Childhood Disintegrative Disorder: causes, symptoms and diagnosis

Childhood Disintegrative Disorder (TDI) is the psychiatric category which was used until recently to speak of one of the forms that Autism Spectrum Disorder (ASD) takes in its early stages of development.

This category has undergone important modifications since the last update of the manuals used in psychiatry and psychology as a clinical guide. However, being recent changes, they are categories that continue to be used in some contexts, and even in combination, so it is worth reviewing them.

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What is Childhood Disintegrative Disorder (TDI)?

Before beginning to describe Childhood Disintegrative Disorder and due to the transformations who have had their diagnostic criteria, it is important to clarify how their own work diagnostics.

The Diagnostic and Statistical Manuals of Mental Disorders (DSM), are compendia published by the American Association of Psychiatry (APA, also for its acronym in English), where a set of clinical manifestations known as disorders is described and grouped mental.

These manuals have existed since the second half of the previous century in five different versions, and although initially their approach was merely descriptive and informative, currently are among the clinical guidelines most used by mental health professionals.

Mentioning this is important to understand what Childhood Disintegrative Disorder was, what criteria continue, and what is its name today.

• You may be interested: "The 6 stages of childhood (physical and mental development)"

TDI: a Pervasive Developmental Disorder

Childhood Disintegrative Disorder is a psychiatric classification proposed by the DSM-IV (the DSM in its fourth version) and which is part of the Generalized Developmental Disorders (PDD); which, in turn, are part of the category of Childhood Onset Disorders, Childhood or Adolescence.

According to DSM-IV, the general characteristic of PDDs is the presence of a severe and widespread disturbance of various areas of early development, which, being serious, is considered inappropriate for the level of development and mental age of the child.

It manifests itself in the following areas: skills for social interaction and communication; as well as by the presence of stereotyped interests and behaviors (stereotypies is the technical name). In the category of PDDs, there were also Autistic Disorder, Rett Disorder, Disorder Asperger's, Pervasive Developmental Disorder, Unspecified, and Disintegrative Disorder Childish.

Main characteristic of Childhood Disintegrative Disorder

The main characteristic of TDI is a marked regression of multiple areas of activity after a period of at least 2 years of development that appears to correspond to the child's age or little girl.

That is, TDI manifests itself when the child is at least two years old, has acquired skills expected for his age and, unexpectedly, a regression occurs in at least two of the following areas: verbal and non-verbal communication (expressive or receptive language), social relationships and adaptive behavior, play, toilet training, skills motorcycles.

It was also known as Heller Syndrome, Dementia Infantilis or Disintegrative Psychosis.

From TDI to TEA

As of May 2013, when the latest version of the statistical manuals of mental disorders (the DSM-V) was published, Disorders of Onset in Infancy, Childhood or Adolescence, ceased to be called that, to become Disorders of the Neurodevelopment.

Childhood Disintegrative Disorder (along with other childhood disorders that fall into the subclassification of PDDs), became part of a single spectrum: the Autism Spectrum Disorder.

DSM-IV Childhood, Childhood, or Adolescent Onset Disorders included Mental Retardation, Pervasive Developmental Disorders, Attention Deficit and Disruptive Behavior Disorders, Motor Skill Disorders, Tic Disorders, Learning, Communication Disorders, Childhood Eating and Eating Disorders, Elimination Disorders, and Other Disorders.

In DSM 5, Neurodevelopmental Disorders are a group of conditions that appear in the early stages of development especially characterized by ** difficulties in establishing interpersonal, socio-adaptive and academic. **

Thus, the subcategories of the DSM-IV that we explained above, become the following: Intellectual Disability, Disorder of the Autism Spectrum, Attention Deficit Hyperactivity Disorders, Motor Disorders, Specific Learning Disorder, Communication Disorders, Eating Disorders, Excretion Disorders and Neurodevelopmental Disorders No Specified.

What are the current diagnostic criteria?

TDI is currently considered to be one of many forms that the early stages of ASD development take; question that today it is becoming easier to diagnose and monitor from the earliest stages.

As such, it is not a disease, so it does not have a cure or treatment, but rather the intervention is about stimulating the adaptive skills within the child's own capabilities and limits, while identifying and meeting the child's needs support for.

ASD is defined in the DSM by the mild, moderate or severe levels, and through two basic criteria: 1. the existence of a persistent difference in communication (verbal and non-verbal) and in interaction with difficulties to establish interpersonal relationships and to adapt in various contexts; and 2. by the presence of restrictive and repetitive patterns of behavior, for example stereotypes, monotony or very restricted rituals.

The causes and mechanisms that generate it are unspecific, although there are suspicions about a central nervous system injury and its relationship to medical diseases or genetic conditions. It usually begins with significant increases in activity levels accompanied by periods of irritability and anxiety, followed by loss of speech.

Bibliographic references:

• Martínez, B. & Rico, D. (2014). Neurodevelopmental Disorders in DSM-5. Workshop at the AVAP Conference, of the University of Valencia. Retrieved April 27, 2018. Available in http://www.avap-cv.com/images/actividades/2014_jornadas/DSM-5_Final_2.pdf
• APA (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). American Psychiatric Publishing: Washington, DC; London.
• APA (1995). Diagnostic and Statistical Manual of Mental Disorders Fourth Version (DSM-IV). Masson: Barcelona
• Volkmar, F. & Cohen, D. (1989). Disintegrative Disorder or "Late Onset" Autism. The Journal of Child Psychology and Psychiatry. 30(5): 717-724.