Anxiety disorder
Anxiety is a common clinical characteristic in people with fragile X syndrome. For advice on the management of anxiety in people with developmental disability, see Anxiety disorders in people with developmental disability. For treatment recommendations, see Psychotropic guidelines.
Anxiety can present at an early age in children with fragile X syndrome (eg by 2 to 4 years of age), and can trigger aggressive behaviour. Although there is limited evidence to support use of pharmacological therapy to manage anxiety in children with fragile X syndrome, medications may be useful in conjunction with nonpharmacological approaches (eg speech and language therapy, occupational therapy, special educational support, behavioural management)123. If pharmacological therapy is considered for anxiety in children younger than 6 years with fragile X syndrome, refer to a practitioner with expertise in fragile X syndrome (eg general practitioner, paediatrician, psychiatrist). A selective serotonin reuptake inhibitor (SSRI) or serotonin and noradrenaline reuptake inhibitor (SNRI) antidepressant may be used, starting with a low dose and increasing slowly according to response. Clonidine or guanfacine may be helpful in children, and for anxiety related to sensory defensiveness.