Shoulder and pelvic muscles are the most affected muscles. Standing up from the floor and lifting up heavy things are difficult for Barth boys. Physical exercise is often difficult for Barth boys Guidance from a physical therapist and an occupational therapist can be very helpful. Finally most Barth boys learn to do all normal physical activities, but they easily tire. The level of fatigue the boys experience varies and typically is more pronounced during periods of growth.
Cognitive development is usually normal.
Some boys with Barth syndrome have had difficulty in school, however. Handwriting can be a painstaking process for the child to produce, and can be equally difficult to read. Spelling, as well as retention of the material poses problems for some Barth students. Some of the boys require more time to complete the assigned work. Often the periods of fatigue, as well as a more frequent number of days absent resulting in missed instruction and work creates problems for a child with Barth syndrome.