Survey of the efficacy of clonidine in fragile X syndrome

Clonidine is a presynaptic α₂-agonist of the norepinephrine system and has been shown to be effective in treating children with attention deficit hyperactivity disorder (ADHD) particularly if hyperarousal, severe hyperactivity, sleep disturbances, tantrums or aggression are seen clinically. Since these problems are commonly seen in children affected by fragile X syndrome, clonidine may be a beneficial medication in this disorder. A survey of the parents of 35 fragile X children who had been treated with clonidine was carried out to assess the benefits and drawbacks of clonidine therapy according to the parents' perspective. Clonidine therapy was initiated at a mean age of 6.6 years and was taken for an average of 1.6 years. At the time of the survey, 77% of children were still on clonidine. Combined psychopharmacotherapy was typical and 71% were taking other medication (usually methylphenidate) for treatment of ADHD. Although 89% of patients were taking clonidine for hyperactivity, other problems were also common including tantrums in 37%, aggression in 40%, anxiety in 49% and sleep disturbances in 37%. Overall, 11% of the parents felt their child's behavior was worse on clonidine, 6% said clonidine had no effect, 20% said clonidine helped their child a little, and 63% said clonidine was very beneficial for their child. This study supports the need for controlled trials regarding the efficacy of clonidine in fragile X syndrome.