PS-75
Title: Prevalence and Predictors of Anxiety Disorders in Adolescent and Adult Males with Fragile X Syndrome
Authors: Jordan A. Ezell, Sara Matherly, Shannon O'Connor, Cameron Thomas, Leonard Abbeduto, Jane Roberts
Introduction: Fragile X syndrome (FXS) is a monogenetic disorder characterized by abnormal social behavior and intellectual disability. The FXS behavioral phenotype is typified by shyness, avoidant eye contact, elevated states of physiological arousal, withdrawn and autistic behaviors (Cohen, 1997). Additionally, high rates of anxiety symptomatology have been reported in FXS with most research focused on broadband, screening level scales. In the one study using DSM-IV diagnostic measures in 58 males with FXS (5 - 27 years old), results indicated that 86% met for any anxiety disorder with Specific Phobia (65%) and Social
Phobia (35%) as the most frequent disorders. Older age, lower IQ and the presence of an autism spectrum disorder were associated with increased prevalence in specific anxiety disorders. The purpose of this study is to advance our understanding of the nature of anxiety disorders in in adolescent males with FXS by examining the prevalence and predictors of anxiety disorders using multiple measures over time and including heritable factors given the high prevalence of anxiety disorders in mothers of children with FXS.
Methods: Participants included males with FXS from 16 to 24 years of age, who demonstrated phrase speech and a nonverbal IQ below 85. In this longitudinal study, screening indices of anxiety preceded diagnostic determination a year later. Screening measures included the Anxiety Depression and Mood Scale (ADAMS) and the Child Behavior Checklist (CBCL) anxiety, internalizing and problem behavior subscales. The diagnostic measure was the Children's Interview for Psychiatric Symptoms-
Parent Version (P-ChIPS), a semi-structured diagnostic interview for anxiety disorders including Specific Phobia, Social Phobia,
Separation and Generalized Anxiety completed by the mother. The Beck Anxiety Inventory (BAI) was completed to determine the relationship of maternal anxiety to child anxiety. The Autism Diagnostic Observation Schedule - 2 was used to document autism severity and non-verbal IQ was measured by the Leiter-R.
Results: Our data indicate that 61% of adolescent males with FXS met criteria for at least one anxiety disorder with 29% for
Specific Phobia, 18% for Social Phobia, and 32% for General Anxiety Disorder. Results from logistic regression analyses indicated that older age predicted Social Phobia (p<0.05, r=0.73) with a trend for the ADAMS anxiety subscale to predict Generalized
Anxiety Disorder (p=0.065, r=0.04) and for maternal anxiety to predict any anxiety (p=0.178, r=0.4). The trend continued for the
CBCL anxiety subscale, internalizing subscale, and anxiety problems subscale to predict any anxiety disorder and to predict
General Anxiety Disorder (p<0.20).
Discussion: This study is consistent with previous work indicating a high prevalence of anxiety disorders in FXS; however, our data indicate generally lower prevalence levels for both any anxiety disorder and for specific disorders. Also, we did not find a relationship between IQ and autism severity to anxiety disorders as has been reported. Yet, we did find that older age indicated increased risk consistent with others. Ours is the first to document a tentative relationship between anxiety symptoms and elevated maternal anxiety features to later diagnoses. This work is important to develop targeted treatments for adolescents and young adults with FXS as well as to surveil children for the emergence of anxiety.
References/Citations:
• Cohen J. Fragile X syndrome. (1997). Why is it important? Aust Fam Physician. Mar;26(3):273-4.
• Cordeiro L, Ballinger E, Hagerman R, Hessl D. (2011). Clinical assessment of DSM-IV anxiety disorders in fragile X syndrome: prevalence and characterization. J Neurodevelopmental Disorders. Mar;3(1):57-67.