Urine amino and organic acids analysis in developmental delay or intellectual disability

Paediatric genomic testing: Navigating medicare rebatable genomic testing

Genomic testing for a genetic diagnosis is becoming standard of care for many children, especially those with a syndromal intellectual disability. While previously this type of specialised testing was performed mainly by clinical genetics teams, it is increasingly being 'mainstreamed' into standard paediatric care. With the introduction of a new Medicare rebate for genomic testing in May 2020, this type of testing is now available for paediatricians to order, in consultation with clinical genetics. Children must be aged less than 10 years with facial dysmorphism and multiple congenital abnormalities or have global developmental delay or moderate to severe intellectual disability. This rebate should increase the likelihood of a genetic diagnosis, with accompanying benefits for patient management, reproductive planning and diagnostic certainty. Similar to the introduction of chromosomal microarray into mainstream paediatrics, this genomic testing will increase the number of genetic diagnoses, however, will also yield more variants of uncertain significance, incidental findings, and negative results. This paper aims to guide paediatricians through the process of genomic testing, and represents the combined expertise of educators, clinical geneticists, paediatricians and genomic pathologists around Australia. Its purpose is to help paediatricians navigate choosing the right genomic test, consenting patients and understanding the possible outcomes of testing.

An explosion, a tsunami, a runaway train: half a century of genetics

Let's face it. There is no way of writing about the last half century of genetics without getting a little bit excitable. All of the terms in the title of this piece have been used by otherwise level-headed geneticists to describe the pace of change in genetics over the past few years. The thing is--they are right. Genetics is moving faster and faster. Five years ago, few people would have predicted that we would be where we are today. Five years from now, presumably, it will seem like 2015 was some kind of Dark Age when nothing much was happening. So it would be easy to lose perspective on the achievements of the past, or to assume that nothing much was happening in genetics until recently. However, everything that is happening in genetics now rests on the foundations built up over the past century, and particularly the past half century. And through that time, this journal has been a part of that story.

Strategies for present and future mental retardation diagnosis

Mental retardation (MR) is a highly heterogeneous condition with a prevalence of 1–3% in the general population. The psychosocial burden on families with mentally handicapped children is extensive. In addition, the accompanying expenses with mental handicaps are considerable. In this review a comprehensive strategy to systematically identify the causative genetic defect in patients with mental retardation is proposed. This strategy is a combination of routinely used and recently developed approaches, such as direct DNA sequencing, single nucleotide polymorphism arrays and expression profiling, to establish a molecular diagnosis in MR patients. Finally, it will be described how these mutations can be studied in different model systems, which can eventually be used to elucidate the neurobiological basis of MR and to facilitate possible therapeutic intervention.

A rational approach to the child with mental retardation for the paediatrician

Mental Retardation (MR) is a problem encountered in almost all paediatric clinical settings. The assessment of a child with MR is a common diagnostic and management dilemma for paediatricians. The field of MR research is currently in a state of flux regarding not just our understanding of the condition, but also in the language and the processes we use in naming, defining and describing MR. This article will provide a better understanding and a rational approach toward MR. Prevalence rates for MR are variable in the literature and may be attributable to the variation in major classification systems and the diversity in study operation definitions and methodologies. Etiologies of MR are diverse and include many different influences. MR most often presents during infancy or preschool years as developmental delay. There is no universally accepted approach to the etiological work-up of mental retardation. The number of medical conditions associated with MR that are completely treatable by medical means remains small. The paediatrician plays a key role establishing short and long term treatment goals, as well as providing support to families who have children with MR.

Metabolic disorders and mental retardation

The metabolic and anatomical substrate of most forms of mental retardation is not known. Because the basis of normal brain function is not sufficiently understood, the basis of abnormal function is understood poorly. Even in disorders where the fundamental biochemical defect is known, such as phenylketonuria (PKU) and other enzyme defects, the exact basis for brain dysfunction is uncertain. The outcome for treated PKU, galactosemia, homocystinuria, and lysosomal disorders is not yet optimal. The various forms of nonketotic hyperglycinemia often respond poorly to current therapy. Less familiar disorders, with or without seizures, such as deficient synthesis of serine or creatine and impaired glucose transport into the brain, and disorders with variable malformations, such as Smith-Lemli-Opitz (SLO) syndrome and the congenital disorders of glycosylation (CDGs), may initially be thought to be a nonspecific form of developmental delay. Less familiar disorders, with or without seizures and disorders with variable malformations may initially be thought to be a nonspecific form of developmental delay. Simple tests of urine, blood, and cerebrospinal fluid may lead to a diagnosis, accurate genetic counseling, and better treatment. Metabolic brain imaging (magnetic resonance spectroscopy (MRS)) has also helped to reveal biochemical abnormalities within the brain.