The Course of Social Avoidance in Fragile X Syndrome
Social avoidance includes failure to initiate interactions, reduced time spent interacting with others, and social interaction restricted to a subset of preferred individuals. Elevated social avoidance is often associated with negative outcomes including reduced relationship quality and educational/vocational difficulties. High levels of social avoidance are commonly observed in individuals with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and anxiety.
Fragile X syndrome (FXS) is a monogenic disorder associated with ASD. In males with FXS, social avoidance emerges in infancy, increases through early childhood, and stabilizes at a high level across adolescence and adulthood. Increased social avoidance across infancy and preschool predicts more severe ASD symptoms but reduced ADHD and anxiety symptoms in children with FXS.
Autism is a lifelong disorder characterized by core problems in social communication and the presence of stereotyped and repetitive behaviors. However, the manifestation of these problems can change over time. In many cases, the severity of autistic symptoms decreases with age; in others, difficulties may become more evident as individuals grow older. In adolescence and adulthood, many individuals also develop additional mental health problems, particularly related to anxiety and depression.
The course of development is highly variable and often very difficult to predict. The most positive outcomes tend to be for individuals who develop useful speech in childhood and have an IQ in the normal range (i.e., 70+). Nevertheless, even among this group, some individuals remain highly dependent as adults. A good outcome also depends on the adequacy of intervention and support available during child- and adulthood.
References and Reading
- Roberts, J. E., Crawford, H., Will, E. A., Hogan, A. L., McQuillin, S., Tonnsen, B. L., … Brewe, A. M. (2019b). Infant social avoidance predicts autism but not anxiety in fragile X syndrome. Frontiers in Psychiatry, 10, 199. https://doi.org/10.3389/fpsyt.2019.00199.