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Fragile X syndrome is a genetic condition that causes a range of developmental problems including learning disabilities and cognitive impairment. Usually, males are more severely affected by this disorder than females.

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Mutations in the FMR1 gene cause fragile X syndrome. The FMR1 gene provides instructions for making a protein called FMRP. This protein helps regulate the production of other proteins and plays a role in the development of synapses, which are specialized connections between nerve cells. Synapses are critical for relaying nerve impulses.

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Fragile X syndrome occurs in approximately 1 in 4,000 males and 1 in 8,000 females. or  .004 in males and .008 in females.

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Fragile X syndrome is inherited in an X -linked dominant pattern. A condition is considered X-linked if the mutated gene that causes the disorder is located on the X Chromosome , one of the two sex chromosomes. (The Y Chromosome is the other sex chromosome.) The inheritance is dominant if one copy of the altered gene in each cell is sufficient to cause the condition. X-linked dominant means that in females (who have two X chromosomes), a mutation in one of the two copies of a gene in each cell is sufficient to cause the disorder. In males (who have only one X chromosome), a mutation in the only copy of a gene in each cell causes the disorder. In most cases, males experience more severe symptoms of the disorder than females.

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Ruth’s Story

Ask Ruth what it’s been like having two sons with full mutation fragile X syndrome, and she’ll tell you. “It’s been so hard. But it’s changed my life. I love it all. Even the struggles have been strengthening.”

Ruth’s two sons, John and David, are both middle-aged. John is about to turn 50. He’s the higher functioning of the two. He’s worked for 29 years as a dishwasher at a cafeteria that’s walking distance from his home. Ruth recalls the time John’s boss asked him to come to work 30 minutes earlier the next day. “They need a face clock. They can see the hands going around, but telling John to come to work earlier the next day doesn’t mean anything. John’s boss needs to tell me or tell the job coach, and we make the adjustment. We take his clock and put it on the copier with the hands where they need to be for him to leave. Then we copy it and put it up beside his other clock. After one day, he’s got it. He knows what it’s supposed to look like.”

Then there’s the time a policewoman picked John up while he was walking to work. She stopped to question him and he ran. When she chased him, he hit her with his gym bag. She locked him in the police car and took him home. Ruth says the officer simply had no idea she was dealing with someone with a disability, nor could the officer have predicted the work Ruth would have to do with John to get him comfortable with police officers again.

David, age 47, is John’s younger brother. He worked for nine years in the kitchen of an inn before he started having trouble with anxiety. The anxiety developed into a panic disorder and he became unable to work. For a few years, the family never went out of town together. Familiar activities like his day program or going to church were fine, but unfamiliar activities and places would send David into panic mode. These days David does volunteer work as part of a day program. Throughout the day, he is with staff members he knows. Ruth says “he feels secure that whoever is with him is someone who won’t push him into a situation he can’t handle.”

Ruth says she would tell parents of younger children with FXS that it does get better.

After a lot of waiting and a little luck, John and David now live together with a third roommate in an independent setting. Monday night is grocery shopping, Tuesday is swimming, Wednesday is bowling, Thursday is floor hockey, and Friday is pizza and movie night with their friends. Saturday is dinner out. Every other weekend John and David go home with Ruth and her husband Earl. At each of these activities they have support.

Ruth and Earl raised their sons before there was a diagnosis of fragile X syndrome.

“The school put a lot of pressure on John and David—thinking their challenges were a result of bad behavior—instead of managing the environment so they didn’t get anxious and upset. If there was one thing I could change for John and David, it would be eliminating that anxiety. My sons seldom have meltdowns anymore, but it’s that anxiety that hurts their lives.”

Ruth and Earl don’t talk with John and David about what will happen when they’re gone. They know their sons will ask them where they’re going and when.

“My sons understand that somebody is going to need to take care of them.” She has two nieces that are younger than John and David. The four cousins grew up together. The nieces will step in when Ruth and Earl can’t. “They know they’re in training and one of them closely watches what I do when there’s a problem, and asks lots of questions.”