What is ERF syndrome?

ERF gene is a member of the ETS family of transcription factors and encodes for ETS2 repressor factor. Mutations in ERF gene has been associated with craniosynostosis syndrome, a premature fusion of one or more of the cranial vault sutures (bones of the baby’s skull join too early). 1,2 Individuals with ERF syndrome can have craniosynostosis (i.e., incorrect joining of skull bones), facial dysmorphism, visual and hearing impairments. Challenges with attention (e.g., attention deficit hyperactivity disorder), fine and gross motor problems are also noted. 1,2,3



For further information, do get in touch with the CRE Speech and Language research team at:


Phone: (03) 9936 6334

Frequently asked questions

There is much variation in the developmental presentation of children with ERF syndrome. Based on present, children with ERF syndrome will take more time to reach developmental speech and language milestones relative to peers.1,2,3

There is large variation in the speech and language abilities of individuals with ERF syndrome. One speech condition that has been linked to ERF syndrome is Childhood Apraxia of Speech (CAS). CAS is a motor speech disorder affecting production, sequencing, and stress of speech. 3

There is considerable variability between individuals with this condition. Currently, there is not enough data to inform exactly how speech develops overtime and when certain milestones can be anticipated. Some individuals do not develop enough verbal speech to rely on this for their daily communication needs. These individuals require augmentative and alternative communication (AAC) systems to communicate, whilst other individuals can rely on verbal speech to communicate.In the literature, the adults with ERF syndrome all have been reported to live independently.1

Of the individuals reported to date in the scientific literature, some individuals attend mainstream school and others require specialist support at school settings.1,3 However, any individual should be assessed for their needs, and should attend the most appropriate education setting based on their needs, the supports available in different educational settings and of course taking into consideration local educational policies.

At present, speech and language therapies are focused on the individual’s specific speech and language needs. A speech pathology assessment will pinpoint the specific areas for support, taking into consideration the goals for the individual/family. Children who have few spoken words or some words that are unclear, may benefit from augmentative and alternative communication (AAC) options (e.g., sign language, electronic speech generating devices).

For verbal children who have CAS, the Nuffield Dyspraxia Programme version 3 (NDP-3) or the Rapid Syllable Transition Treatment (ReST), are two programs which have been proven to be effective in a randomised controlled trial.4 There are currently a number of other CAS focused therapies undergoing rigorous clinical testing, including Dynamic Tactile Temporal Cueing.5 One treatment that is often used for children who are minimally verbal and who benefit from tactile prompts (prompts to the lips, cheek etc) to help stimulate speech production is Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT). 6,7 Yet to date, none of these therapies have not been specifically trialled with children with neurogenetic conditions. Further to the speech production therapies, children who have delayed language also require early intervention programs targeting early language development.8

For information and support on childhood apraxia of speech:


  1. Glass, G. E., O'Hara, J., Canham, N., Cilliers, D., Dunaway, D., Fenwick, A. L., ... & Wilson, L. C. (2019). ERF‐related craniosynostosis: The phenotypic and developmental profile of a new craniosynostosis syndrome. American Journal of Medical Genetics Part A179(4), 615-627.
  2. Chaudhry, A., Sabatini, P., Han, L., Ray, P. N., Forrest, C., & Bowdin, S. (2015). Heterozygous mutations in ERF cause syndromic craniosynostosis with multiple suture involvement. American Journal of Medical Genetics Part A167(11), 2544-2547.
  3. Kaspi, A., Hildebrand, M. S., Jackson, V. E., Braden, R., Van Reyk, O., Howell, T., ... & Morgan, A. T. (2022). Genetic aetiologies for childhood speech disorder: novel pathways co-expressed during brain development. Molecular psychiatry, 1-17.
  4. Murray, E., McCabe, P., & Ballard, K. J. (2015). A randomized controlled trial for children with childhood apraxia of speech comparing rapid syllable transition treatment and the Nuffield Dyspraxia Programme–Third Edition. Journal of Speech, Language, and Hearing Research58(3), 669-686.
  5. Strand, E. A. (2020). Dynamic temporal and tactile cueing: A treatment strategy for childhood apraxia of speech. American Journal of Speech-Language Pathology29(1), 30-48.
  6. Morgan, A. T., Murray, E., & Liegeois, F. J. (2018). Interventions for childhood apraxia of speech. Cochrane Database of Systematic Reviews, (5).
  7. Namasivayam, A. K., Huynh, A., Granata, F., Law, V., & van Lieshout, P. (2021). PROMPT intervention for children with severe speech motor delay: a randomized control trial. Pediatric research89(3), 613-621.
  8. Ebbels, S. H., McCartney, E., Slonims, V., Dockrell, J. E., & Norbury, C. F. (2019). Evidence‐based pathways to intervention for children with language disorders. International journal of language & communication disorders54(1), 3-19.

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