Childhood disintegrative disorder and autism spectrum disorder

a systematic review

Chirag Mehra, Annesha Sil, Tammy Hedderly, Marinos Kyriakopoulos, Ming Lim, Jessica Turnbull, Francesca Happe, Gillian Baird, Michael Absoud (Corresponding Author)

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Aim
In an attempt to clarify the debate surrounding the diagnostic validity of childhood disintegrative disorder (CDD), we systematically reviewed its characteristics and compared it with autism spectrum disorder (ASD).

Method
Four databases were searched (PubMed, PsycINFO, Embase, and Web of Science). Included articles had participants with CDD, as defined by symptoms present in the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and the International Classification of Diseases, 10th Revision. Comparison groups were those with ASD and ASD with regression. Case studies were excluded.

Results
Twenty articles, comprising 96 participants with CDD (80 males, 16 females), were included. Most studies were cross‐sectional. The prevalence of CDD was 1.1 to 9.2 per 100 000, with a mean age at regression of 3 years 2 months (SD 1y 1mo), with a range of 2 years to 7 years. In addition to core CDD symptoms, most had intellectual impairment, anxiety, challenging behaviours, and regressed in toileting skills. Participants with CDD and ASD shared core diagnostic and extra‐diagnostic features. However, participants with CDD seemed to have more severe symptoms and a different symptom profile, including apparently typical development before regression, faster regression, more affective symptoms, and more global developmental deficit. Possible genetic and autoimmune neurobiological mechanisms were identified.

Interpretation
There is limited high‐quality evidence describing the aetiology and outcomes of CDD. However, given the qualitative and prognostic differences between ASD and CDD, we recommend that future diagnostic criteria should distinguish late‐onset regression.
Original languageEnglish
Pages (from-to)523-534
Number of pages12
JournalDevelopmental Medicine and Child Neurology
Volume61
Issue number5
Early online date13 Dec 2018
DOIs
Publication statusPublished - May 2019

Fingerprint

Affective Symptoms
International Classification of Diseases
PubMed
Diagnostic and Statistical Manual of Mental Disorders
Anxiety
Autism Spectrum Disorder
Databases

Keywords

  • Autism Spectrum Disorder/diagnosis
  • Child
  • Child, Preschool
  • Humans
  • Intellectual Disability/complications
  • Language Disorders/complications
  • Social Behavior Disorders/complications
  • REGRESSION
  • DSM-IV
  • DEMENTIA
  • NEUROTROPHIC FACTOR
  • INFANTILE-AUTISM
  • PERVASIVE DEVELOPMENTAL DISORDERS
  • CHILDREN
  • DE-NOVO MUTATIONS
  • PSYCHOSIS
  • EPIDEMIOLOGY

ASJC Scopus subject areas

  • Clinical Neurology
  • Developmental Neuroscience
  • Pediatrics, Perinatology, and Child Health

Cite this

Childhood disintegrative disorder and autism spectrum disorder : a systematic review. / Mehra, Chirag; Sil, Annesha; Hedderly, Tammy; Kyriakopoulos, Marinos; Lim, Ming; Turnbull, Jessica; Happe, Francesca ; Baird, Gillian; Absoud, Michael (Corresponding Author).

In: Developmental Medicine and Child Neurology, Vol. 61, No. 5, 05.2019, p. 523-534.

Research output: Contribution to journalArticle

Mehra, C, Sil, A, Hedderly, T, Kyriakopoulos, M, Lim, M, Turnbull, J, Happe, F, Baird, G & Absoud, M 2019, 'Childhood disintegrative disorder and autism spectrum disorder: a systematic review', Developmental Medicine and Child Neurology, vol. 61, no. 5, pp. 523-534. https://doi.org/10.1111/dmcn.14126
Mehra, Chirag ; Sil, Annesha ; Hedderly, Tammy ; Kyriakopoulos, Marinos ; Lim, Ming ; Turnbull, Jessica ; Happe, Francesca ; Baird, Gillian ; Absoud, Michael. / Childhood disintegrative disorder and autism spectrum disorder : a systematic review. In: Developmental Medicine and Child Neurology. 2019 ; Vol. 61, No. 5. pp. 523-534.
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abstract = "AimIn an attempt to clarify the debate surrounding the diagnostic validity of childhood disintegrative disorder (CDD), we systematically reviewed its characteristics and compared it with autism spectrum disorder (ASD).MethodFour databases were searched (PubMed, PsycINFO, Embase, and Web of Science). Included articles had participants with CDD, as defined by symptoms present in the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and the International Classification of Diseases, 10th Revision. Comparison groups were those with ASD and ASD with regression. Case studies were excluded.ResultsTwenty articles, comprising 96 participants with CDD (80 males, 16 females), were included. Most studies were cross‐sectional. The prevalence of CDD was 1.1 to 9.2 per 100 000, with a mean age at regression of 3 years 2 months (SD 1y 1mo), with a range of 2 years to 7 years. In addition to core CDD symptoms, most had intellectual impairment, anxiety, challenging behaviours, and regressed in toileting skills. Participants with CDD and ASD shared core diagnostic and extra‐diagnostic features. However, participants with CDD seemed to have more severe symptoms and a different symptom profile, including apparently typical development before regression, faster regression, more affective symptoms, and more global developmental deficit. Possible genetic and autoimmune neurobiological mechanisms were identified.InterpretationThere is limited high‐quality evidence describing the aetiology and outcomes of CDD. However, given the qualitative and prognostic differences between ASD and CDD, we recommend that future diagnostic criteria should distinguish late‐onset regression.",
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N2 - AimIn an attempt to clarify the debate surrounding the diagnostic validity of childhood disintegrative disorder (CDD), we systematically reviewed its characteristics and compared it with autism spectrum disorder (ASD).MethodFour databases were searched (PubMed, PsycINFO, Embase, and Web of Science). Included articles had participants with CDD, as defined by symptoms present in the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and the International Classification of Diseases, 10th Revision. Comparison groups were those with ASD and ASD with regression. Case studies were excluded.ResultsTwenty articles, comprising 96 participants with CDD (80 males, 16 females), were included. Most studies were cross‐sectional. The prevalence of CDD was 1.1 to 9.2 per 100 000, with a mean age at regression of 3 years 2 months (SD 1y 1mo), with a range of 2 years to 7 years. In addition to core CDD symptoms, most had intellectual impairment, anxiety, challenging behaviours, and regressed in toileting skills. Participants with CDD and ASD shared core diagnostic and extra‐diagnostic features. However, participants with CDD seemed to have more severe symptoms and a different symptom profile, including apparently typical development before regression, faster regression, more affective symptoms, and more global developmental deficit. Possible genetic and autoimmune neurobiological mechanisms were identified.InterpretationThere is limited high‐quality evidence describing the aetiology and outcomes of CDD. However, given the qualitative and prognostic differences between ASD and CDD, we recommend that future diagnostic criteria should distinguish late‐onset regression.

AB - AimIn an attempt to clarify the debate surrounding the diagnostic validity of childhood disintegrative disorder (CDD), we systematically reviewed its characteristics and compared it with autism spectrum disorder (ASD).MethodFour databases were searched (PubMed, PsycINFO, Embase, and Web of Science). Included articles had participants with CDD, as defined by symptoms present in the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and the International Classification of Diseases, 10th Revision. Comparison groups were those with ASD and ASD with regression. Case studies were excluded.ResultsTwenty articles, comprising 96 participants with CDD (80 males, 16 females), were included. Most studies were cross‐sectional. The prevalence of CDD was 1.1 to 9.2 per 100 000, with a mean age at regression of 3 years 2 months (SD 1y 1mo), with a range of 2 years to 7 years. In addition to core CDD symptoms, most had intellectual impairment, anxiety, challenging behaviours, and regressed in toileting skills. Participants with CDD and ASD shared core diagnostic and extra‐diagnostic features. However, participants with CDD seemed to have more severe symptoms and a different symptom profile, including apparently typical development before regression, faster regression, more affective symptoms, and more global developmental deficit. Possible genetic and autoimmune neurobiological mechanisms were identified.InterpretationThere is limited high‐quality evidence describing the aetiology and outcomes of CDD. However, given the qualitative and prognostic differences between ASD and CDD, we recommend that future diagnostic criteria should distinguish late‐onset regression.

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KW - PERVASIVE DEVELOPMENTAL DISORDERS

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KW - DE-NOVO MUTATIONS

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