History and physical are vital in the diagnosis and assessment of DGS. Most cases get diagnosed in the prenatal and pediatric periods, diagnosis can also occur in adulthood.

• Palatal abnormalities (69%), particularly velopharyngeal incompetence (VPI), submucosal cleft palate, and cleft palate; characteristic facial features (present in the majority of Caucasian individuals) including hypertelorism.

• Hearing loss (both conductive and sensorineural) (Hearing loss with craniofacial syndromes)

• Laryngotracheoesophageal anomalies

• Skeletal abnormalities

• Autism and Autism spectrum disorders
• Seizures (without hypocalcemia)
• Learning difficulties (70-90%)

A complete cardiopulmonary evaluation can reveal murmurs, cyanosis, clubbing, or edema consistent with aortic arch anomalies, conotruncal defects (e.g., tetralogy of Fallot, truncus arteriosus, pulmonary atresia with ventricular septal defect, transposition of the great vessels, interrupted aortic arch), or tricuspid atresia.

Recurrent sinopulmonary infections due to T cell deficiency as a result of thymic hypoplasia

Signs of hypocalcemia, including twitching and muscle spasm, may be evident as a result of parathyroid hypoplasia. Chvostek’s and Trousseau’s signs may be positive.

Delayed development, unusual behavior, or signs of psychiatric disorders may be observable.^[1]