She had a normal chromosomal microarray, negative fragile X and MECP2 testing, and an autism gene panel revealed a maternally inherited (non-pathogenic) variant in NSD1. She had been tried on multiple psychotropics without significant benefit, including risperidone, clonidine, valproic acid, memantine, aripiprazole, and sertraline. The gene discussed is MECP2; the disease is autism.