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How do symptoms of ASD and ADHD predict language and communication abilities in Fragile X Syndrome?

Sat, March 23, 9:45 to 11:15am, Hilton Baltimore, Floor: Level 1, Latrobe

Integrative Statement

Introduction:
Language impairments are strongly associated with social difficulties across neurodevelopmental disorders, including fragile X syndrome (FXS), autism spectrum disorder (ASD), and attention deficit / hyperactivity disorder (ADHD). The fragile x syndrome (FXS) phenotype is associated with high prevalence and great variability in ASD and ADHD symptomatology. It is unclear how variability in these behaviours affects outcomes in language and communication. Previous research suggests that, above and beyond having a diagnosis of FXS, more severe ASD symptoms lead to additional impairments in pragmatic language. Much less is known about how ADHD symptomatology might influence language development in this population. To date, no studies have investigated these three aspects of the FXS phenotype together.
Hypothesis:
We hypothesised that boys with FXS would experience delay in the acquisition of structural and pragmatic language, over and above their developmental delay, that lower levels of ASD and ADHD symptomatology would predict their sentence use, and that ASD and ADHD symptomatology would be inversely related to structural and pragmatic abilities specifically.
Study Population:
Participants to this study took part in a larger longitudinal study of FXS. Thirty-six young boys with FXS provided data on language and communication at three time-points, 12-months apart.
Methods:
In the current study, we investigated the relationship between ASD and ADHD symptomatology and communication and language in boys with FXS. Well-validated measures of communication and language (the Child Communication Checklist-2, CCC-2), as well as ASD and ADHD symptomatology (the Social Communication Questionnaire and the Conners’ rating scales) were used.
Results:
Communication and language profiles for boys with FXS were delayed relative to developmental level. Furthermore, impairments in both structural and pragmatic language occurred over and above what is expected given lower developmental levels. Moreover, ASD symptomatology predicted sentence usage in boys with FXS, and was related to greater impairments in both structural and pragmatic language abilities. On the other hand, ADHD symptomatology was related to impairments in pragmatic language specifically, and not structural language or sentence use. Finally, and longitudinally, early autistic symptomatology, in addition to developmental level, explained variance in general communicative ability two years later, whereas ADHD symptomatology related to pragmatic aspects of language specifically, and in particular behaviours associated with inappropriate initiation, such as interrupting others who are speaking.
Conclusions:
As comorbidity of inattentive / hyperactive symptoms, as well as autism spectrum, is common across atypically developing children, considering the interactive and cascading influences of these symptoms on communication is vital. Using fragile X syndrome as a model, our findings highlight the need to investigate longitudinal predictors of complex but crucial phenotypes like communication in atypically developing children. An approach based on individual differences over time within a group with atypical development can provide novel insights into the role of ASD and ADHD symptomatology in communication and language development. Furthermore, our findings point to implications for early interventions targeting attention, social cognition, and language impairments.

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