SHANK3 and Global developmental delay: 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.