With the release of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Edition V (DSM-V) in 2013, many developmental and behavioral disorders were reclassified or included in the new diagnosis of autism spectrum disorders (ASD). Childhood disintegrative disorder (CDD), though it was discovered and diagnosed long before autism, is now classified as one of the low-functioning subsets of ASD. Though it is on the ASD spectrum, CDD has its own specific nuances, characterizations and ramifications that make it important to discuss and understand.
Childhood disintegrative disorder, also known as Heller’s syndrome or disintegrative psychosis, follows a different pattern of onset from ASD, but it is no less detrimental to the psychological and social well-being of the children who suffer from it. Many would claim that it is more detrimental. In the article below, we’ll discuss the finer points of CDD, including its history, current understandings, and related therapies, to provide a deeper understanding of what it is and how it is treated.
An Early Discovery
Doctor Theodore Heller first discovered CDD in 1908, many years before the first diagnosis of autism. This is why it may also be referred to as Heller syndrome. It is a rare condition, characterized by its late onset (typically > 3 years old), that causes developmental delays in motor skills, social function, language, and social skills. Currently, its cause (etiology) is also unknown.
As a rule, many ASDs present with delayed or absent developmental features (particularly at the age they should commonly be developed). This includes social skills, receptive language skills, play with peers, motor skills, and/or bowel or bladder control issues. CDD and its symptoms fit within these classifications, so it remains a subset of ASD.
Childhood disintegrative disorder is so named because those afflicted develop normally for the first several years of their life. However, around age three or four, they suddenly lose their acquired skills – essentially, their development ‘disintegrates.’ While the speed with which this disintegration can occur varies, it often occurs quickly (and for many parents, horrifyingly). Dr. Heller codified the disorder after treating six children, originally calling the extreme developmental regression he noted ‘dementia infantilis’ to describe the loss of basic skills that was observed.
In 1994, CDD (which is what dementia infantilis has come to be known as) was officially recognized and added to the DSM-IV. It is categorized as a part of the current autism spectrum because it shares such a similar profile of debilitating developmental effects. In an unofficial capacity, physicians and psychiatrists both have recognized the symptom profile for some time. Over the last several decades, it was called both disintegrative psychosis of childhood (DPC) or childhood-onset pervasive developmental disorder (COPDD). Before the clarification of CDD in the DSM-IV diagnosticians and care providers simply labeled it as late childhood onset autism.
Signs and Symptoms
Because children with this disorder tend to develop at a normal rate for the first three to four years of life, physicians (and parents) must know the signs of its onset. The first indication many doctors have is when a parent brings their child to them for observation, specifically related to new onset of behavior or communication issues. In about 75% of CDD cases, the loss of skills or regressive behaviors is preceded by intense anxiety and/or terror in the child. This may present as nightmares or waking nightmares, or confusion/patterns of jumpy disturbance. This type of preceding behavior or occurrences are known as a prodrome (this is not required for CDD diagnosis).
True diagnostic criteria for CDD require that a child exhibit abnormal or regressive behavior in at least two major areas (with normal development for at least the first two years after birth), such as:
– Ability to maintain or initiate conversations with others (receptive and expressive language skills)
– Ability to develop peer relations and demonstrate social and emotional reciprocity
– Natural motor skills and behaviors consistent with healthy physical/spatial awareness
– Bowel or bladder control (if already present)
– Restricted, repetitive or stereotyped behaviors (like head bobbing or hand flapping) unrelated to other conditions
How might this look to a parent or care provider? Children with CDD will often be incapable of extended dialogue with others and may exhibit a marked reticence to initiate communication, even in comfortable surroundings. They may also exhibit regression in social skills already acquired, no longer able to make or keep friends or respond in appropriate ways to the emotional needs of those friends. They may also respond inappropriately (or not respond) in social situations, lacking the ability to do things like say hello or goodbye or answer questions directed at them. Lastly, a parent may notice the onset of new repetitive movements or urinary or stooling accidents when there were none.
Related Resource: Top 20 Best Applied Behavior Analysis Programs
Therapy for Childhood Disintegrative Disorder
Treatment for CDD is going to be similar to treatment for autism. Like ASD treatments, the emphasis is usually on early intervention, largely behavioral-based, and based on the child’s specific needs. Possible therapies for CDD include speech and language therapy, occupational therapy, sensory integration therapy and social skills development. Much like ASD, there are no pharmacological therapies specific for CDD, but depending on a child’s symptoms, some antipsychotics or selective serotonin reuptake inhibitors (SSRIs) may help treat some of the behavioral symptoms.
Parent involvement and education can prove integral to any form of treatment success. Though therapies with licensed care providers are necessary, the child will spend much more time with their primary caregivers. To best enhance what is being taught and learned in therapy, a child must also be encouraged and instructed in the home.
The medical community continues to work to broaden its understanding of autistic disorders to render appropriate and helpful therapies and aids to those who suffer from them. Greater understanding of the physiological underpinnings and genetic components of such developmental disorders continue to help establish effective treatments or preventative therapy(ies). While CDD is a recognizably different type of autism spectrum disorder, it continues to impact the lives of children, parents, and caregivers in similar ways and continues to be treated comparably.
ABA Programs Guide
Updated May 2020
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