Anthony is an outgoing, fidgety 11-year-old who has fragile X syndrome. His favorite activities are swimming, riding his bike, and playing computer games, but he is always moving from one thing to another. Although he can maintain his focus during some activities that he likes, he is typically very distractible and has difficulty sticking with one activity for long. Anthony is described as a “social butterfly” with a fun sense of humor. His conversation is laced with catchy, adult-sounding phrases and he frequently mimics television characters. He talks rapidly and often with great expression, his excitement sometimes escalating into silliness. He bites his finger and shakes his hands when he becomes excited. Anthony is a loving, caring child who keeps everyone laughing and always has a smile to share.

At home, Anthony enjoys spending time with his parents, Cassandra and Charles, and playing with his siblings. He has an 8-year-old brother, Terrence, who also has fragile X syndrome, and a 6-year-old sister, Alicia, who is not affected. Anthony is patient and easy-going with his younger siblings, except when his little brother screams or cries. Then Anthony covers his ears and anxiously orders him to “Cut it out!” He is sensitive to loud or sudden noises and sometimes becomes distracted by subtle noises such as the air conditioner turning on or a radio playing in the next room.

Anthony takes care of his personal grooming routine; brushing his teeth, washing his face, going to the bathroom, and showering, independently. But his parents monitor for “quality control” since he sometimes hurries through it. Anthony dresses independently but needs help tying his shoes. His mother sometimes has to offer a “fashion consultation” when Anthony makes unwise clothing choices, such as pulling out his favorite baggy shorts in February, and she has stocked his wardrobe with pull-on shirts since he still has trouble with buttons.

Anthony has two regular chores at home: taking out the trash and setting and clearing the table. He does these chores proudly and happily, and he becomes especially excited when the garbage man comes. On trash pick-up day he often runs out to greet the garbage man and lifts the lid for him, saying, “Hi, whatcha doin’?” and yells, “Thank you!” as he leaves. His mom can also count on him to pitch in when it is time to clean up toys, dust, or vacuum—he has always loved to help with household jobs, although he sometimes needs to be reminded to finish tasks.

Anthony also enjoys “working” with his dad, who owns a wrecker service and garage. He began riding on wrecker calls with his dad when he was a preschooler. He loved the flashing lights and the big truck. To his dad’s amazement, Anthony remembers directions well, and he frequently points out familiar landmarks on the way to relatives’ homes.

Charles and Cassandra are proud of the progress Anthony has made during his elementary years. However, the “gap” between Anthony and his peers is becoming more noticeable. His parents are afraid Anthony might endure a lot of teasing when he moves into middle school. They want him to have the opportunity to continue his inclusive activities, but in middle school they are worried that it might be much harder for him. They also are concerned about his future. What will he be like as an adult? Will he be able to keep a job and support himself? Will he ever be able to get through the day independently? Even though they are aware that there are programs and opportunities for adults with mental retardation, it is difficult for them to picture how and where Anthony will fit in.

Anthony, a fifth grader, is in Mrs. Johnson’s self-contained, cross-categorical classroom with eight children in grades 3-5. His current eligibility category for school services is “Other Health Impaired” since he has a medical diagnosis of fragile X syndrome. Anthony started in Mrs. Johnson’s class when he was a third grader. He adjusted to her class easily and his parents have been pleased with his progress. In terms of schoolwork, Anthony’s strength is visual learning. He loves puzzles and computer games. Sometimes he can learn things very quickly if he can understand a task visually or if it is demonstrated for him. Mrs. Johnson keeps the class routine highly structured and uses a variety of visual cues to prompt students.

Anthony is motivated to do his best and to please others. He is able to sight read about 75 words consistently but has great difficulty learning words phonetically. Mathematics is the most difficult academic area for him. Because of his trouble with math, his teacher has taught him to use a calculator to solve math problems. Writing is also difficult for Anthony, so his teacher modifies tasks for him. For instance, Anthony frequently uses the word processor to type assignments and is allowed to spell his name using letter stamps or alphabet magnets rather than always trying to write them himself. When frustrated by difficult tasks, he sometimes declares, “I want to go home now” and pushes his chair away from his desk. At times he can be persuaded to continue working with the promise of a reward or surprise. If the demands are too high, however, he bites his hand.

Anthony frequently gets up from his seat and begins to talk to other children in his class unless an adult is working directly with him. When reminded, though, he is willing to go back to his seat and work. His teacher recently had to place his desk in the corner of the room facing the wall so that there are fewer visual distractions for him. As a result, there is less temptation for him to leave his seat.

In addition to working on academic concepts such as reading and counting, Mrs. Johnson has focused her efforts on teaching Anthony social and adaptive skills in order to foster independence. For instance, she often pairs her students up to work on a common task so that they have opportunities for social interaction, and she encourages them to greet one another appropriately each morning. He can order his food in the cafeteria, dispose of his tray correctly, and he always sees to it that the cafeteria tables and chairs are wiped clean when his class is finished. He enjoys working on simple cooking and assembly tasks in the classroom.

Ms. Johnson has found that Anthony is interested in a wide variety of topics and that he is an enthusiastic participant in most class activities. She works hard to make all aspects of the instructional day as “hands on” as possible for her students, and she has found that integrating science topics with reading and math captures Anthony’s attention well. Last week he enjoyed writing sentences about their hermit crab and drew a surprisingly detailed picture of the hermit crab’s house.

Anthony loves going to school and talks about his classmates at home. His daily reports often feature the same details. His favorite friend is Lauren, whom he tries to sit beside whenever he can. His teacher reports that his interest in her has intensified lately, and that he often tries to talk to her when he is supposed to be working quietly. He takes Dexedrine on school days to target his hyperactivity and help him focus on his work.

As Anthony matures, it is becoming easier for him to regulate his own behavior. He is able to remain calm during group activities, which enables him to participate in a variety of inclusive settings. He has attended music, art, PE, computer lab, and lunch with a general education class since kindergarten. Now he also attends special activities with them and often stays after lunch when the teacher reads aloud to the class. He is very aware of his daily routine and makes the transition between the two classrooms now with minimal support. When he was younger, a classroom assistant usually accompanied him. Anthony thrives on interaction with other kids, and quickly learns the names of all his “buddies” in the regular class each year.