
Information
Frequently Asked Questions
Cornelia de Lange Syndrome (CdLS) is a genetic disorder present from birth. It is usually due to an acquired change mutation in one of seven important developmental genes at or shortly after conception.
In 1933, Dr. Cornelia de Lange, a Dutch paediatrician, described two children with similar features, one 17 months and the other 6 months, who were admitted within weeks of each other to Emma Children's Hospital. The first child had pneumonia. Her first year of life had been characterised by a lot of feeding difficulties and she was very small for her age, with a proportionately smaller head circumference. Dr. de Lange noted other unusual facial characteristics.
Soon after this child was discharged, a second little girl was admitted. Not only did they have common medical problems, but their resemblance to each other was remarkable. In each case the doctor described what she observed with great care and detail.
Professor de Lange followed her own advice: 'Observe closely first.' No where was the puzzled physician able to find a similar patient described in medical literature. Cornelia de Lange is now generally credited with describing the collection of symptoms comprising the syndrome that bears her name.
The syndrome is sometimes referred to as Brachmann-de-Lange Syndrome after Dr W. Brachmann, who described a similar patient in 1916. Dr de Lange may have overlooked his report because he concentrated on characteristics of the upper limbs and wrote on the facial symptoms less specifically.
'Syndrome' is a medical term for a condition in which there is a collection of signs (observable body changes), symptoms and/or behaviour, recognisable by a doctor’s examination. Individuals with a syndrome may not have all of its associated signs and symptoms, but they must have enough to be considered “diagnostic.”
The signs of CdLS may be obvious from birth or even prenatally, especially if severely involved, but may not be diagnosed until the child is older when it is milder. It causes such a broad range of potential physical, cognitive and medical challenges that it is now known as the CdLS spectrum disorder. CdLS does not discriminate— it affects both genders equally and it’s seen in all ethnic backgrounds.
It typically affects: growth, with smaller body and head size; skeletal system, with smaller hands and feet or missing forearms and fingers; development, with delayed development, intellectual disability or learning disabilities; behavior, with ADHD, anxiety or autistic features; and internal body organs including the GI, cardiac, genitourinary and neurologic body systems.
The occurrence of CdLS is estimated to be 1:10,000 and 1:30,000 live births.
Researchers have identified seven separate genes: NIPBL, SMC1A, SMC3, HDAC8, RAD21, ANKRD11 and BRD4 genes that, when altered, cause CdLS.
The diagnosis of CdLS is primarily a clinical one based on signs and symptoms observed through an evaluation by a physician, including a medical history, physical examination and laboratory tests. However, genetic testing can be helpful in confirming the clinical diagnosis and assessing which gene is involved.
Each child will progress at their own rate as the penetrance of any phenotypic signs or symptoms is variable. Meaning that even with the same CdLs diagnosis the extent or degree the symptoms of CdLs occur or are showns will vary child to child. However, you can generally expect a slower than average rate of development. The area of speech and communication is often delayed, even in the more mildly affected. Infant stimulation programs and other developmental and therapeutic interventions are strongly recommended.
You are not alone! We can connect you with other CdLS families in your region who are facing similar challenges. Send us an email letting us know where you are located and we get you in touch with someone close to you.
Get involved! Whether donating time, money or expertise every little bit helps.
Events are an important and effective way to raise awareness of CdLS and to support the organisation. There are a variety of events that the CdLSA sponsors and others that are hosted by community members.
Want to help fundraise? All fundraising and donations go to sponsoring events in our communities, hosting national and internation conferences and supporting our families. You can do this in a variety of ways:
· Become a member. It is easy but so impactful.
· Run for a reason. Get your friends, family coworkers and anyone else to sponsor charity running event near you. Find a run near you and create a team here AUS or NZ
· Host an event – these could be everything from a morning team to Quiz Night the options are endless.
· Or simply donate.
Our community is worldwide! The Cornelia de Lange Syndrome Association (Australasia) is part of the CdLS World organisation connecting us with families and experts from all over the world. Being connected internationally allows us access to a lot of useful information and experiences about Cornelia de Lange Syndrome.
Click the purple buttons below to find out more about the CdLS community around the world.
Involving individuals with CdLS and their families and primary carers in health decisions is essential. Below are resource available to you to keep track of health events, details of behaviours and support families.

Consensus Statement
The international Scientific Advisory Council (SAC) and Federation of CdLS National Support Groups collaborated to produce this consensus statement which is presented here in two versions.
The first version was published in 'Nature Reviews, Genetics' in October 2018, and the Lay version which is a translation of the same document using language which is easier for families to understand (Translation in thanks to people at Cerebra Centre)

Growth Charts
Growth charts for height, weight and head circumference parameters of boys or girls with CdLS at different ages.
Using these parameters, a practitioner can follow growth as compared to other affected individuals rather than the unaffected population. If an individual deviates from the CdLS curve, then further investigation may be warranted.

Know Your Genes
Understand genes of CdLS and what they are.
Changes (or mutations) in the 70% of individuals with CdLS. Individuals with classic findings of CdLS, including characteristic facial features and limb anomalies, are likely to have a change identified in the NIPBL gene. However, changes in NIPBL have been found in individuals with both classic and mild presentations. The degree of severity depends on the specific type of mutation that occurs and where the mutation falls within the NIPBL gene.
Changes in the NIPBL can be found in approximately SMC1A and SMC3 5% of individuals with CdLs. Individuals with SMC1A or SMC3 mutations typically have fewer structural differences, such as a limb difference or heart difference. Such individuals also tend to present with less significant growth restriction than those with NIPBL mutations. However, individuals with SMC1A or SMC3 mutations will still typically have intellectual disability that can range from moderate to severe.
Changes in the RAD21 can be found in approximately 1-2% of individuals with CdLs. Individuals with mutations in RAD21 typically do not have major structural differences and milder cognitive impairment compared to those with “classic” CdLS. These individuals typically display growth retardation, minor skeletal anomalies, and facial features that overlap with CdLs.
Changes in the HDAC8 can be found in approximately 5% of individuals with CdLs. Individuals with mutations in HDAC8 have facial features which overlap with CdLS but typically display delayed closure of the anterior fontanel, hooded eyelids, a wider nose, varying pattern of skin pigmentation, and friendly personalities. Growth restriction also tends to be less significantly affected with this gene and a lower frequency of microcephaly is reported.
The BRD4 protein is known to interact with the NIPBL protein and mutations in the BRD4 gene have been recently reported in a few individuals with an atypical CdLS. However, from those that have been found to carry a BRD4 mutation, significant overlap with CdLS was noted. The key overlapping features observed include growth retardation, global developmental delay, congenital heart defects, hearing loss, seizures, and gastroesophageal reflux.
Changes in the gene ANKRD11 have been reported in several individuals with a non-classic CdLS phenotype, and others have been noted in several clinical observations. Individuals with changes in ANKRD11 show features that overlap with the facial characteristics and suggestive features of CdLS.
Mosaicism, means there are different groups of cells with different genetic make-up in a person. This means that some cells in the person will have the CdLs mutation and others will not. Mosaicism has been found to occur frequently in CdLS. Approximately 15-20% of individuals with classic features of CdLS have mosaic changes in NIPBL; and although it is rare, individuals with CdLS can also have mosaic changes in SMC3, RAD21 or SMC1A. These mosaic changes cannot be found using genetic testing that examines an individual’s DNA from their white blood cells and are generally tested using a skin swab.
Research Update

University of California Irvine-Led Study
Unlocks the Secrets of Birth Defect Origins
Findings Offer New Targets for Early Detection & Prevention Strategies
Contact Us
Reach out for support if you or a loved one has been diagnosed with CdLS or you suspect they might have CdLS. Want to connect with other CdLS families? We can help connect families with others in you area.
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