Fragile X & Autism
Autism Spectrum Disorder
Autism spectrum disorder (ASD) is a behavioral diagnosis. The range of symptoms in ASD vary and are generally characterized by an impaired ability to communicate and interact socially with other people. Sometimes children will not meet the diagnostic criteria for ASD but will have autistic-like features.
The diagnosis of ASD is usually made by a developmental or general pediatrician, neurologist, psychologist, psychiatrist, or other specialist. A clinician may make a diagnosis of ASD after observing the behavior and language of a child and using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for their evaluation. In addition, the diagnosis may be made after evaluating the child using a number of testing instruments, such as the Autism Diagnostic Observation Schedule – 2nd edition (ADOS-2) or the Autism Diagnostic Interview – Revised (ADI-R). These instruments are considered the gold standard—the most accurate instruments available—for a diagnosis and are often used in research.
There is no blood test for ASD, and imaging studies such as MRIs don’t diagnose the condition—it is purely a behavioral diagnosis similar to Attention Deficit Hyperactivity Disorder (ADHD).
Causes of ASD
Much remains unknown about the condition—including what causes it in many individual cases. However, when a child is diagnosed with ASD, blood tests are often ordered to rule out the known genetic causes. FXS is the most common known single gene cause of ASD. Other genetic causes of ASD include deletions of chromosome 15q, tuberous sclerosis, and other rare genetic conditions.
Many times, a child with ASD will be tested or evaluated for all the known genetic causes of autism but no cause will be found. However, family studies have shown that in families with one child with ASD there is an increased risk for another child to have the condition. This risk is not as high as in those families with an identified single gene cause, such as FXS. It is more in line with multifactorial risks, similar to heart defects or cleft lip. This leads experts to believe there is a genetic component even in those without a single gene identified cause.
Many researchers are trying to determine both the genetic and non-genetic factors that contribute to ASD.
The FXS / ASD Relationship
Whereas ASD is a behavioral diagnosis, FXS is a medical, or more accurately, a genetic diagnosis.
When associated with FXS, ASD is caused by the genetic change or mutation in the Fragile X gene. If a child is diagnosed with ASD and then diagnosed with FXS, he or she still has ASD, it is just that the cause of their ASD is known. It is no different than someone with FXS also having ADHD or any other behavioral symptom of FXS.
The article FXS and ASD: Similar But Different highlights a well-attended panel discussion at the 13th International Fragile X Conference that addressed the topic: FXS and ASD: Clinical Insights into the Similarities and Differences for Diagnosis and Treatment.
Children with FXS That Have ASD
Many studies have evaluated the FXS-ASD link over the past decade. Since many children with FXS are interested in social interactions, they may not meet the diagnostic criteria for ASD, even though they exhibit some features of ASD such as poor eye contact, shyness, social anxiety, hand-flapping and sensory issues. Autism is much more common in boys with FXS than in girls with FXS. According to the CDC, a national parent survey found that 46% of males and 16% of females with FXS have been diagnosed or treated for ASD. The FORWARD Registry & Database tells us that 40% of individuals with FXS are diagnosed with ASD by their doctor in a Fragile X Clinic.
Children with ASD that Have FXS
Studies show that individuals with FXS who have autism can have a more significant intellectual disability (lower IQ) than those with FXS who do not have autism.
About 10% of children with ASD are identified as having another genetic and chromosomal disorder, such as Fragile X syndrome. Given the possibility of a link, it is recommended that all children with ASD, both male and female, be referred for genetic evaluation and testing for FXS and any other genetic cause of ASD.
ASD’s Effect on Children with FXS
Studies show that individuals with FXS who have autism can have a more significant intellectual disability (lower IQ) than those with FXS who do not have autism. For further reading on the relationship between autism and Fragile X syndrome, see Fragile X Syndrome Related Concerns on the CDC website, and related consensus documents and articles below.