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What is Childhood Disintegrative Disorder?
Childhood disintegrative disorder (CDD) is one of the pervasive developmental disorders marked by developmental impairments in communication and social skills. The seemingly normal two years of development include age-appropriate communication, social relatedness, play and adaptive behaviors (Corcoran & Walsh, 2006).
The beginning of regression occurring after at least two years of “normal” development is a distinguishing factor of CDD. Children with this disorder begin to lose the skills that they have worked to develop during the first two years of life.
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Childhood Disintegrative Disorder Symptoms
Childhood disintegrative disorder symptoms manifest as a significant loss of formerly acquired skills before the age of ten in at least two of the following areas: expressive or receptive language, social skills or adaptive behavior, bowel or bladder control, and play or motor skills (APA, 2000). The loss of two of the aforementioned skills must be in combination with abnormalities in functioning in two additional areas. The DSM-IV-TR identifies the three areas of functioning, in which two must be impaired, as 1) qualitative impairment in social interaction, 2) qualitative impairments in communication or 3) restricted, repetitive and stereotyped patterns of behavior, interests, and activities.
Qualitative impairment in social interaction may be the lack of developed relationships or social skills. The child may no longer be able to relate to other people and may show no interest in doing so. Qualitative impairments in communication may feature repetitious verbal and nonverbal communication that possibly interferes with the ability to converse. The repetition may carry over into their play behaviors and limit the activity or subject areas in which the child is able to interact. For example, a child may not be able to participate in sports or extracurricular activities due to the interference of repeated motions or verbalizations. This realm of impaired functioning also includes delayed or nonexistent verbalization. The third and final area of impaired functioning can be observed as habitual mannerisms. Interests and activities may appear to be obsessive and limited.
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Development and Course of Symptoms
Corcoran and Walsh (2006) stated that the onset of childhood disintegrative disorder symptoms typically occurs between the ages of three and four and can be gradual or abrupt. The gradual progression can span some weeks or months, while abrupt may be weeks or even days. The DSM-IV-TR diagnostic features state that acquired skills are lost in almost all areas for most children (APA, 2000). Once the loss of skills occurs, the prognosis is bleak. In seventy-five percent of childhood disintegrative disorder cases, the observed deterioration of behavior and development plateau, after which gains are minimal (Corcoran & Walsh, 2006). It is important to rule out other pervasive development disorders when reviewing the symptoms possibly associated with CDD.
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American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, 4th edition, (DSM-IV-TR). Washington, DC: American Psychiatric Association.
Corcoran, J. & Walsh, J. (2006). Clinical assessment and diagnosis in social work practice. New York: Oxford University Press.