Fragile X Girls Less Aware of Bullying, Study Suggests

School-aged girls with fragile X syndrome are less aware of bullying than children of the same age and intellectual abilities, a study suggests.

These findings indicate that difficulties in interpreting social signals could place these girls in vulnerable situations. Developing socials skills to mitigate deficits in communication and interaction is of particular importance, scientists said.

The study, “Bullying victimization in young females with Fragile-X syndrome,” was published in the journal Genes.

Girls with fragile X have higher levels of social anxiety, shyness and tend to have poor eye contact, as well as difficulties with attention, social interaction, communication, and learning. 

Fragile X is the main genetic cause of autism and intellectual disability.

Studies have shown that people with intellectual disability are at greater risk of bullying — repetitive aggressive behaviors with harmful intent, which can take the form of verbal and physical aggression, and includes social isolation or exclusion.

How bullying affects school-aged girls with fragile X has not been studied until now, as researchers based at the Autonomous University of Barcelona enrolled 40 girls, ages 7 to 16. The group included 26 with fragile X and 14 without fragile X, but with similar intellectual abilities as controls. 

Intellectual abilities were reported as the intelligence quotient (IQ), using the Wechsler Intelligence Scale for Children-Fifth Edition. 

Among those with fragile X, 50% of participants scored in the range of mild-to-moderate intellectual disability. The remaining girls scored in the medium to medium-low range. No statistically significant difference in IQ was found between patients and controls. 

Parents completed questionnaires to assess the extent of bullying. 

In particular, the Adaptative Behavior Assessment System-Second Edition tool was used to assess communication, function and academic skills, as well as social and recreational behaviors, and parameters such as self-care. 

In turn, the Child and Adolescent Evaluation System assessed a wide range of emotional and behavioral problems, including depression, anxiety, hyperactivity and impulsivity, and learning difficulties. It also measured difficulties with family and peers, problems regulating emotions, self-esteem, social competence, and ability to integrate. Specifically, the items “Risk of school bullying,” “Lack of social support,” “Isolated by classmates,” “Insult by classmates,” and “Afraid of a classmate” were used to establish the presence of bullying.

The battery of socialization questionnaire assessed four domains of socialization — leadership, joviality, social sensitiveness, and self-control — three domains that disrupt socialization (aggressiveness, apathy, and shyness), and a global social adaptation scale. 

Although the results were not statically significant, the percentage of girls at risk of school bullying (50% vs, 42.9%), or experiencing lack of social support (42.3% vs. 28.6%), isolation and fear of classmates were higher in the fragile X group compared to controls. In contrast, the control group had higher proportion of girls “Insulted by their classmates” than the girls with fragile X (35.7% vs. 36.9%).

A statistical analysis found that some components of bullying were associated with having fragile X. Factors such as joviality, social competence and integration, and personal resources had different impacts on the risk of bullying in girls with fragile X compared to controls. In contrast to the controls, where scores indicating risk of school bullying were associated with worse scores in these factors, no such link was seen in girls with fragile X.

In the absence of risk of school bullying, girls with fragile X scored lower (less awareness of bullying) in joviality, social competence and integration, and personal resources, than controls.

A similar pattern was seen in “Lack of social support,” “Isolated by classmates,” “Insulted by classmates,” and “Afraid of a classmate,” with girls with fragile X scoring lower than controls.

Overall, parents of girls in the control group reported more bullying than those of children with fragile X. As such, “difficulties in social communication and interaction [as seen in fragile X] could lead to difficulties in interpreting social signals and correctly identifying situations of bullying,” the scientists wrote.

“It is important to note that presenting difficulties in identifying situations of bullying does not imply the absence of it,” they added.

Importantly, girls who were bullied showed more depression symptoms, lower levels of joviality and personal resources, and more difficulties with social competence and interaction, as well as self-care. 

In conclusion, “when planning interventions for girls with [fragile X syndrome] in situations of bullying … there must be a more specific focus on direct work with the girls themselves, placing special emphasis on developing their social skills, and on mitigating any deficits in their social communication and interaction,” the investigators wrote.