A 2023 report outlines the experiences and challenges of implementing NBS for ALD in Nebraska including a lack of genotype-phenotype correlations, absence of predictive biomarkers for childhood cerebral ALD or adrenomyeloneuropathy, and a high proportion of ABCD1 variants of uncertain significance combining to cause unique counseling difficulties [269]. The gene discussed is ABCD1; the disease is adrenomyeloneuropathy.