CHD2-related disorder: What to do next when your child has been diagnosed

What are CHD2-related disorders?

CHD2-related disorders are rare neurodevelopmental conditions caused by spelling changes in the CHD2 gene. Genes are the instructions our bodies use to grow and work properly.

The CHD2 gene is responsible for creating proteins that control or regulate other genes (and whether those genes are turned "on" or "off"). Spelling changes in the CHD2 gene can disrupt the regulation of other genes and lead to differences in the brain (called encephalopathy). These changes in the brain can lead to seizures (epilepsy), cognitive differences, and developmental delays.

Top resources for finding accurate medical information on CHD2-related disorders

Resources written for the general public

• Genetic and Rare Diseases Information Center: CHD2-related disorders
• Medline Plus: CHD2-related disorders

Science-heavy resources targeted at clinicians:

• National Library of Medicine: CHD2-related disorders
• OMIM: CHD2-related disorders

Should I get a second opinion for a CHD2-related disorder diagnosis?

Rare diseases require specialized expertise. Consider seeking a second opinion from a physician who focuses specifically on your child's condition. A fresh perspective can confirm the diagnosis, reveal additional treatment options, or simply provide reassurance about your care plan.

For many rare diseases, it can be hard to find a specialist with relevant experience. You can try asking providers you have seen, referring to community resources (see Section 5 below), or consulting a genetic counselor.

What does a genetic counselor do when my family has received a CHD2-related disorder diagnosis?

Certified Genetic Counselors have completed a program of study focused on understanding and providing information about genetic disorders. A genetic counselor can help you understand the genetic aspects of your child's diagnosis, what it means for your family, and whether testing is recommended for siblings or other relatives.

Genetic counseling can take place in person or in a telemedicine visit. The National Society of Genetic Counselors offers a tool for finding a genetic counselor.

Should other family members undergo genetic testing for a CHD2-related disorder?

In most cases, CHD2-related disorders are caused by a spelling change in a gene that is new in a child. This is called a de novo genetic condition, meaning the spelling change in the gene was not passed down from either parent. When this happens, the chance for another child in the family to have the same genetic change is usually low (under 1%).

In rare cases, a genetic change can be passed down from a parent to a child that causes a CHD2-related disorder. This type of inheritance is called autosomal dominant, which means one genetic change is enough to cause the condition. A genetic counselor can help explain what this means for your family and whether testing is recommended for siblings, parents, or other family members.

What should I ask my child's specialists about a CHD2-related disorder diagnosis?

Knowing what to ask can help you make the most of appointments with specialists. You can use these questions as a guide to discuss care that is specific to your child's diagnosis.

For questions specific to your child's situation, Citizen Health offers a free doctor's appointment preparation tool that incorporates your child's medical records and provides appointment preparation suggestions through an AI chat interface.

What symptoms should we monitor for a CHD2-related disorder?

Every child with a CHD2-related disorder will have their own experience. There are a few features that have been seen in many individuals with CHD2-related disorders, though not every child will experience all of these, and how much each feature affects your child can vary. It is important to partner with your child's care team to identify any differences in development or health.

Generally, the following features are reported to be associated with CHD2-related disorders:

• Seizures (epilepsy is the name for chronic or repetitive seizures) - there are different types of seizures associated with CHD2-related disorders:
  • Refractory (seizures continue even with medications)
  • Drop attacks (sudden, brief loss of muscle control, can cause the person to collapse)
  • Myoclonic (sudden, involuntary jerks or muscle twitches)
  • Absence (sudden loss of consciousness, can look like blank staring)
  • Atonic (weak muscle tone)
  • Others (would be reviewed by a neurologist)
• Light sensitivity (also called "clinical photosensitivity" when flashing light can trigger a seizure)
• Cognitive differences (including intellectual disability with a range of severity)
• Developmental regression (when previously achieved skills are lost)
• Developmental delays (not hitting infantile/childhood milestones)
• Brain findings (differences observed on a test called electroencephalogram, or EEG)
• Behavioral differences or conditions (including autism and ADHD)

What is the expected progression of a CHD2-related disorder?

CHD2-related disorders are lifelong conditions, and every child's experience is different. Here is a general picture of what to possibly expect:

In the first years of life (infancy and early childhood)

Seizures are usually the first major sign, and they typically begin within the first few months-years of life. For many children, the onset comes on suddenly and can involve multiple seizures a day. Common seizure types include full-body stiffening and shaking, sudden muscle jerks, eyelid fluttering, and brief drop attacks. Low muscle tone and feeding difficulties can also appear early on. Your care team can connect you with therapies to help.

* One thing to keep watch for early on: light sensitivity. Many children have seizures triggered by flashing lights or certain visual patterns. It's worth discussing this with your child's neurologist early on because it can affect everyday things like screen time and daily life events. Your child's care team can review effective ways to manage light sensitivity.

Through childhood

Most children experience delays in learning, communication, and behavior. Many children are diagnosed with autism or autistic features. Speech is commonly affected, and many children use alternative communication tools like picture boards or voice-generating devices to express themselves. Seizures often continue and frequently require more than one medication to manage. Your child's doctor will determine which medication(s) are the best fit. Behavioral support and developmental therapies can make a real difference during these years.

In adolescence

Seizures can worsen around puberty for some children. Some young people also go through periods where developmental progress slows or skills they had previously gained become harder. This is a recognized part of the condition for some individuals and is not something anyone did wrong. Behavioral challenges may shift or continue during this time as well.

In adulthood

Many adults with CHD2-related disorders continue to need support with daily life, communication, and seizure management. Meaningful communication is absolutely possible with the right tools. With good support in place, adults with CHD2-related disorders experience connection, joy, and quality of life. Research into targeted treatments is actively underway (see Finding clinical trial opportunities & supporting research into CHD2-related disorders section below)

What treatments are available for a CHD2-related disorder?

• There is currently no cure for CHD2-related disorders. However, there is an active research space surrounding potential treatments and clinical trials. Read more about potentially available clinical trials here.
• Treatment focuses on managing symptoms and supporting development, and care is highly specific to each individual. Treatment typically includes medication to manage seizures, specific medications will be determined by your child's doctor. Treatment also can include services and support for developmental and intellectual delays. See Section 3 for more on developmental therapies.

What healthcare providers should be on my child's care team?

Your child's CHD2-related disorder care team is the group of providers who work together to support your child's health, development, and quality of life.

CHD2-related disorders affect multiple body systems, so your child's care team will likely extend well beyond a single doctor, and building it early matters, as waitlists for specialty and therapeutic services can be long. All of the following providers may not be helpful depending on your child's specific needs, but here's a quick guide of providers you might meet and what they can help with.

Specialist Physicians

A neurologist will likely be one of your most important partners, helping manage seizures and monitoring your child's neurological development over time. A developmental pediatrician can help pull together the big picture, coordinating evaluations and keeping an eye on how your child is growing and developing across different areas. A geneticist is often a helpful hub for families navigating a rare disease diagnosis, especially when you're dealing with multiple specialists at once. A psychiatrist or psychologist who specializes in intellectual disabilities can be a lifeline for managing behavioral challenges and anxiety.

Therapeutic Providers

A physical therapist can support your child's movement, muscle tone, balance, and motor skills. An occupational therapist focuses on everyday skills, fine motor development, and adaptive equipment. A speech-language pathologist can work on communication, including alternative and augmentative communication (AAC) methods, as well as feeding. A feeding therapist can provide specialized support if eating and swallowing are challenging. Behavioral therapists can help with emotional regulation and development of adaptive behaviors.

This is not a complete list, but it can serve as a starting point. Each child will have their own individual journey, and you can ask your child's doctor which providers make sense for your child's specific needs. For a deeper look at therapeutic services and how to access them, see Section 3.

Finding clinical trial opportunities & supporting research into CHD2-related disorders

When you participate in research, you help your child and other families in the future. Medical research studies can be very different from each other. Some test new treatments, while others are "natural history studies" that just collect information about a disease's impact over time.

Natural history studies are designed to help researchers learn more about the condition. This information is important for creating future treatments. Traditional natural history studies can involve additional medical appointments over the course of several years.

Clinical trials are research studies that help doctors find new treatments. Some trials test new medicines or therapies that aren't available yet. Even if you may choose not to participate, it can be good to know what options exist for your child's condition. Your child's doctor or disease organization can help you find trials that might be a good fit. The U.S. government also maintains a registry at clinicaltrials.gov.

Patient registries collect health information from people with specific diseases to help research move faster and connect families with clinical trials. Registries also show researchers and drug companies that families are engaged and want to help develop new treatments, which can bring more funding and research attention to a disease. Some diseases have more than one registry you can join. Patient Advocacy Groups typically establish and maintain patient registries for specific rare diseases. (See Section 5 below to learn more).

The Coalition to Cure CHD2 has a helpful page that explains the difference between various types of clinical research. Visit this link to learn more.

Organizing and maintaining your child's medical records for a CHD2-related disorder

Rare disease patients see many different doctors, often across different medical and technological systems that may not talk to each other. Unfortunately, that means the burden often falls on caregivers to track care holistically, identify "gaps," and make sure nothing gets missed. Keeping your records as organized and centralized as you can from early on is likely to improve your ability to manage your child's care down the road.

You can start by creating a one-page sheet with your child's diagnosis, current medications, allergies, and emergency contacts. Bring this sheet to every appointment. It can really help in emergencies or when you see a new doctor.

Many caregivers establish one (or several) records binder(s) in which they keep track of appointments, medication updates, symptoms, and other ongoing medically relevant information.

We also encourage caregivers to consider Citizen Health's free tools for centralizing, managing, accessing, and extracting key information from health records. Our system will collect all your health records, across doctors and health systems, making them available on our secure online platform that can provide answers in real time based on questions you ask (like "What medications has my child been prescribed in the past year?" or "When did we last see an orthopedist?")

As a company built by rare disease caregivers, we aim to overcome the need for physical records binders. But ultimately the important question is what works for you and your family.

Before age 3: Understanding early intervention services for children with a CHD2-related disorder

Early intervention provides therapies and support for children from birth to age 3 who have delays or disabilities. Services may include physical therapy, occupational therapy, speech therapy, and other developmental support.

Every state has an early intervention program, and you can ask for an evaluation even if your child doesn't have a formal diagnosis yet. In some states, early intervention programs are called "birth to three", "early steps", or "first steps".

It's never too early to search for early intervention services in your state. Learn more from ECTA, the Early Childhood Technical Assistance Center.

3 & up: School services for children with a CHD2-related disorder

IEPs and 504 plans

When your child turns 3, they move from early intervention to school-based services. An Individualized Education Program (IEP) is a legal document that describes the special instruction, therapies, and support your child needs to learn at school.

A 504 plan provides accommodations for students who don't need special instruction but need support because of a disability. Understanding your rights and these plans helps make sure your child gets the right services throughout their school years.

Communicating with your school

Building a good relationship with your child's school team is important. You know your child better than anyone, and that knowledge is incredibly valuable. Come to meetings prepared with information about your child's needs, share your concerns and hopes openly, and never hesitate to ask questions if something isn't clear.

If your child has seizures, their school will likely create something called a Seizure Action Plan, a written document from your child's neurologist that tells school staff exactly what to do if a seizure occurs. Most schools are required to have one on file, and many states have specific laws about seizure management in schools. See the Epilepsy Foundation's guide to navigating seizure management in the school system here.

You are an equal and essential member of your child's school team. Other CHD2 families can also be a valuable resource for navigating school as many have experience advocating for communication support and seizure plans and are willing to share what worked for them.

Assistive devices and equipment for CHD2-related disorders

Depending on your child's needs, assistive technology and adaptive equipment can help with independence, communication, and quality of life. This might include communication devices (augmentative and alternative communication or AAC), mobility equipment, adaptive seating and positioning, feeding equipment, or adaptive toys and tools. Your child's therapists can recommend the right devices, and many are covered by insurance or available through school programs.

Some devices and equipment can be expensive but can very often be covered by insurance. If coverage is denied, be sure to talk to your doctors about writing an appeal letter or a Letter of Medical Necessity. These documents can be critical for getting insurance coverage for devices and equipment.

Respite care

Caring for a child with complex medical needs is hard work, and taking breaks is important for your health and your family's wellbeing. Respite care provides temporary relief, giving you time to rest, handle other responsibilities, or just recharge. Options range from a few hours with a trained caregiver to overnight or weekend programs.

Respite isn't a luxury. It's a necessary part of taking care of your family long-term. The non-profit Access to Respite Care and Help (ARCH) provides guidance on how to find a respite care provider.

Building your support systems as a CHD2-related disorder caregiver

Being a caregiver to a child with a CHD2-related disorder is a heavy responsibility. You can't do it alone, and you don't have to. Building a network of support including family, friends, medical providers, therapists, other parents, and community resources, creates a safety net for hard days as well as people to celebrate victories with.

When asking for help, it helps to be specific: people want to support you but often don't know how. Whether it's meals, watching your other children, or just someone to listen, letting others help is good for everyone.

Don't forget about support for other family members! If your child has siblings check out the Sibling Support Project.

Medicaid and Social Security eligibility for CHD2-related disorders

Even if your family income exceeds typical Medicaid limits, children with rare diseases may qualify for Medicaid through special pathways designed for those with disabilities or significant medical needs.

A program called Katie Beckett or TEFRA waivers allows children with disabilities to qualify for Medicaid based on their own income rather than family income. Additionally, children with significant functional limitations may qualify for Supplemental Security Income (SSI), which provides monthly payments and often automatically qualifies them for Medicaid. These programs can provide crucial coverage for therapies, equipment, and services private insurance won't cover.

Learn more about Medicaid in your state through this interactive map from NORD.

ABLE savings accounts for CHD2-related disorders

On that note, if your child qualifies for SSI, they may also be eligible for an ABLE (Achieving a Better Life Experience) account. ABLE accounts are tax-advantaged savings accounts specifically designed for people with disabilities that are opened in a child's name but do not count against the $2,000 asset limit that typically applies to programs like SSI and Medicaid. Find out more at ablenrc.org.

Understanding your insurance coverage for CHD2-related disorders

What's covered

• Your insurance policy determines what services, therapies, equipment, and medications are covered for your child. Start by reading your plan documents to understand your benefits, deductibles, co-pays, and out-of-pocket maximums. Call your insurance company's customer service or case management department as many insurers assign case managers to children with complex medical needs who can help you understand your coverage.
• Don't assume something isn't covered until you've asked. Many families are surprised to learn what benefits are available when properly documented.
• Keep notes of every call you make, including the date, time, person you spoke with, and what they said. This documentation can be very helpful later.
• Most children's hospitals also have a financial counselor or patient navigator who may be able to help with insurance or financial coverage issues.

Therapy & rehabilitation

• When considering insurance coverage for therapies and rehabilitation services, make sure to see if your plan has a cap for the number of therapy visits per year. Many children with complex needs will exceed that cap and appeals or additional insurance coverage plans may be needed.

Medical equipment

• If your child needs durable medical equipment such as a wheelchair, walker, orthotics, or at home equipment, getting insurance coverage for that equipment will likely require prior authorization or a letter of medical necessity.

Denials & appeals

• Insurance companies often deny coverage for therapies, equipment, or medications at first but denials can often be overturned with the right documentation. If coverage is denied, you have the right to appeal, and many families win their appeals.
• An effective appeal letter includes: your child's diagnosis and how it affects their daily life, specific medical reasons from doctors explaining why the service or item is necessary, references to your insurance policy language that supports coverage, research or medical guidelines supporting the treatment, and a clear request for reconsideration. Many patient organizations and hospital financial counselors can help you write strong appeals. You can even appeal multiple times, and many families win on their second or third attempt. You're advocating for your child, and persistence often pays off.

Non-discrimination protections for CHD2-related disorders

The Genetic Information Nondiscrimination Act (GINA) is a federal law that protects you from genetic discrimination in health insurance and employment. Health insurance companies cannot use genetic information to deny coverage, raise your premiums, or determine eligibility. However, GINA does not cover life insurance, disability insurance, or long-term care insurance. Employers cannot use genetic information when making hiring, firing, or promotion decisions. Understanding these protections can give you confidence in pursuing genetic testing and sharing results with your child's healthcare providers without fear.

Learn more about these protections from the American Society of Human Genetics.

Why connect with other CHD2-related disorders families?

Finding and connecting with families who have walked in your rare disease shoes can be life-changing. Other parents navigating the same diagnosis can offer practical advice, emotional support and hope based on their shared experience. They can understand the daily challenges and the victories, big and small, in ways that others can't. Disease-specific communities often become a lifeline and a source of hope that remind you that you are not alone.

Local CHD2-related disorders support groups

Your genetic counselor or other healthcare provider may be able to connect you with local families in your area. It is totally appropriate to ask your providers if they know of any local families who might be willing to connect with you for a phone call or even a play date.

Some rare diseases are so exceptionally rare that it might not be possible to connect locally with another person with the same rare disease. But collectively, rare diseases are not that rare! Connecting with broader rare disease groups is another great option. Many states and communities have organizations that support all rare diseases.

Patient advocacy groups (PAGs) for CHD2-related disorders

Patient advocacy groups exist for many rare diseases and serve as a central hub for connections, reliable information, research updates and advocacy efforts. These organizations work to advance research, improve care standards, raise awareness, and support families. They often host conferences, maintain family directories or registries, fund research, provide educational resources, and fight for policies that benefit the community.

Connecting with your disease's advocacy organization gives you access to experts, researchers, and a network of families while contributing to the larger mission of finding treatments and cures.

One great resource, the Coalition to Cure CHD2 (CCC) is a group formed by parents of children with CHD2-related disorders. The CCC aims to connect families, improve the quality of life of those affected by these conditions, and contribute towards research with the end goal of identifying a cure. The CCC spans access across 50 countries. Citizen Health has partnered with the CCC to help families centralize medical records and contribute to research. Learn more about Citizen Health's partnership with the CCC here.

Disease-specific conferences and events

Many patient advocacy groups will help spread awareness through conferences and events. These can include in person events or online events and are great opportunities to connect with others and to stay on the cutting edge of new research opportunities.

Attending a conference focused on your child's condition can be transformative. These gatherings bring together families, researchers, doctors, and advocates in one place. You'll hear about the latest research, learn from medical experts, meet families at different stages of the journey, and let your child connect with others like them.

Many families describe their first conference as the moment they felt less alone. While attending may require travel and expense, many organizations offer scholarships or financial assistance to help families participate. If you can go, it's often worth it.