Kessler Katherine A, Kaur Mandeep, Shaffer Elizabeth
Psychiatry, Cape Fear Valley Health, Fayetteville, USA.
Child and Adolescent Psychiatry, Cape Fear Valley Health, Fayetteville, USA.
Cureus. 2024 Jul 15;16(7):e64589. doi: 10.7759/cureus.64589. eCollection 2024 Jul.
It is the current consensus amongst the psychiatric community that children undergoing evaluation for developmental delays and/or autism spectrum disorder (ASD) should be offered genetic testing early in the diagnostic process. Identifying genetic abnormalities can provide insight into patient prognosis and may reveal other medical complications that could arise throughout a patient's life. Despite these recognized benefits, genetic testing is often delayed or not offered and therefore deprives families of valuable knowledge about their child's future health outcomes. We present a case of a six-year-old patient who presented to our child and adolescent psychiatry office for behavioral concerns. She had received an ASD diagnosis years prior to presentation, but for unknown reasons, genetic testing had never been pursued. Genetic testing was obtained in our office, and the results revealed three different mutations that were linked to ASD and various other medical complications including epilepsy. With this knowledge, the patient's family gained important insight into their child's prognosis. This case highlights the necessity for adopting a point-of-care testing (POCT) model when evaluating children with developmental delays and/or ASD. Through this model, genetic testing would be offered to families during the initial visit for these patients. This would help streamline this process and allow for more widespread detection of genetic disorders linked to ASD and coexisting medical sequelae. Having this knowledge would empower families with a better understanding of their child's condition and would allow families to work together with providers to determine the best possible treatment plan.
目前,精神医学界的共识是,对于正在接受发育迟缓评估和/或自闭症谱系障碍(ASD)评估的儿童,应在诊断过程的早期提供基因检测。识别基因异常可以深入了解患者的预后情况,并可能揭示患者一生中可能出现的其他医学并发症。尽管有这些公认的益处,但基因检测往往被推迟或未被提供,因此剥夺了家庭了解孩子未来健康状况的宝贵知识。我们介绍一个病例,一名六岁患者因行为问题前来我们的儿童和青少年精神病科就诊。她在就诊前几年就被诊断为患有自闭症谱系障碍,但不知为何从未进行过基因检测。我们科室进行了基因检测,结果显示有三种不同的突变,这些突变与自闭症谱系障碍以及包括癫痫在内的各种其他医学并发症有关。有了这些信息后,患者家属对孩子的预后有了重要的了解。这个病例凸显了在评估发育迟缓儿童和/或自闭症谱系障碍儿童时采用即时检测(POCT)模式的必要性。通过这种模式,可以在这些患者初次就诊时就为其家属提供基因检测。这将有助于简化这一过程,并能更广泛地检测与自闭症谱系障碍相关的基因疾病以及并存的医学后遗症。掌握这些知识将使家属更好地了解孩子的病情,并使家属能够与医疗服务提供者共同确定最佳的治疗方案。