What to do next when your child has been diagnosed with Friedreich's ataxia

Top resources for finding accurate medical information on Friedreich’s ataxia

Resources written for the general public

• NIH Genetic and Rare Diseases Information Center (GARD): Friedreich’s Ataxia
• Medline Plus: Friedreich’s Ataxia
• National Organization for Rare Disorders (NORD): Friedreich's Ataxia

Science-heavy resources targeted at clinicians:

• National Library of Medicine GeneReviews: Friedreich’s Ataxia 
• OMIM: Friedreich's Ataxia

Should I get a second opinion for a Friedreich's ataxia diagnosis?

Rare diseases require specialized expertise. Consider seeking a second opinion from a Neurologist or Ataxia Specialist. 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 Friedreich's ataxia 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 Friedreich's ataxia?

Friedreich's ataxia is inherited in a recessive pattern, which means that in most cases, both parents carry one copy of a genetic change but don't have symptoms themselves. When a child inherits a genetic change from both parents, they develop the condition. Carriers are healthy and are not at risk of developing the disease

Speaking with a genetic counselor about how your child's condition was inherited can help determine if testing is recommended for siblings, parents, or other family members. Testing parents can confirm if they are carriers of the genetic change and help assess the risk for future pregnancies or other relatives. Your genetic counselor can explain your family's specific situation, who should consider testing, and the best timing for those tests.

What symptoms should we monitor for Friedreich’s ataxia? 

• Everyone with Friedreich’s ataxia experiences some kind of ataxia (loss of coordination and balance), but other symptoms (including balance changes, walking, fine motor skills, and fatigue) vary and may appear gradually over time. 
• Heart conditions like cardiomyopathy (thickening of the heart muscle) and arrhythmias (irregular heartbeat) are common and may not cause noticeable symptoms early on.
• Scoliosis (curvature of the spine) affects many individuals with Friedreich’s ataxia.
• Diabetes can develop in childhood or adulthood.
• Over time, some people develop slurred speech, difficulty swallowing, or changes in vision and hearing. Tracking these changes can help your care team adjust treatment and support as needed.

What is the expected progression of Friedreich’s ataxia?

• Friedreich's ataxia is a progressive condition, meaning symptoms change over time, but how quickly and in what way varies significantly from person to person. Most people are diagnosed between ages 5 and 15, though about 25% have late-onset Friedreich’s ataxia that begins in adulthood and typically progresses more slowly.
• The first signs usually involve difficulty with balance and walking. Over time, coordination challenges may extend to the arms and hands, and speech may become affected. Many people need mobility aids like a cane, walker, or wheelchair within 10–15 years of symptom onset. Friedreich’s ataxia can also affect the heart, spine, and other body systems over time. It's important to know that while Friedreich’s ataxia affects motor function, it does not affect intelligence. 

What treatments are available for Friedreich's ataxia? 

• In February 2023, the FDA approved omaveloxolone (Skyclarys®) for people 16 years and older with Friedreich’s ataxia. It's a once-daily capsule that, in clinical studies, showed benefit on a standard neurological rating scale. Your child's doctor can discuss whether it's appropriate, what monitoring is needed (including liver tests), and how it fits into your child's overall care plan.
• It's important to know that Skyclarys does not cure Friedreich’s ataxia. It could be one part of a comprehensive approach that includes therapies, heart and diabetes screening, and supports for school and daily life. 
• Beyond Skyclarys, researchers are actively studying several other potential treatments, including gene therapies that aim to fix the underlying genetic problem, treatments to boost frataxin (the protein that's missing in Friedreich’s ataxia), and therapies that help protect cells from damage. 
• There are also many developmental therapies available (see Section 3).
• Your care team can help you understand whether your child qualifies for any clinical trials currently underway.

What healthcare providers should be on my child’s care team for Friedreich's ataxia?

Your child’s Friedreich’s ataxia care team is the group of providers who work together to support your child's health, development, and quality of life. 

Friedreich’s ataxia affects multiple body systems. Your child may benefit from specialists beyond neurology, such as cardiology (the heart), orthopedics (the musculoskeletal system), endocrinology (diabetes monitoring or growth management), Ophthalmology (eyes), and Audiology (hearing). Ask your doctor which specialists should be part of your child's care. 

Geneticists, doctors who specialize in genetic disorders, are often very good at managing care for patients with complex rare diseases.

Therapeutic providers, such as a physical therapist (mobility and motor skills), occupational therapist (daily living skills and fine motor development), speech-language pathologist (communication and feeding), or behavioral therapist (supporting emotional regulation and adaptive behavior), are equally important members, supporting your child's development, communication, and daily functioning. Ask your 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 Friedreich's ataxia

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. 

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

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.

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).

Another way to support Friedreich’s ataxia research is by sharing the medical records you already have. The Friedreich’s Ataxia Research Alliance (FARA) has partnered with Citizen Health to create a platform where families can contribute de-identified data from their existing medical records (things like echocardiograms, neurology notes, therapy records, and more) to FARA-approved researchers.

Unlike traditional natural history studies that require extra clinic visits, this approach lets you contribute from home using records you've already collected. Your real-world experiences (cardiac changes over time, mobility progression, speech development) can help researchers better understand Friedreich’s ataxia and design more effective clinical trials.

Learn more about this here.

Organizing and maintaining your child’s medical records for Friedreich's ataxia

Friedreich's ataxia 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.

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 Friedreich's ataxia

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. 

You are an equal and essential member of this team. Other members of your Friedreich's ataxia community can also be valuable resources for navigating your child’s school experience. 

Assistive devices and equipment for Friedreich's ataxia

Depending on your child's needs, assistive technology and adaptive equipment can help with independence, communication, and quality of life. This might include mobility equipment (braces/orthotics, walkers, gait trainers, wheelchairs), positioning supports and standers, or adaptive toys and tools. Your therapists can recommend the right devices and timing - the right tools can increase participation and comfort. 

Many devices and pieces of equipment are covered by insurance or available through school programs. 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 Friedreich's ataxia caregiver

Being a caregiver to a child with Friedreich's ataxia 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 Friedreich’s ataxia

Even if your family income exceeds typical Medicaid limits, children with Friedreich's ataxia 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.

Understanding your insurance coverage for Friedreich's ataxia

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 genetic 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.

Finding and connecting with families who have walked in your rare disorder 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 Friedreich's ataxia 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. 

Friedreich’s ataxia patient advocacy groups (PAGs)

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.

Citizen Health partners with Friedreich’s Ataxia Research Alliance (FARA), a global community of families, scientists, and advocates dedicated to accelerating research toward treatments and a cure for Friedreich’s ataxia and supporting those living with the condition.

 More information about this partnership can be found 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.