Toilet Training in Fragile X Syndrome.
Elizabeth Berry-Kravis, Sharon A Kidd, Ave M Lachiewicz and 6 others
PMID 31593026WHAT IT FOUND
Toilet training in Fragile X syndrome is significantly delayed, with females training much earlier than males.
Language level and autism diagnosis are the strongest predictors of delay. Males with autism and poor language skills may not achieve independent toileting until their mid-teens.
Key findings
01Language acquisition level and autism spectrum disorder status were the strongest independent predictors of toilet training delay in both males and females with Fragile X syndrome.
02Females were three times more likely to achieve toileting milestones at any given age than males, though this sex difference disappeared when accounting for language, intellectual disability, and behavior.
03Only about 70% of males with Fragile X syndrome and comorbid autism achieved bladder and bowel training milestones by age 16.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
Data relied on parent report and recollection, which introduces potential recall bias regarding the exact age of training achievement. The study lacked a control group of individuals with autism but without Fragile X syndrome, making it difficult to separate the specific effects of autism from the effects of Fragile X syndrome itself. Inter-rater reliability for autism diagnosis was not established, meaning diagnostic inconsistencies across clinics may have influenced the results. The sample was drawn from a specialized registry, which may over-represent families able to attend clinics, potentially excluding those with the most severe behavioral challenges who are harder to bring to appointments.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume that sex alone determines toilet training success. While females trained earlier, the study found that this difference was driven by their generally better language skills and lower rates of autism. Once language and autism status were accounted for, sex was no longer an independent predictor, meaning a male with good language and no autism may train earlier than a female with poor language and autism.