Genetic Considerations in Young Children with Developmental Delays
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1 Early Intervention Training Program at the University of Illinois at Urbana-Champaign presents Genetic Considerations in Young Children with Developmental Delays The webinar will begin at (1:30 PM CST). There will be minimal audio before the webinar begins. Please run the audio setup wizard to make sure your speakers work. You will not need to test your microphone! (Skip microphone setup) Audio Setup Wizard
2 Today s Presenters Kruti Acharya, MD Assistant Professor Director, Illinois LEND University of Illinois Chicago Dorelia Rivera Parent Director of Blue Cross Blue Shield/Healthcare Service Corporation
3 Today s Moderators Maria Matticks Consultant Early Intervention Training Program Michaelene M. Ostrosky Head and GoldstickFamily Scholar, Special Education, University of Illinois AlissaJones Research Specialist Early Intervention Training Program
4 Survey & Certificate This webinar has ILLINOIS EI credit as well as ILLINOIS STATE LICENSURE* credit *OT, PT, SLP, SW, Nutrition/Dietitian Look for unique AFTER the webinar with the survey from Early Intervention Training Program complete survey to get certificate If you joined as a group, each individual will need to complete the unique survey for credit
5 Chat Move the column Rollover the top or right side border to resize the chat box. type in this box lower left side of screen
6 Who do we have participating with us today? A. Parent/caregiver B. Early Interventionist C. CFC Staff D. Administrators E. Other (list in Chat Room)
7 Genetic Considerations in Young Children with Developmental Delay. Kruti Acharya, MD DoreliaRivera EITP webinar March 2, 2016
8 Disclosure Neither presenter has any financial or commercial relationships to disclose
9 Learning objectives Identify red flags of genetic disorders that providers might observe during evaluations with children Review current genetic screening and testing technologies Access resources for screening, referral for further testing and counseling, Employ strategies for communicating with and supporting families and for coordinating care with specialists
10 What is genetics? What are genes? Body s instruction manual Mutations no effect cause new variations cause disease DNA
11 What is genetics? What are genes? Body s instruction manual Mutations no effect cause new variations cause disease DNA
12 How common are genetic diseases? 10,000 single- 30% pediatric gene genetic hospitalizations disorders are due to a identified genetic disease 2.5 million Illinois residents are affected by a genetic disorder
13 Recognizing Clinical Red Flags
14 Family health history
15 Family health history
16 SCREEN mnemonic for family history SC Some Concerns. Do you have any concerns about diseases or conditions that run in the family? Trotter, Martin 2007
17 SCREEN mnemonic for family history SC Some Concerns. Do you have any concerns about diseases or conditions that run in the family? R Reproduction. Have there been any problems with pregnancy, infertility, or birth defects in your family? Trotter, Martin 2007
18 SCREEN mnemonic for family history SC Some Concerns. Do you have any concerns about diseases or conditions that run in the family? R Reproduction. Have there been any problems with pregnancy, infertility, or birth defects in your family? E Early disease, death, or disability. Have any members of your family died or become sick at an early age? Trotter, Martin 2007
19 SCREEN mnemonic for family history SC Some Concerns. Do you have any concerns about diseases or conditions that run in the family? R Reproduction. Have there been any problems with pregnancy, infertility, or birth defects in your family? E Early disease, death, or disability. Have any members of your family died or become sick at an early age? E Ethnicity. How would you describe your ethnicity? or Where were your parents born? Trotter, Martin 2007
20 SCREEN mnemonic for family history SC Some Concerns. Do you have any concerns about diseases or conditions that run in the family? R Reproduction. Have there been any problems with pregnancy, infertility, or birth defects in your family? E Early disease, death, or disability. Have any members of your family died or become sick at an early age? E Ethnicity. How would you describe your ethnicity? or Where were your parents born? N Nongenetic. Are there any other risk factors or nonmedical conditions that run in your family? Trotter, Martin 2007
21 Rule of too/two TOO TWO TOO tall TOO short TOO early TOO many TWO tumors TWO generations TWO in the family TWO birth defects TOO young TOO different Chen, Saul 2013
22 Developmental red flags Global developmental delay Intellectual disability Autism Spectrum Disorder Fragile X? Hearing loss
23 Physical red flags Dysmorphic features Unusual growth patterns Skin findings
24 Kayla s Story: Symptoms Rash Fever Joint pain Periodic fevers Conjunctivitis Headaches Seizures
25
26 Types of genetic screening and testing
27 Screening Tests Testing done ona specified population Individualsare asymptomatic Notdesigned to diagnose, simply to identify individuals at higher risk Diagnostic Tests Testing done on specified individuals Individuals maybe symptomatic Individualsmay have had a positive screening test May lead to diagnostic tests May lead to treatment options
28 Poll: Have you or someone in your immediate family had any kind of genetic testing? Yes No
29 Newborn Period
30 Newborn screening Screening leads to early intervention to prevent morbidity and mortality Positive results require Positive results require confirmation
31 Illinois Newborn screening Screens 29 conditions Some genetic and some not genetic
32 Case: Newborn screening Photo Credit:
33 What to say about abnormal newborn screening result? Formal consent not obtained, so parents maybe unsure of screening goals and process Confirmatory testing required
34 What to say about abnormal newborn screening result? Formal consent not obtained, so parents maybe unsure of screening goals and process Confirmatory testing required Newborn screening does not screen for every known mutation Continued reassurance and support whether confirmatory testing positive or negative
35 Case: Genetic diagnosis at birth Photo credit:
36 What percentage of parents of children with Down Syndrome are dissatisfied with the experience of receiving their child s diagnosis? A. 10% B. 25% C. 50% D. 90%
37 How to deliver news postnatally? Language matters Be positive and calm Congratulate on birth of baby Avoid language expressing pity or sorrow Be sensitive and empathic BG Skotko et al, Pediatrics. 2009
38 How to deliver news postnatally? Ask about parent s familiarity, knowledge and experience with condition Do not overwhelm with information Address fears BG Skotko et al, Pediatrics. 2009
39 What should we talk about once diagnosis confirmed? Parents and professionals prioritize different information Parents value information about abilities and potential Sheets KB, et al. Am J Med Genet Part A, 2011.
40 Childhood Genetic Testing
41 Childhood genetic testing Targeted testing when child has red flags or symptoms according to published guidelines (autism, intellectual disabilities) JB Moeschler, Pediatrics, 2014
42 Childhood genetic testing Targeted testing when child has red flags or symptoms according to published guidelines (autism, intellectual disabilities) Cascade testing/ pedigree analysis of affected proband JB Moeschler, Pediatrics, 2014
43 Reasons for genetic testing Access to research treatment protocols Condition-specific family support Co-management of patients in medical home Clarification of etiology Prognosis/ Expected clinical course Recurrence risks Symptom management and surveillance for known problems Avoidance of unnecessary or redundant tests Refined treatment options JB Moeschler, Pediatrics, 2014
44 Which genetic test is not routinely used? A. Karyotype B. Fluorescence In Situ Hybridization C. Chromosomal Microarray D. Whole ExomeSequencing
45 Types of cytogenetic tests KARYOTYPE FISH
46 Chromosomal Microarray Chromosomal microarray Detect duplications, deletions and copy number variations Does not detect specific gene mutations No information about structural nature or sequencing Results: abnormal, variant of uncertain significance, likely benign
47 Types of cytogenetic tests
48 Kayla s Story: Diagnosis NOMID neonatal-onset multisystem inflammatory disease Most causes genetic Rare-Only 100 known cases world-wide
49
50 Communicating with Families around Childhood Testing
51 Barriers to effective communication Low genetic literacy and numeracy Lack of provider knowledge Limted access to genetic counseling Cultural considerations Expectation gap Genetic determinism K.D. Christianson et al, Public Health Genomics, 2010, C Kaye and B Korf, Pediatrics, 2013, JM Butty et al, J Community Genetics, 2012; DS Catz, Community Genetics, 2005
52 Pre-test counseling = informed consent Benefits Risks Alternatives No testing
53 Benefits May reveal cause Possible testing outcomes (abnormal, uncertain, likely benign)
54 Benefits May reveal cause May inform prognosis Possible testing outcomes (abnormal, uncertain, likely benign) Variability in genetic expression Not always 1:1 Correlation between Genotype and Phenotype
55 Risks Reveals information about parents Misattributed paternity Carrier status Incidental findings Risk of discrimination
56 K Peikoff, NY Times, April 7, 2014
57 Genetic Information Nondiscrimination Act (GINA) of 2008 protects against all types of insurance discrimination A. True B. False
58 Genetic Information Nondiscrimination Act (GINA) of 2008
59 Genetic Information Nondiscrimination Act (GINA) of 2008
60 Affordable Care Act of 2010 (ACA) People with genetic conditions Cannot be denied coverage Cannot be charged higher premiums
61 Post-test counseling Review limits of test What results can tell us What we don t yet know If uncertain, discuss need for parental testing
62 Post-test counseling Review limits of test What results can tell us What we don t yet know If uncertain, discuss need for parental testing Resources Connect to support groups Referral to genetic specialist Follow-up
63 Kayla s Story
64 Supporting Families and Coordinating Care
65 Genetics Services Map Local Public Health Departments Clinical Genetic Centers
66 Resources for Families National Organization for Rare Disorders
67 Kayla s Story: Treatment
68 Kayla s Story: Moving Forward Peers Her own voice When and how to explain School life My work life
69 Conclusion
70 Conclusion Prepare families for visit from a genetic specialist How we communicate with families frames their experience Communicate uncertainty
71 Conclusion Written resources and support group referrals Follow-up critical
72
73 Thank you! Questions: Illinois LEND Program: Illinoislend.org
74 Thank you for your participation!
75 Survey & Certificate You will receive with survey from Early Intervention Training Program Must complete unique survey to get certificate Certificate will be ed after survey completion (within 24 hours) Issues with survey or certificate, please contact us at
76 Thank you for supporting the children and families of Illinois! Let s Keep in Touch! Visit our Website EITP.education.illinois.edu Follow us on Join Our Facebook Group Early Intervention Training Program at The University of Illinois The Early Intervention Training Program at the University of Illinois The Children s Research Center 51 Gerty Drive, Room 105 Champaign, IL 61820
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