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The most frequent tend to be huge deletions at 18q21 encompassing the TCF4 gene and frameshifting/nonsense solitary nucleotide variants. Nonetheless, variations in noncoding areas may also induce Pitt-Hopkins problem by disrupting the conventional pre-mRNA splicing equipment. Here we explain three patients with Pitt-Hopkins problem caused by a big removal in chromosome 18, a nonsense variation, and a novel variant located in intron 11 of TCF4 c.922+5G A. Using RT-PCR analysis and