragile X boys, treat anxiety to fix autistic-looking behaviors.

✓ Read this if BCBAs working with school-age boys with Fragile X in classroom or residential settings
✗ Skip if Clinicians who only serve kids with classic autism and no genetic testing

01Research in Context

01

What this study did

Doctors looked at 14 boys with Fragile X. All boys lived in a hospital school.

They watched each boy for weeks. They wrote down every odd behavior they saw.

They asked: are these boys autistic, or just scared?

02

What they found

Every boy was hyper and impulsive. Most were also very anxious.

Only one boy met the rules for autism. The rest had poor eye contact and flapped hands because of fear, not autism.

03

How this fits with other research

Laugeson et al. (2014) later tested 30 FXS boys with photos of faces. The boys still avoided people even when they could read the feelings. This supports the 1988 idea that anxiety, not poor skill, drives the social retreat.

Eussen et al. (2016) looked at preschool FXS boys. They saw the same low self-control and high activity found in the 1988 teens. It shows these traits start early.

Bowen et al. (2012) used eye-tracking in teens. They found that looking too long at scared faces matched high anxiety scores. This gives us a quick, measurable way to spot the same anxiety the 1988 team saw by watching.

04

Why it matters

If a child with FXS looks autistic, check anxiety first. Treat the fear and you may fix the gaze aversion, hand flapping, and even some hyperactivity. Use short calm instructions, give choices, and reward brave eye contact. You might skip the full autism label and its heavier programs.

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Track eye contact during easy tasks; reinforce every calm look with a token and praise.

02At a glance

Intervention
not applicable
Design
case series
Sample size
14
Population
developmental delay
Finding
not reported

03Original abstract

Fragile X syndrome is a newly recognized X-linked disorder which has been associated with a high prevalence of psychiatric disturbance, particularly attention deficit disorder and autism. The present study involved the neuropsychiatric evaluation of 14 males with the disorder who were between the ages of 3 to 27 years. Pervasive hyperactivity, impulsivity, and attentional deficits were found among all of the subjects, while a significant degree of anxiety was manifested by more than half. Although the majority of subjects exhibited poor eye contact, atypical speech and language functioning, and stereotyped behavior, only one met DSM-III diagnostic criteria for a persistent pervasive developmental disorder. Gaze aversion, noted among half of the subjects, was attributed to underlying anxiety rather than to autistic social dysfunction because of the otherwise socially engaged and affectionate behavior exhibited by the subjects. Failure to make this distinction in the context of cognitive and linguistic impairments associated with fragile X syndrome may account for the high rates of autism reported by other investigators.

Journal of autism and developmental disorders, 1988 · doi:10.1007/BF02212191