To the Editor: We understand the concern raised by Dr Saul1 that a fragile X analysis is not included along with a microarray in the testing algorithm for the categories of “multiple nonspecific concerns,” “autism and intellectual disability,” and “no gene panel available” (Figure 1) of our recent publication.2 The algorithm refers to clinical problems in addition to intellectual disability and autism. Fragile X testing is discussed twice in the text as first-tier molecular testing for autism and intellectual disability. Furthermore, in Figure 1, suspicion of a triplet-repeat disorder (such as fragile X) should prompt a triplet-repeat analysis. Our article was intended to inform clinicians on how to select from among the often confusing variety of available molecular testing options. The algorithm is not presented as a formal guideline. Other papers, including a guideline from the American College of Medical Genetics and Genomics, are more comprehensive and appropriate for specific clinic problems such as intellectual disability and autism.3,4

Disclosure

Y.X., A.A., and M.R.H. work for a nonprofit diagnostic laboratory. W.R.W. declares no conflict of interest.