It is important to add that cases 3 (PPM1D), 9 (SYNGAP1), 13 and 14 (NLRC4), 15 and 16 (RAG1), 19 and 20 (SHANK3), and 21 (CHK2) also had preexisting ASD or developmental delay prior to developing PANS. This evidence concerns the gene PPM1D and Global developmental delay.