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Childhood Disintegrative Disorder (CDD)

Childhood Disintegrative Disorder is one of a number of childhood disorders categorized as Pervasive Develop-mental Disorders or Autism Spectrum Disorders. It is the rarest of the disorders in the ASD category and it is characterized by the loss of previously acquired language and social skills. A child may demonstrate the ability to speak in two or three word phrases and then gradually or abruptly lose his/her ability to communicate or uses only fragments of words. Social and emotional development will also regress, with impaired ability to relate to others. Where a child might have previously accepted reassurance from a parent in the form of a hug or a pat on the back, she/he will lose the ability to be comforted, and even may withdraw from touch and contact.

It is important to distinguish this regression from that commonly seen from time to time in normal childhood development. Most children experience physical and mental development in spurts, and it is common for them to take an occasional step backward. For example, a child who is toilet trained may suddenly have an ‘accident’. However, children with Childhood Disintegrative Disorder will appear to develop normally for two years, and then exhibit persistent regression to a much lower functional level.

Overall, the social, communication, and behavioral symptoms of CDD can resemble those of Autism, with impairments in social interaction and communication, restricted, repetitive, or stereotypical patterns of behavior, or interests, and loss of previously acquired skills like toilet training, drawing or riding a tricycle. Coordination and gait can be awkward, and the child may become aggressive, and withdraw from peers. Childhood Disintegrative Disorder occurs only after at least two years of normal development, but before the age of ten.

The average age of onset is between ages three and four. The onset can be gradual or abrupt. Childhood Disintegrative Disorder is the rarest of the Pervasive Developmental Disorders, and no single cause has been identified. Research indicates that the cause may be from a combination of genetic predisposition and prenatal environmental stress. Genetic factors may include a family history of autism or Asperger Disorder. Environmental factors can include birth trauma, premature birth, viral exposure, toxoplasmosis, rubella, cytomegalovirus infection, and other viral infections. Like patients with Autism, children who suffer from PDD are at increased risk for seizures.

What are the symptoms?

• Normal development for at least 2 yrs after birth (age appropriate play, verbal, non-verbal, and motor skills)
• Loss of bowel or bladder control
• Loss of motor skills
• Is not comforted by physical contact from parent or care-giver
• Inability to sustain conversation, repetitive language
• Loss of expressive or receptive language
• Loss of previously acquired skills (typically between age 3-4) before age 10
• Loss of social skills or adaptive behavior
• Strange or eccentric play behavior
• Impaired non-verbal skills and emotional reciprocity
• Restricted or repetitive behaviors, mannerisms and interests
• Is not interactive with peers

How is it diagnosed and treated?

CDD may be discovered in well child check-ups. However, because this disorder involves loss of previously acquired skills, it is usual for the parent to bring the symptoms to the attention of the health care provider. Childhood Disintegrative Disorder was recognized and documented prior to Autism. The symptoms were documented in 1908, but there were documented cases before that time. CDD can be difficult to diagnose because it can appear similar to other disorders like Mental Retardation, Head Trauma, Dementia, Schizophrenia, Selective Mutism, Expressive Language Disorder, or one of its sister syndromes: Autism, Rett’s Syndrome, or Asperger Syndrome. Doctors will perform a thorough medical and mental evaluation to rule out other illnesses or disorders. Diagnostic criteria include:

• Clinically significant loss of previously acquired skills, prior to age 10
• Change or absence in play and behaviors alone or with peers
• Poor motor skills, restricted mannerisms and interests
• Unable to control bladder or bowels
• Regression in speech and non-verbal skills
• Lack of emotional reciprocity, inability to sustain conversation

In some cases, Childhood Disintegrative Disorder can be associated with Mental Retardation, metachromatic leukodystrophy, and Schilder's disease. The risk of seizures in CDD patients increases with age and peaks at adolescence.

Much of the treatment protocol for CDD is the same as that prescribed for Autism, because of the similarity in the two disorders. Unfortunately, the prognosis for this disorder is limited. Loss of function is usually permanent, but, in some cases, behaviors can be modified with appropriate treatment.

Treatment(s) can include:

• Speech Therapy
• Medications as appropriate for behavioral, mood issues, anti-seizure medication if appropriate (SSRIs and neuroleptics may be effective, but with some risk of significant side effects)
• Applied Behavioral Analysis
• Special Education Programs
• Nutritional Counseling (isolated improvements have been noted with Feingold diet, low-yeast diet, high-vitamin regimens, etc.)
• Psychiatric evaluation and treatment as appropriate

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