2016 Gatlinburg Conference Poster
PS-44
Title: Effect of Anxiety Disorders on Functional Daily Living Skills in Young Adult Males with Fragile X Syndrome
Authors: Sara Matherly, Jane Roberts, Angela Thurman, Andrea McDuffie, Leonard Abbeduto
Introduction: Fragile X syndrome (FXS) is the most common inherited genetic cause of intellectual disability (ID). Daily living,
socialization, and communication skills play pivotal roles in the life success of individuals with ID and encompass specific domains
of functional skills. Research has illustrated that the majority of adult males with FXS master basic daily living skills, such as
toileting, eating, and bathing (Bailey, 2009). However, co-occurring mental health conditions of an autism spectrum disorder
have been found to negatively influence more complex functional skills related to adult independence for individuals with FXS
(Hartley, 2011). FXS is also characterized by anxiety and social withdrawal in comparison to general ID populations, indicating a
profound, pervasive effect of the FMR1 gene mutation on anxiety symptoms. Despite the striking prevalence of anxiety in FXS,
these debilitating symptoms often go untreated and their impact on functional skills related to adult independence remains
unknown. The purpose of this study was to evaluate the dimensional and diagnostic effects of anxiety disorders on daily living
skills in young adult males with FXS, which may inform targets for interventions with young adult services.
Methods: This sample represents preliminary data from a larger ongoing study. Participants included 30 young adult FXS males
(Mage=18.6 (2.3) with nonverbal IQs below 85. The Children's Interview for Psychiatric Syndromes: Parent Version (PChIPS) was
used to characterize participants for anxiety disorders including Specific Phobia, Social Phobia, Separation Anxiety and
Generalized Anxiety. The Autism Diagnostic Observation Schedule-2 provided an autism severity index for each participant,
which was examined as a predictor of daily living skills in analyses. The Child Behavior Checklist, a parent-report instrument,
assessed dimensional aspects of anxious/depressed behaviors. The Waisman Activities of Daily Living Scale (W-ADL), a parentreport questionnaire, rated independence of daily living skills from a scale of 0 to 34 with greater scores indicative of more skills.
Results: Young adult males with FXS had a mean of 22.12 (SD 5.08) reflecting mastery of between 8-11 out of 17 possible daily
living skills. Additionally, 60% of participants met criteria for at least 1 anxiety disorder on the PChIPS with 23% falling above the
at risk clinical cutoff on the CBCL and 13% meeting criteria across both measures. Daily living skills were negatively related to
autism severity (B=-.83, p<.05; R2=.54) and positively related to anxiety on the CBCL (B=.67, p<.05) and Leiter Growth scores
(B=.17, p<.05). Lastly, only the presence of Separation Anxiety Disorder on the PChIPS resulted in significantly reduced functional
daily living skills (B=-8.37, p<.05; R2=.17).
Discussion: These findings indicate that daily living skills are impaired in young adult males with FXS. Given that reduced daily
living skills were associated with lower nonverbal IQ and elevated autism symptoms, this suggests that these individuals are in
need for more intensive and, perhaps, more specialized treatment to increase their daily living skills. A complex pattern
emerged with poor daily living skills associated with decreased anxiety symptoms yet, also, with the presence of Separation
Anxiety Disorder. Perhaps, elevated anxiety at a sub-threshold level serves to heighten awareness and mobilize efforts towards
adaptive behavior while anxiety at a higher, diagnostic level results in impairment.
References/Citations:
• Bailey, D. B., Raspa, M., Holiday, D., Bishop, E., & Olmsted, M. (2009). Functional skills of individuals with fragile X
syndrome: A lifespan cross-sectional analysis. American Journal on Intellectual and Developmental Disabilities, 114(4),
289-303. doi:10.1352/1944-7558-114.4.289-303
• Hartley, S. L., Seltzer, M. M., Raspa, M., Olmstead, M., Bishop, E., & Bailey, D. B. (2011). Exploring the adult life of men
and women with fragile X syndrome: Results from a national survey. American Journal on Intellectual and
Developmental Disabilities, 116(1), 16-35. doi:10.1352/1944-7558-116.1.16