IGF1 and Monosomy 22q13: Currently, the lack of a truly mechanistic understanding of the link between molecular, neuroanatomical/functional, and cognitive processes impedes informed selection of “primary endpoints.” For example, in a pilot trial of insulin-like growth factor-1 (IGF-1) in Phelan McDermid Syndrome the Aberrant Behavior Checklist (ABC) social withdrawal subscale was chosen as the primary outcome measure because it is well validated in ASD and ID and accepted within pediatric psychopharmacology research (40).