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Questionnaire: Is genetic testing right for my child?
1
Name
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First Name
Last Name
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2
Does your child have any of the following features?
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References: 1. Manickam K, et al.
Genet Med
. 2021;23(11):2029-2037(ES). 2. Smith L, et al.
J Genet Couns
. 2023 Apr;32(2):266-280.
Delay in or loss of developmental milestones, such as grasping objects, rolling over, walking, and babbling/talking
Intellectual disability
Congenital anomalies (birth defects such as a cleft palate or congenital heart defects)
Epilepsy/seizures (not caused by trauma, infection, or stroke)
None of the above
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Does your child have any of the following features or diagnoses, and/or a history of them?
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Growth issues or failure to thrive
Unusual muscle tone (either too low or too high)
Autism spectrum disorder
Cerebral palsy
Significant hearing or vision challenges
Muscle or movement differences like hypotonia, dystonia, or spasticity
Referrals to multiple specialists for complex care needs
None of the above
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4
Has your child received genetic testing before?
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What type of genetic testing has your child received?
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Single-gene test (e.g., FMR1 testing)
Multi-gene panels (which test for a subset of genes related to epilepsy)
Chromosomal microarray (CMA)
Exome or genome testing
I don’t know
Other
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QUIZ
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