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

This category has undergone significant changes since the last update of the manuals used in psychiatry and psychology as clinical guidelines. However, as these are recent changes, they are categories that are still used in some contexts, and even in combination, so it is worth reviewing them.

What is Childhood Disintegrative Disorder (CDD)?

Before starting to describe Childhood Disintegrative Disorder and due to the transformations that its diagnostic criteria have had, it is important to clarify how the diagnoses themselves work.

The Diagnostic and Statistical Manuals of Mental Disorders (DSM) are compendia published by the American Psychiatric Association (APA), which describe and group together a set of clinical manifestations known as mental disorders.

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

Mentioning this is important for understanding what Childhood Disintegrative Disorder was, what criteria it continues to meet, and what it is currently called.

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 forms part of the Pervasive Developmental Disorders (PDD); which, in turn, form part of the category of Disorders of initiation in infancy, childhood or adolescence .

According to the DSM-IV, the general characteristic of GDT is the presence of a severe and widespread disturbance of several areas of early development , which, being severe, is considered inappropriate for the child’s developmental level and mental age.

It manifests itself in the following areas: social interaction and communication skills; as well as the presence of stereotyped interests and behaviors (stereotypes is the technical name).
In the category of GDD, there were also Autistic Disorder, Rett Disorder, Asperger’s Disorder, Pervasive Developmental Disorder Not Otherwise Specified and Childhood Disintegrative Disorder.

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 apparently corresponded to the child’s age.

That is, TDI manifests itself when the child is at least two years old, has acquired skills expected for his or her age and, unexpectedly, 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, sphincter control, motor skills.

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

From TDI to TEA

As of May 2013, when the last version of the statistical manuals of mental disorders (the DSM-V) was published, Childhood and Adolescent Onset Disorders were no longer called that way, but became Neurodevelopmental Disorders.

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

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

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

Thus, the subcategories of DSM-IV explained above become the following: Intellectual Disability, Autism Spectrum Disorder, Attention Deficit Hyperactivity Disorder, Motor Disorders, Specific Learning Disorder, Communication Disorders, Eating Disorders, Excretion Disorders and Unspecified Neurodevelopmental Disorders.

What are the current diagnostic criteria?

TDI is now considered to be one of the many forms that the early stages of ASD development take; a matter that today is increasingly easy to diagnose and accompany from the early stages.

As such, it is not a disease, so there is no cure or treatment. Rather, the intervention is about stimulating adaptive skills within the child’s own capacities and limits, while identifying and meeting support needs.

ASD is defined in the DSM by mild, moderate or severe levels, and through two basic criteria: 1. the existence of a persistent difference in communication (verbal and non-verbal) and social interaction with difficulties in establishing interpersonal relationships and in adapting 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 an injury to the central nervous system and its relationship with medical diseases or genetic conditions. It generally 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, University of Valencia. Retrieved April 27, 2018. Available at http://www.avap-cv.com/images/actividades/2014_jornadas/DSM-5_Final_2.pdf
  • PLA (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.