Fragile X Syndrome: Medications for Aggressive Behavior?
Hirsch, David, The Exceptional Parent
Q Our 14-year-old son has fragile X syndrome. Although he had routine chromosome testing a number of years ago, the results of that test were normal. The fragile X diagnosis was confirmed only recently by direct DNA analysis. Our son doesn't seem to have many of the prominent physical features of fragile X, but he has mild to moderate mental retardation, and it seems he is falling farther behind each year. My other major concern is some behavioral symptoms he is exhibiting - primarily aggressive, sometimes violent, behavior towards me, his classmates and, occasionally, his teachers. We have tried behavior modification at home and at school with limited success.
Are there any medications that can safely be used to help control his aggressive behavior? I certainly do not want him to be sedated, but I am afraid that if his behavior does not improve, he win fall even farther behind.
A Increasingly, professionals are realizing that behavioral symptoms are often an important component of certain medical problems, such as fragile X syndrome and, in fact, can often lead to severe problems if not adequately recognized and treated. I strongly believe that if not dealt with appropriately, the behavioral problems seen in fragile X and other developmental disorders can often lead to poor school performance which, in turn, may cause a child to fall farther behind his or her peers academically.
Behavioral symptoms, if any, vary greatly between individuals with fragile X syndrome and also may vary in the same individual with age. However, aggressive behavior, sometimes with violent outbursts, is not uncommon in adolescents or even younger children with fragile X syndrome. Nevertheless, before considering the use of medications, doctors should perform a comprehensive medical evaluation to rule out physical problems that might be contributing to such behavior. For example, doctors should investigate the possibility that the child is having seizures - specifically complex-partial seizure - a type of seizure that includes altered consciousness and often "automatisms, (robot-like behaviors such as running, fumbling with objects or clothing, or lip-smacking). Sometimes complex-partial seizures may appear as aggressive or violent behavior. Other medical problems that cause physical pain - such as chronic infections or gastrointestinal problems including constipation, cramps or gastroesophageal reflux (severe heartburn), may also lead to aggressive behavior, especially in an individual who lacks sufficient language ability to express his or her discomfort.
Environmental overstimulation or situational stress caused by changes in schedule, surroundings or school staff may also contribute to aggressive or other behavioral changes. In addition, it is important to remember that all teenagers - including those with mental retardation - have to deal with the physical and emotional changes of adolescence. Difficulty in coping with these changes another source of stress.
If medical and social/environmental issues have been ruled out as a cause for your sons behavior, one more evaluation should be done prior to the use of medications specifically intended to deal with aggression. If possible, a psychologist or psychiatrist experienced in evaluating individuals with developmental disabilities should evaluate your son for psychological problems such as depression or obsessive-compulsive behaviors. If a psychological problem is the source of your sons aggressive behavior, it is important that he receive appropriate treatment for that condition. And even if no psychological problem is diagnosed, a psychologist or psychiatrist with experience in developmental disabilities may be able to work with your sons pediatrician in selecting an appropriate medication to deal with his aggression.
Many professionals believe that typical behavior modification techniques are largely unsuccessful in dealing with the specific behavioral problems associated with fragile X syndrome. …