Current Treatment Recommendations
When problem behaviors occur, it is important to recognize that they may be caused by hyperarousal, and to first try to identify any sources that may be overstimulating the person. The initial intervention should always be to try to reduce environmental stimulation. When that is not possible, it may be advisable to remove the person from the overstimulating environment. A non-stimulating, quiet and “safe” place should be designated, so that when hyperarousal occurs, the individual can have a place to quickly retreat to where he will be able to dearouse, regain his composure, and re-establish a sense of well-being before returning to his previous activity.
Proactive strategies to prevent hyperarousal include modifying the physical environments of individuals with FXS (e.g., their homes, classrooms, and workplaces) to reduce their stimulating quality. Examples might include providing natural or incandescent lighting instead of fluorescent lighting, and introducing sound-dampening material such as curtains or acoustic tiles in order to minimize sound reverberation and echo.
It is important to recognize that the sources of stimulation vary within environments such as classrooms, and to situate individuals away from arousing stimuli. For example, seat the child away from the bell that signals class changes, or away from open doors that admit distracting sounds from adjunct rooms or hallways.
When exposure to intense stimulation is unavoidable, such as during assemblies, fire drills or other busy events, a familiar person should accompany the individual to help him remain calm and provide continuity.
Unfamiliarity and unpredictability can be arousing, and attempts to reduce them for the person with Fragile X syndrome are highly advisable. Strategies along these lines may include engaging in role play to help an individual anticipate social situations, or providing picture schedules to prepare her for changes in activities or routines.
An occupational therapist can provide valuable insight and advice regarding accommodations to improve an individual’s physical and social environment to reduce its arousing quality, and can also recommend ways to provide an appropriate sensory diet to help her maintain control and feel calm and focused throughout the day.
Teaching individuals with Fragile X syndrome personal stress-reducing strategies such as “square breathing,” muscle relaxation techniques, and visualization of tranquil places, can also help them cope with unavoidable exposures to stimulation.
Medication may also be helpful in some cases, by reducing the person’s threshold for becoming hyperaroused when exposed to stimulating environments. See Medications for Individuals with Fragile X Syndrome.