Educational Strategies for Individuals with Fragile X Syndrome
Students with FXS represent a broad spectrum of cognitive abilities with individual variation. Nevertheless, there is a well-documented cognitive and behavioral phenotype. Most males with FXS exhibit deficits in cognition ranging from mild to severe. Females tend to demonstrate the same patterns but with a more mild presentation. Auditory and sequential processing deficits are frequently associated with the syndrome. Additionally, most students have executive functioning skill deficits, e.g., planning, attending, sustaining effort, generating problem solving strategies, using feedback and self-monitoring.
Males with FXS may exhibit relative strengths in verbal labeling, simultaneous learning, receptive vocabulary (which is often higher than expressive), visual perception tasks, imitation, and activities of daily living. Their weaknesses typically lie in higher level thinking and reasoning, complex problem solving, sequential tasks, quantitative skills, motor planning, socialization and communication.
Strengths of females with FXS include vocabulary and comprehension, short-term visual memory, reading, writing and spelling. Their weaknesses tend to include abstract thinking, understanding spatial relationships, quantitative and conversational processing, short-term auditory memory, maintaining attention and impulsive behavior. Mathematic skills are generally an area of challenge for females and males with FXS with performance in this area lower than would be expected even when accounting for IQ.
Generalized mild hypotonia and joint laxity (looseness) are seen in most children with fragile X syndrome. This has an impact on educational performance. Fine motor tasks such as handwriting are often difficult to master. It is likely that a student with fragile X syndrome will have some agree of gross and fine motor incoordination throughout his academic career and as such his education plan should emphasize compensatory skills (e.g. use of a computer as an alternative to handwriting).
Individuals with FXS also present with significant sensory processing issues. This can be a factor in the school setting across all ages, and often presents as a challenge for classroom teachers. Please see Sensory Processing and Integration Issues in Fragile X Syndrome for a detailed description of sensory processing and strategies for addressing this across settings.
The assistive technology plan should involve programs and applications designed to enhance learning based on the specific cognitive and learning profile of the individual with FXS. Modified mice/keyboards and touch screens can be used to interface with technologies for educational purposes and to reduce motor demands, thus reducing limitations from motor dyspraxia and allowing responses more reflective of the ability of the individual with FXS. These technologies often allow content to be delivered visually capitalizing on the visual learning and visual memory strengths of those with FXS.
Key developmental challenges in school age individuals have been identified. Also see: Lesson Planning Guide: A Practical Approach for the Classroom.
Strategies for teachers that have been found to be most useful when educating children with FXS include (but are not limited to):
- To the degree possible, provide a calm and quiet classroom environment with built-in breaks and a predictable daily routine. Consistency and predictability are keys to a successful classroom, which ultimately benefits all students.
- Teach the student to request a break and provide a “safe” refuge area (be cautious not to confuse this with a timeout area.)
- Consider distractibility and anxiety issues when arranging seating for the student (e.g. avoid the middle of a group, seat the student away from doorways and a/c or heating vents.)
- Use small-group or one-to-one instruction when teaching novel tasks. This pre-teaching activity can greatly increase the long-term success for the child in the general classroom environment.
- Infuse a sensory diet, developed with an occupational therapist, into the student’s day to address the sensory processing issues.
- Give ample time for processing and alternative methods of responding.
- Simplify visually presented materials to eliminate a cluttered or excessively distracting and over stimulating.
- Use high and low technological adaptations, such as word tiles, sticky notes and the computer, for writing assignments.
- Provide a visual schedule and/or transitional object or task to prompt transitions.
- Use manipulatives, visual material paired with auditory input, videos, and models.
- Provide social skills lessons and social stories and engage typical peers to model appropriate behaviors.
- Provide completion or closure for activities and lessons.
- Capitalize on strengths in modeling, memory, simultaneous and associative learning.
- Use indirect questioning in a triad format to include a child with FXS, a typical peer, and teacher, rather than direct questioning to the child with FXS.
- Utilize “Cloze” or “fill-in” techniques for assessments to help facilitate executive function skills. This is where certain words from the text are removed and the participant is asked to replace the missing words.
- Use backward chaining—ask the student to finish the task after you begin it.
- Provide visual cues—such as visual icons, color coding, numbering, and arrows—to help organize tasks.
- Use reinforcements, such as “high fives”, rather than hugs or pats on the back (close physical contact tends to over-stimulate children with FXS).
- Introduce novel tasks interspersed with familiar tasks to hold attention and reduce anxiety.
- Avoid forcing eye contact or giving “look at me” prompts. Gaze avoidance for individuals with FXS serves as a protective and/or compensatory behavior. Recognizing this will allow both the educator as well as the student to engage socially, decreasing outburst and flight behavior due to hyper-arousal. Many students with FXS increase and initiate eye contact when they are comfortable with staff, so allow for opportunities by being available and by not forcing the eye contact.
Many of these strategies are suitable for the Specially Designed Instruction (SDI) and Accommodations section in the IEP.