This article may be too technical for most readers to understand.(June 2023) |
Syndromic autism (or syndromic autism spectrum disorders) denotes cases of autism spectrum disorder that are associated with a broader medical condition, generally a syndrome. Cases without such association, which account for the majority of total autism cases, are known as non-syndromic autism (or non-syndromic autism spectrum disorders).
Studying the differences and similarities (e.g. common pathways) between syndromic and non-syndromic cases can provide insights about the pathophysiology of autism and pave the way to new autism therapies. [1] [2] [3] [4]
Autism spectrum disorder (ASD) is referred to as syndromic when it is one of the many characteristics associated with a broader medical condition, generally a syndrome.
Syndromic autism represents about 25% of the total ASD cases. [4] [5] In most[ quantify] cases, its etiology is known. [2] [4]
Monogenic disorders are one of the causes of syndromic autism, which in this case are also known as monogenic autism spectrum disorders. They account for about 5% of the total ASD cases.
Certain[ which?] syndromic forms of ASD can also have different[ compared to?] phenomenology.[ clarification needed]
Non-syndromic autism, also called classic autism or idiopathic autism (as in most cases, the etiology is unknown), represents the majority of total autism cases.
In most[ quantify] cases, its cause is polygenic.[ citation needed]
A 2017 study[ relevant?] proposed to replace the classification "syndromic"/"non-syndromic" ASD into one based on the genetic etiology of the condition, specifying if the syndromic condition occurs in the context of a " phenotype first" clinically defined syndrome or from a " genotype first" molecularly defined syndrome. [4][ clarification needed]
Following the proposal, ASD would be divided into three genetic categories: [4]
Syndromes recognized by clinicians (depending on their experience), typically confirmed by a targeted genetic testing.
Syndromes recognized by genome-wide testing, not by hypothesis-driven testing (since clinical recognition is difficult).
Currently undefined.[ clarification needed]
Condition | Cause | Chromosome(s) involved (if a mutation) | ASD prevalence ( 95% CI) | Clinically/Molecularly defined | Other characteristics | Ref. |
---|---|---|---|---|---|---|
Fragile X syndrome |
Monogenic disorder: FMR1 (encodes FMRP) |
X | 30% (20.0–31.0) [male individuals only] 22% (15.0–30.0) [mixed sex] 14% (13–18) [female individuals only] |
Clinically defined [in some males] | Long/narrow face, macroorchidism, long ears and philtrum, mild to moderate intellectual disability, hyperactivity, intellectual disability (ID), seizures | [1] [3] [4] [6] |
Rett syndrome |
Monogenic disorder: MECP2 |
X | 61.0% (46.0–74.0) [female individuals only] | Clinically defined | Microcephaly, breathing irregularities, language deficits, repetitive/stereotyped hand movements, epilepsy, ID | [1] [3] [4] |
MECP2 duplication syndrome |
Monogenic disorder: MECP2 |
X | 100% [in a single study composed by 9 male participants] | Clinically defined | Brachycephaly, spasticity, recurrent respiratory infections, gastrointestinal hypermotility, genitourinary abnormalities, epilepsy, ID | [1] [4] [7] |
Tuberous sclerosis complex |
Monogenic disorder: TSC1 TSC2 |
9 16 |
36.0% (33.0–40.0) | Clinically defined | Benign tumours in multiple organs, epilepsy | [1] [3] [4] |
Angelman's syndrome |
Monogenic disorder: UBE3A |
15 | 34.0% (24.0–37.0) | Cheerful demeanour, microcephaly, epilepsy, speech deficits, sleep disturbance, epilepsy, ID | [1] [3] | |
Phelan-McDermid syndrome |
Monogenic disorder: SHANK3 |
22 | 84% [in a single study composed by 32 participants] | Molecularly defined | [4] [8] | |
Timothy syndrome |
Monogenic disorder: CACNA1C |
12 | 80% [in a single study composed by 17 participants] | Clinically defined | [4] [9] | |
Smith-Lemli-Opitz syndrome |
Monogenic disorder: DHCR7 |
11 | 55% [in a single study composed by 33 participants] | [10] | ||
Neurofibromatosis type I |
Monogenic disorder: NF1 |
17 | 18% (9.0–29.0) | Clinically defined | [3] [4] | |
PTEN hamartoma tumor syndrome |
Monogenic disorder: PTEN |
10 | 17% (8–27) | Clinically defined | [4] [11] | |
Down syndrome |
Chromosomal disorder: trisomy 21 |
21 | 16% (8.0–24.0) | Clinically defined | [3] [4] | |
Cohen's syndrome |
Monogenic disorder: VPS13B |
8 | 54% (44.0–64.0) | Clinically defined | [3] [4] | |
Cornelia de Lange syndrome | Polygenic disorder | 43% (32.0–53.0) | Clinically defined | [3] [4] | ||
CHARGE syndrome |
Monogenic disorder: CHD7 |
8 | 28% (16–41) | Clinically defined | [4] [12] [13] | |
Noonan's syndrome | Polygenic disorder | 15% (7.0–26.0) | [3] | |||
William's syndrome |
Microdeletion syndrome: 7q11.23 |
7 | 12% (6.0–20.0) | [3] [14] | ||
22q11.2 deletion syndrome |
Microdeletion syndrome: 22q11.2 |
22 | 11% (5.0–19.0) | Clinically defined | [3] [4] | |
Fetal valproate spectrum disorder |
Teratogen: valproate |
8–15% [in VPA exposed children] | Clinically defined | [4] [15] [16] |
This article may be too technical for most readers to understand.(June 2023) |
Syndromic autism (or syndromic autism spectrum disorders) denotes cases of autism spectrum disorder that are associated with a broader medical condition, generally a syndrome. Cases without such association, which account for the majority of total autism cases, are known as non-syndromic autism (or non-syndromic autism spectrum disorders).
Studying the differences and similarities (e.g. common pathways) between syndromic and non-syndromic cases can provide insights about the pathophysiology of autism and pave the way to new autism therapies. [1] [2] [3] [4]
Autism spectrum disorder (ASD) is referred to as syndromic when it is one of the many characteristics associated with a broader medical condition, generally a syndrome.
Syndromic autism represents about 25% of the total ASD cases. [4] [5] In most[ quantify] cases, its etiology is known. [2] [4]
Monogenic disorders are one of the causes of syndromic autism, which in this case are also known as monogenic autism spectrum disorders. They account for about 5% of the total ASD cases.
Certain[ which?] syndromic forms of ASD can also have different[ compared to?] phenomenology.[ clarification needed]
Non-syndromic autism, also called classic autism or idiopathic autism (as in most cases, the etiology is unknown), represents the majority of total autism cases.
In most[ quantify] cases, its cause is polygenic.[ citation needed]
A 2017 study[ relevant?] proposed to replace the classification "syndromic"/"non-syndromic" ASD into one based on the genetic etiology of the condition, specifying if the syndromic condition occurs in the context of a " phenotype first" clinically defined syndrome or from a " genotype first" molecularly defined syndrome. [4][ clarification needed]
Following the proposal, ASD would be divided into three genetic categories: [4]
Syndromes recognized by clinicians (depending on their experience), typically confirmed by a targeted genetic testing.
Syndromes recognized by genome-wide testing, not by hypothesis-driven testing (since clinical recognition is difficult).
Currently undefined.[ clarification needed]
Condition | Cause | Chromosome(s) involved (if a mutation) | ASD prevalence ( 95% CI) | Clinically/Molecularly defined | Other characteristics | Ref. |
---|---|---|---|---|---|---|
Fragile X syndrome |
Monogenic disorder: FMR1 (encodes FMRP) |
X | 30% (20.0–31.0) [male individuals only] 22% (15.0–30.0) [mixed sex] 14% (13–18) [female individuals only] |
Clinically defined [in some males] | Long/narrow face, macroorchidism, long ears and philtrum, mild to moderate intellectual disability, hyperactivity, intellectual disability (ID), seizures | [1] [3] [4] [6] |
Rett syndrome |
Monogenic disorder: MECP2 |
X | 61.0% (46.0–74.0) [female individuals only] | Clinically defined | Microcephaly, breathing irregularities, language deficits, repetitive/stereotyped hand movements, epilepsy, ID | [1] [3] [4] |
MECP2 duplication syndrome |
Monogenic disorder: MECP2 |
X | 100% [in a single study composed by 9 male participants] | Clinically defined | Brachycephaly, spasticity, recurrent respiratory infections, gastrointestinal hypermotility, genitourinary abnormalities, epilepsy, ID | [1] [4] [7] |
Tuberous sclerosis complex |
Monogenic disorder: TSC1 TSC2 |
9 16 |
36.0% (33.0–40.0) | Clinically defined | Benign tumours in multiple organs, epilepsy | [1] [3] [4] |
Angelman's syndrome |
Monogenic disorder: UBE3A |
15 | 34.0% (24.0–37.0) | Cheerful demeanour, microcephaly, epilepsy, speech deficits, sleep disturbance, epilepsy, ID | [1] [3] | |
Phelan-McDermid syndrome |
Monogenic disorder: SHANK3 |
22 | 84% [in a single study composed by 32 participants] | Molecularly defined | [4] [8] | |
Timothy syndrome |
Monogenic disorder: CACNA1C |
12 | 80% [in a single study composed by 17 participants] | Clinically defined | [4] [9] | |
Smith-Lemli-Opitz syndrome |
Monogenic disorder: DHCR7 |
11 | 55% [in a single study composed by 33 participants] | [10] | ||
Neurofibromatosis type I |
Monogenic disorder: NF1 |
17 | 18% (9.0–29.0) | Clinically defined | [3] [4] | |
PTEN hamartoma tumor syndrome |
Monogenic disorder: PTEN |
10 | 17% (8–27) | Clinically defined | [4] [11] | |
Down syndrome |
Chromosomal disorder: trisomy 21 |
21 | 16% (8.0–24.0) | Clinically defined | [3] [4] | |
Cohen's syndrome |
Monogenic disorder: VPS13B |
8 | 54% (44.0–64.0) | Clinically defined | [3] [4] | |
Cornelia de Lange syndrome | Polygenic disorder | 43% (32.0–53.0) | Clinically defined | [3] [4] | ||
CHARGE syndrome |
Monogenic disorder: CHD7 |
8 | 28% (16–41) | Clinically defined | [4] [12] [13] | |
Noonan's syndrome | Polygenic disorder | 15% (7.0–26.0) | [3] | |||
William's syndrome |
Microdeletion syndrome: 7q11.23 |
7 | 12% (6.0–20.0) | [3] [14] | ||
22q11.2 deletion syndrome |
Microdeletion syndrome: 22q11.2 |
22 | 11% (5.0–19.0) | Clinically defined | [3] [4] | |
Fetal valproate spectrum disorder |
Teratogen: valproate |
8–15% [in VPA exposed children] | Clinically defined | [4] [15] [16] |