Deletion 1p36 (del1p36) syndrome is the most common human disorder resulting from a terminal autosomal deletion. This condition is molecularly and clinically heterogeneous. Deletions involving two non-overlapping regions, known as the distal (telomeric) and proximal (centromeric) critical regions, are sufficient to cause the majority of the recurrent clinical features, although with different facial features and dysmorphisms. SPEN encodes a transcriptional repressor commonly deleted in proximal del1p36 syndrome and is located centromeric to the proximal 1p36 critical region. Here, we used clinical data from 34 individuals with truncating variants in SPEN to define a neurodevelopmental disorder presenting with features that overlap considerably with those of proximal del1p36 syndrome. The clinical profile of this disease includes developmental delay/intellectual disability, autism spectrum disorder, anxiety, aggressive behavior, attention deficit disorder, hypotonia, brain and spine anomalies, congenital heart defects, high/narrow palate, facial dysmorphisms, and obesity/increased BMI, especially in females. SPEN also emerges as a relevant gene for del1p36 syndrome by co-expression analyses. Finally, we show that haploinsufficiency of SPEN is associated with a distinctive DNA methylation episignature of the X chromosome in affected females, providing further evidence of a specific contribution of the protein to the epigenetic control of this chromosome, and a paradigm of an X chromosome-specific episignature that classifies syndromic traits. We conclude that SPEN is required for multiple developmental processes and SPEN haploinsufficiency is a major contributor to a disorder associated with deletions centromeric to the previously established 1p36 critical regions.Neurodevelopmental disorders (NDDs) and intellectual disability (ID) affect approximately 1%-3% of the general population. 1-3 NDDs/ID are largely genetically determined, but identification of the underlying molecular causes has been hampered by clinical and genetic heterogeneity. During the last decades, the use of high-resolution array-based copy number variant (CNV) analysis and second-generation sequencing techniques has improved our knowledge of the genetic basis of both syndromic and non-syndromic NDDs/ID. [2][3][4] Notwithstanding these achievements, the genetic basis of NDDs/ID is still unsolved in a large proportion of affected individuals.Deletion 1p36 (del1p36) syndrome, first described by Shapira and colleagues in 1997, 5 is the most common autosomal terminal deletion syndrome in humans, occurring in about 1 in 5,000 births. [6][7][8] This disorder is characterized by developmental delay (DD)/ID, behavioral abnormalities, hypotonia, seizures, brain anomalies, vision problems, hearing loss, orofacial clefting, congenital heart defects (CHDs), cardiomyopathy, renal anomalies, short

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SPTBN1 encodes βII-spectrin, the ubiquitously expressed β-spectrin that forms micrometer-scale networks associated with plasma membranes. Mice deficient in neuronal βII-spectrin have defects in cortical organization, developmental delay, and behavioral deficiencies. These phenotypes, while less severe, are observed in haploinsufficient animals, suggesting that individuals carrying heterozygous SPTBN1 variants may also present with measurable compromise of neural development and function. Here we identify heterozygous SPTBN1 variants in 29 individuals who present with developmental, language and motor delays, mild to severe intellectual disability, autistic features, seizures, behavioral and movement abnormalities, hypotonia, and variable dysmorphic facial features. We show that these SPTBN1 variants lead to effects that affect βIIspectrin stability, disrupt binding to key molecular partners, and disturb cytoskeleton organization and dynamics. Our studies define SPTBN1 variants as the genetic basis of a neurodevelopmental syndrome, expand the set of spectrinopathies affecting the brain, and underscore the critical role of βII-spectrin in the central nervous system. Spectrins are ubiquitously expressed, elongated polypeptides that bind membrane lipids and ankyrins to line the plasma membrane 1,2 . The spectrin meshwork is formed by heterodimeric units of α-spectrin and β-spectrin assembled side-to-side in antiparallel fashion, which then form head-to-head tetramers that crosslink F-actin to form spectrin-actin arrays 1,2 . Mammalian neurons express the most diverse repertoire of spectrins, which Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use: http://www.nature.com/authors/editorial_policies/license.html#terms *

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The purpose of this closely aligned conceptual replication study was to investigate the efficacy of a Tier 2 kindergarten mathematics intervention. The replication study differed from the initial randomized controlled trial on three important elements: geographical region, timing of the intervention, and instructional context of the counterfactual. Similar to the original investigation, however, the current study tested the same intervention, used the same outcome measures and statistical analyses, and involved the same population of learners. A total of 319 kindergarten students with mathematics difficulties from 36 kindergarten classrooms participated in the study. Students who were randomly assigned to the treatment condition received the intervention in small-group formats, with 2 or 5 students per group. Control students participated in a no-treatment control condition. Significant effects on proximal and distal measures of mathematics achievement were found. Effect sizes obtained for all measures fell within or exceeded the upper bound of the effects reported in the initial study. Implications for systematically situating replication studies in larger frameworks of intervention research and reporting rates of treatment response across replication studies are discussed.