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Childhood disintegrative disorder

April 18, 2024

Childhood disintegrative disorder (CDD), also known as Heller's syndrome and disintegrative psychosis, is a rare condition characterized by late onset of developmental delays—or severe and sudden reversals—in language (receptive and expressive), social engagement, bowel and bladder, play and motor skills.[3][4] Researchers have not been successful in finding a cause for the disorder.[3][4] CDD has some similarities to autism and is sometimes considered a low-functioning form of it.[5][6][4] In May 2013, CDD, along with other sub-types of PDD (Asperger's syndrome, Classic autism, and PDD-NOS), was fused into a single diagnostic term called "autism spectrum disorder" under the new DSM-5 manual.[7]

Childhood disintegrative disorder
Other namesHeller syndrome,
disintegrative psychosis,
dementia infantilis
SpecialtyPsychiatry, pediatrics
Usual onset3-4 years of age
Differential diagnosisregressive autism, Rett syndrome, lead poisoning, mercury poisoning, HIV infection, brain tumor, certain seizure disorders (e.g. Landau-Kleffner syndrome), and some neurodegenerative diseases (e.g.variant Creutzfeldt-Jakob disease)[1][2]

CDD was originally described by Austrian educator Theodor Heller (1869–1938) in 1908, 35 years before Leo Kanner and Hans Asperger described autism. Heller had previously used the name dementia infantilis for the syndrome.[8]

An apparent period of fairly normal development is often noted before a regression in skills or a series of regressions in skills.[9][4] The age at which this regression can occur varies;[10] after three years of normal development is typical.[11] The regression, known as a 'prodrome,' can be so dramatic that the child may be aware of it, and may in its beginning even ask, vocally, what is happening to them.[4][12] Some children describe or appear to be reacting to hallucinations, but the most obvious symptom is that skills apparently attained are lost.[4]

Many children are already somewhat delayed when the disorder becomes apparent, but these delays are not always obvious in young children.[4] This has been described by many writers as a devastating condition, affecting both the family and the individual's future.[4] As is the case with all pervasive developmental disorder categories, there is considerable controversy about the right treatment for CDD.[4]

Signs and symptoms edit

CDD is a rare condition, with only 1.7 cases per 100,000.[13][14][15]

A child affected with childhood disintegrative disorder shows normal development. Up until this point, the child has developed normally in the areas of language skills, social skills, comprehension skills, and has maintained those skills for about two years.[16][17] However, between the ages of two and 10, skills acquired are lost almost completely in at least two of the following six functional areas:[18]

Lack of normal function or impairment also occurs in at least two of the following three areas:[19]

In her book Thinking in Pictures, Temple Grandin argues that compared to "Kanner's classic autism" and to Asperger syndrome, CDD is characterized with more severe sensory processing disorder but less severe cognitive problems.[20] She also argues that compared to most autistic individuals, persons with CDD have more severe speech pathology and they usually do not respond well to stimulants.[20]

Causes edit

All of the causes of childhood disintegrative disorder are still unknown.[3][4] Sometimes CDD surfaces abruptly within days or weeks, while in other cases it develops over a longer period of time. A Mayo Clinic report indicates: "Comprehensive medical and neurological examinations in children diagnosed with childhood disintegrative disorder seldom uncover an underlying medical or neurological cause. Although the occurrence of epilepsy is higher in children with childhood disintegrative disorder, experts don't know whether epilepsy plays a role in causing the disorder."[21]

CDD, especially in cases of later age of onset, has also been associated with certain other conditions, particularly the following:[11]

  • Lipid storage diseases: In this condition, a toxic buildup of excess fats (lipids) takes place in the brain and nervous system.
  • Subacute sclerosing panencephalitis: Chronic infection of the brain by a form of the measles virus causes subacute sclerosing panencephalitis. This condition leads to brain inflammation and the death of nerve cells.
  • Tuberous sclerosis (TSC): TSC is a genetic disorder. In this disorder, tumors may grow in the brain and other vital organs like kidneys, heart, eyes, lungs, and skin. In this condition, noncancerous (benign) tumors, hamartomas, grow in the brain.
  • Leukodystrophy: In this condition, the myelin sheath does not develop in a normal way, causing white matter in the brain to eventually fail and disintegrate.

Treatment edit

Loss of language and skills related to social interaction and self-care are serious. The affected children face ongoing disabilities in certain areas and require long-term care. Treatment of CDD involves both behavior therapy, environmental therapy and medications.[22]

  • Behavior therapy: Applied behavior analysis (ABA) is considered to be the most effective form of treatment for autism spectrum disorders by the American Academy of Pediatrics.[23] The primary goal of ABA is to improve quality of life, and independence by teaching adaptive behaviors to children with autism,[24] and to diminish problematic behaviors like running away from home, or self-injury[25] by using positive or negative reinforcement to encourage or discourage behaviors over time.[26]
  • Environmental therapy: Sensory enrichment therapy uses enrichment of the sensory experience to improve symptoms in autism, many of which are common to CDD.
  • Medications: There are no medications available to directly treat CDD. Antipsychotic medications are used to treat severe behavior problems like aggressive stance and repetitive behavior patterns. Anticonvulsant medications are used to control seizures.

References edit

  1. ^ Dr.Mary Lowthe (25 January 2021). "Childhood Disintegrative Disorder".
  2. ^ Hiroshi Kurita (2011). Textbook of Autism Spectrum Disorders. American Psychiatric Pub. p. 102. ISBN 9781585623419.
  3. ^ a b c Charan, Sri Hari (January–April 2012). "Childhood disintegrative disorder". Journal of Pediatric Neurosciences. 7 (1): 55–57. doi:10.4103/1817-1745.97627. PMC 3401658. PMID 22837782. Childhood disintegrative disorder (CDD), also known as Heller's syndrome and disintegrative psychosis, is a rare condition characterized by late onset (>3 years of age) of developmental delays in language, social function, and motor skills. [...] The cause of childhood disintegrative disorder is unknown.
  4. ^ a b c d e f g h i j "Definitions for childhood disintegrative disorder". Definitions.net. STANDS4. from the original on 25 September 2022. Retrieved 25 September 2022. Childhood disintegrative disorder, also known as Heller's syndrome and disintegrative psychosis, is a rare condition characterized by late onset of developmental delays in language, social function, and motor skills. Researchers have not been successful in finding a cause for the disorder. CDD has some similarity to autism, and is sometimes considered a low-functioning form of it, but an apparent period of fairly normal development is often noted before a regression in skills or a series of regressions in skills. Many children are already somewhat delayed when the disorder becomes apparent, but these delays are not always obvious in young children. [...] The regression can be so dramatic, that the child may be aware of it, and in its beginning he may even ask, vocally, what is happening to him. Some children describe or appear to be reacting to hallucinations, but the most obvious symptom is that skills apparently attained are lost. This has been described by many writers as a devastating condition, affecting both the family and the individual's future. As is the case with all pervasive developmental disorder categories, there is considerable controversy about the right treatment for CDD.
  5. ^ McPartland J, Volkmar FR (2012). "Autism and related disorders". Neurobiology of Psychiatric Disorders. Handbook of Clinical Neurology. Vol. 106. pp. 407–18. doi:10.1016/B978-0-444-52002-9.00023-1. ISBN 9780444520029. PMC 3848246. PMID 22608634. {{cite book}}: |journal= ignored (help)
  6. ^ Venkat A, Jauch E, Russell WS, Crist CR, Farrell R (August 2012). "Care of the patient with an autism by the general physician". Postgrad Med J. 88 (1042): 472–81. doi:10.1136/postgradmedj-2011-130727. PMID 22427366. S2CID 12331005.
  7. ^ "Childhood Disintegrative Disorder (Heller's Syndrome)". 25 January 2021.
  8. ^ Mouridsen SE (June 2003). "Childhood disintegrative disorder". Brain Dev. 25 (4): 225–8. doi:10.1016/s0387-7604(02)00228-0. PMID 12767450. S2CID 25420772.
  9. ^ Rogers SJ (2004). "Developmental regression in autism spectrum disorders". Ment Retard Dev Disabil Res Rev. 10 (2): 139–43. doi:10.1002/mrdd.20027. PMID 15362172.
  10. ^ Hendry CN (January 2000). "Childhood disintegrative disorder: should it be considered a distinct diagnosis?". Clin Psychol Rev. 20 (1): 77–90. doi:10.1016/S0272-7358(98)00094-4. PMID 10660829.
  11. ^ a b Malhotra S, Gupta N (December 1999). "Childhood disintegrative disorder". J Autism Dev Disord. 29 (6): 491–8. doi:10.1023/A:1022247903401. PMID 10638461. S2CID 189899310.
  12. ^ Dobbs, David (6 July 2016). "The most terrifying childhood condition you've never heard of". Spectrum. Simons Foundation Autism Research Initiative. from the original on 25 September 2022. Retrieved 25 September 2022. During this anxiety-ridden prologue, known as a 'prodrome,' a child will often seem keenly aware that something is wrong.
  13. ^ Fombone E (June 2002). "Prevalence of childhood disintegrative disorder". Autism. 6 (2): 149–57. doi:10.1177/1362361302006002002. PMID 12083281. S2CID 145771483.
  14. ^ Fombonne E (June 2009). "Epidemiology of pervasive developmental disorders". Pediatr. Res. 65 (6): 591–8. doi:10.1203/PDR.0b013e31819e7203. PMID 19218885.
  15. ^ Fombonne, Eric (2002). "Prevalence of Childhood Disintegrative Disorder". Autism. 6 (2): 149–157. doi:10.1177/1362361302006002002. PMID 12083281. S2CID 145771483.
  16. ^ Charan, Sri Hari (2012). "Childhood disintegrative disorder". Journal of Pediatric Neurosciences. 7 (1): 55–57. doi:10.4103/1817-1745.97627. ISSN 1817-1745. PMC 3401658. PMID 22837782.
  17. ^ Malhotra, Savita; Gupta, Nitin (1999-12-01). "Childhood Disintegrative Disorder". Journal of Autism and Developmental Disorders. 29 (6): 491–498. doi:10.1023/A:1022247903401. ISSN 1573-3432. PMID 10638461. S2CID 189899310.
  18. ^ "A Guide to Childhood Disintegrative Disorder". Elemy. from the original on 25 September 2022. Retrieved 25 September 2022.
  19. ^ Braaten, Ellen, ed. (29 January 2018). The SAGE Encyclopedia of Intellectual and Developmental Disorders. Vol. 2. SAGE Publications. ISBN 9781506353296. Lack of normal function or impairment also occurs in at least two of the following three areas: Social interaction, Communication, and Repetitive behavior and interest patterns.
  20. ^ a b Grandin, Temple (7 September 2008). Thinking in Pictures. Bloomsbury Publishing. ISBN 9781408807309. Retrieved 25 September 2022.
  21. ^ Childhood Disintegrative Disorder - Causes September 29, 2007, at the Wayback Machine
  22. ^ Mughal, Saba; Faizy, Rubina M.; Saadabadi, Abdolreza (January 2022). Autism Spectrum Disorder. Treasure Island, Florida: StatPearls Publishing. PMID 30247851. from the original on 25 September 2022 – via National Center for Biotechnology Information Bookshelf. Treatment of childhood disintegrative disorder requires behavior therapy, environmental therapy, and medications.
  23. ^ Myers, Scott M.; Johnson, Chris Plauché (1 November 2007). "Management of Children With Autism Spectrum Disorders". Pediatrics. 120 (5): 1162–1182. doi:10.1542/peds.2007-2362. ISSN 0031-4005. PMID 17967921.
  24. ^ Matson, Johnny; Hattier, Megan; Belva, Brian (January–March 2012). "Treating adaptive living skills of persons with autism using applied behavior analysis: A review". Research in Autism Spectrum Disorders. 6 (1): 271–276. doi:10.1016/j.rasd.2011.05.008.
  25. ^ Summers, Jane; Sharami, Ali; Cali, Stefanie; D'Mello, Chantelle; Kako, Milena; Palikucin-Reljin, Andjelka; Savage, Melissa; Shaw, Olivia; Lunsky, Yona (November 2017). "Self-Injury in Autism Spectrum Disorder and Intellectual Disability: Exploring the Role of Reactivity to Pain and Sensory Input". Brain Sci. 7 (11): 140. doi:10.3390/brainsci7110140. PMC 5704147. PMID 29072583.
  26. ^ "Applied Behavioral Strategies - Getting to Know ABA". from the original on 2015-10-07. Retrieved 2015-12-16.

Further reading edit

  • Maurice, Catherine (1993). Let me hear your voice: a family's triumph over autism. New York: Knopf. ISBN 978-0-679-40863-5. OCLC 26633221.
  • Westphal A, Schelinski S, Volkmar F, Pelphrey K (February 2013). "Revisiting regression in autism: Heller's dementia infantilis. Includes a translation of Über Dementia Infantilis". J Autism Dev Disord. 43 (2): 265–71. doi:10.1007/s10803-012-1559-z. PMID 22677931. S2CID 3924122.
  • Dobbs, David (6 July 2016). "The most terrifying childhood condition you've never heard of". Spectrum. Retrieved 6 May 2017.

External links edit

  • NIH/Medline

April 18, 2024
childhood, disintegrative, disorder, also, known, heller, syndrome, disintegrative, psychosis, rare, condition, characterized, late, onset, developmental, delays, severe, sudden, reversals, language, receptive, expressive, social, engagement, bowel, bladder, p. Childhood disintegrative disorder CDD also known as Heller s syndrome and disintegrative psychosis is a rare condition characterized by late onset of developmental delays or severe and sudden reversals in language receptive and expressive social engagement bowel and bladder play and motor skills 3 4 Researchers have not been successful in finding a cause for the disorder 3 4 CDD has some similarities to autism and is sometimes considered a low functioning form of it 5 6 4 In May 2013 CDD along with other sub types of PDD Asperger s syndrome Classic autism and PDD NOS was fused into a single diagnostic term called autism spectrum disorder under the new DSM 5 manual 7 Childhood disintegrative disorderOther namesHeller syndrome disintegrative psychosis dementia infantilisSpecialtyPsychiatry pediatricsUsual onset3 4 years of ageDifferential diagnosisregressive autism Rett syndrome lead poisoning mercury poisoning HIV infection brain tumor certain seizure disorders e g Landau Kleffner syndrome and some neurodegenerative diseases e g variant Creutzfeldt Jakob disease 1 2 CDD was originally described by Austrian educator Theodor Heller 1869 1938 in 1908 35 years before Leo Kanner and Hans Asperger described autism Heller had previously used the name dementia infantilis for the syndrome 8 An apparent period of fairly normal development is often noted before a regression in skills or a series of regressions in skills 9 4 The age at which this regression can occur varies 10 after three years of normal development is typical 11 The regression known as a prodrome can be so dramatic that the child may be aware of it and may in its beginning even ask vocally what is happening to them 4 12 Some children describe or appear to be reacting to hallucinations but the most obvious symptom is that skills apparently attained are lost 4 Many children are already somewhat delayed when the disorder becomes apparent but these delays are not always obvious in young children 4 This has been described by many writers as a devastating condition affecting both the family and the individual s future 4 As is the case with all pervasive developmental disorder categories there is considerable controversy about the right treatment for CDD 4 Contents 1 Signs and symptoms 2 Causes 3 Treatment 4 References 5 Further reading 6 External linksSigns and symptoms editCDD is a rare condition with only 1 7 cases per 100 000 13 14 15 A child affected with childhood disintegrative disorder shows normal development Up until this point the child has developed normally in the areas of language skills social skills comprehension skills and has maintained those skills for about two years 16 17 However between the ages of two and 10 skills acquired are lost almost completely in at least two of the following six functional areas 18 Expressive language skills being able to produce speech and communicate a message Receptive language skills comprehension of language listening and understanding what is communicated Social skills and self care skills Control over bowel and bladder Play skills Motor skillsLack of normal function or impairment also occurs in at least two of the following three areas 19 Social interaction Communication Repetitive behavior and interest patternsIn her book Thinking in Pictures Temple Grandin argues that compared to Kanner s classic autism and to Asperger syndrome CDD is characterized with more severe sensory processing disorder but less severe cognitive problems 20 She also argues that compared to most autistic individuals persons with CDD have more severe speech pathology and they usually do not respond well to stimulants 20 Causes editAll of the causes of childhood disintegrative disorder are still unknown 3 4 Sometimes CDD surfaces abruptly within days or weeks while in other cases it develops over a longer period of time A Mayo Clinic report indicates Comprehensive medical and neurological examinations in children diagnosed with childhood disintegrative disorder seldom uncover an underlying medical or neurological cause Although the occurrence of epilepsy is higher in children with childhood disintegrative disorder experts don t know whether epilepsy plays a role in causing the disorder 21 CDD especially in cases of later age of onset has also been associated with certain other conditions particularly the following 11 Lipid storage diseases In this condition a toxic buildup of excess fats lipids takes place in the brain and nervous system Subacute sclerosing panencephalitis Chronic infection of the brain by a form of the measles virus causes subacute sclerosing panencephalitis This condition leads to brain inflammation and the death of nerve cells Tuberous sclerosis TSC TSC is a genetic disorder In this disorder tumors may grow in the brain and other vital organs like kidneys heart eyes lungs and skin In this condition noncancerous benign tumors hamartomas grow in the brain Leukodystrophy In this condition the myelin sheath does not develop in a normal way causing white matter in the brain to eventually fail and disintegrate Treatment editLoss of language and skills related to social interaction and self care are serious The affected children face ongoing disabilities in certain areas and require long term care Treatment of CDD involves both behavior therapy environmental therapy and medications 22 Behavior therapy Applied behavior analysis ABA is considered to be the most effective form of treatment for autism spectrum disorders by the American Academy of Pediatrics 23 The primary goal of ABA is to improve quality of life and independence by teaching adaptive behaviors to children with autism 24 and to diminish problematic behaviors like running away from home or self injury 25 by using positive or negative reinforcement to encourage or discourage behaviors over time 26 Environmental therapy Sensory enrichment therapy uses enrichment of the sensory experience to improve symptoms in autism many of which are common to CDD Medications There are no medications available to directly treat CDD Antipsychotic medications are used to treat severe behavior problems like aggressive stance and repetitive behavior patterns Anticonvulsant medications are used to control seizures References edit Dr Mary Lowthe 25 January 2021 Childhood Disintegrative Disorder Hiroshi Kurita 2011 Textbook of Autism Spectrum Disorders American Psychiatric Pub p 102 ISBN 9781585623419 a b c Charan Sri Hari January April 2012 Childhood disintegrative disorder Journal of Pediatric Neurosciences 7 1 55 57 doi 10 4103 1817 1745 97627 PMC 3401658 PMID 22837782 Childhood disintegrative disorder CDD also known as Heller s syndrome and disintegrative psychosis is a rare condition characterized by late onset gt 3 years of age of developmental delays in language social function and motor skills The cause of childhood disintegrative disorder is unknown a b c d e f g h i j Definitions for childhood disintegrative disorder Definitions net STANDS4 Archived from the original on 25 September 2022 Retrieved 25 September 2022 Childhood disintegrative disorder also known as Heller s syndrome and disintegrative psychosis is a rare condition characterized by late onset of developmental delays in language social function and motor skills Researchers have not been successful in finding a cause for the disorder CDD has some similarity to autism and is sometimes considered a low functioning form of it but an apparent period of fairly normal development is often noted before a regression in skills or a series of regressions in skills Many children are already somewhat delayed when the disorder becomes apparent but these delays are not always obvious in young children The regression can be so dramatic that the child may be aware of it and in its beginning he may even ask vocally what is happening to him Some children describe or appear to be reacting to hallucinations but the most obvious symptom is that skills apparently attained are lost This has been described by many writers as a devastating condition affecting both the family and the individual s future As is the case with all pervasive developmental disorder categories there is considerable controversy about the right treatment for CDD McPartland J Volkmar FR 2012 Autism and related disorders Neurobiology of Psychiatric Disorders Handbook of Clinical Neurology Vol 106 pp 407 18 doi 10 1016 B978 0 444 52002 9 00023 1 ISBN 9780444520029 PMC 3848246 PMID 22608634 a href Template Cite book html title Template Cite book cite book a journal ignored help Venkat A Jauch E Russell WS Crist CR Farrell R August 2012 Care of the patient with an autism by the general physician Postgrad Med J 88 1042 472 81 doi 10 1136 postgradmedj 2011 130727 PMID 22427366 S2CID 12331005 Childhood Disintegrative Disorder Heller s Syndrome 25 January 2021 Mouridsen SE June 2003 Childhood disintegrative disorder Brain Dev 25 4 225 8 doi 10 1016 s0387 7604 02 00228 0 PMID 12767450 S2CID 25420772 Rogers SJ 2004 Developmental regression in autism spectrum disorders Ment Retard Dev Disabil Res Rev 10 2 139 43 doi 10 1002 mrdd 20027 PMID 15362172 Hendry CN January 2000 Childhood disintegrative disorder should it be considered a distinct diagnosis Clin Psychol Rev 20 1 77 90 doi 10 1016 S0272 7358 98 00094 4 PMID 10660829 a b Malhotra S Gupta N December 1999 Childhood disintegrative disorder J Autism Dev Disord 29 6 491 8 doi 10 1023 A 1022247903401 PMID 10638461 S2CID 189899310 Dobbs David 6 July 2016 The most terrifying childhood condition you ve never heard of Spectrum Simons Foundation Autism Research Initiative Archived from the original on 25 September 2022 Retrieved 25 September 2022 During this anxiety ridden prologue known as a prodrome a child will often seem keenly aware that something is wrong Fombone E June 2002 Prevalence of childhood disintegrative disorder Autism 6 2 149 57 doi 10 1177 1362361302006002002 PMID 12083281 S2CID 145771483 Fombonne E June 2009 Epidemiology of pervasive developmental disorders Pediatr Res 65 6 591 8 doi 10 1203 PDR 0b013e31819e7203 PMID 19218885 Fombonne Eric 2002 Prevalence of Childhood Disintegrative Disorder Autism 6 2 149 157 doi 10 1177 1362361302006002002 PMID 12083281 S2CID 145771483 Charan Sri Hari 2012 Childhood disintegrative disorder Journal of Pediatric Neurosciences 7 1 55 57 doi 10 4103 1817 1745 97627 ISSN 1817 1745 PMC 3401658 PMID 22837782 Malhotra Savita Gupta Nitin 1999 12 01 Childhood Disintegrative Disorder Journal of Autism and Developmental Disorders 29 6 491 498 doi 10 1023 A 1022247903401 ISSN 1573 3432 PMID 10638461 S2CID 189899310 A Guide to Childhood Disintegrative Disorder Elemy Archived from the original on 25 September 2022 Retrieved 25 September 2022 Braaten Ellen ed 29 January 2018 The SAGE Encyclopedia of Intellectual and Developmental Disorders Vol 2 SAGE Publications ISBN 9781506353296 Lack of normal function or impairment also occurs in at least two of the following three areas Social interaction Communication and Repetitive behavior and interest patterns a b Grandin Temple 7 September 2008 Thinking in Pictures Bloomsbury Publishing ISBN 9781408807309 Retrieved 25 September 2022 Childhood Disintegrative Disorder Causes Archived September 29 2007 at the Wayback Machine Mughal Saba Faizy Rubina M Saadabadi Abdolreza January 2022 Autism Spectrum Disorder Treasure Island Florida StatPearls Publishing PMID 30247851 Archived from the original on 25 September 2022 via National Center for Biotechnology Information Bookshelf Treatment of childhood disintegrative disorder requires behavior therapy environmental therapy and medications Myers Scott M Johnson Chris Plauche 1 November 2007 Management of Children With Autism Spectrum Disorders Pediatrics 120 5 1162 1182 doi 10 1542 peds 2007 2362 ISSN 0031 4005 PMID 17967921 Matson Johnny Hattier Megan Belva Brian January March 2012 Treating adaptive living skills of persons with autism using applied behavior analysis A review Research in Autism Spectrum Disorders 6 1 271 276 doi 10 1016 j rasd 2011 05 008 Summers Jane Sharami Ali Cali Stefanie D Mello Chantelle Kako Milena Palikucin Reljin Andjelka Savage Melissa Shaw Olivia Lunsky Yona November 2017 Self Injury in Autism Spectrum Disorder and Intellectual Disability Exploring the Role of Reactivity to Pain and Sensory Input Brain Sci 7 11 140 doi 10 3390 brainsci7110140 PMC 5704147 PMID 29072583 Applied Behavioral Strategies Getting to Know ABA Archived from the original on 2015 10 07 Retrieved 2015 12 16 Further reading editMaurice Catherine 1993 Let me hear your voice a family s triumph over autism New York Knopf ISBN 978 0 679 40863 5 OCLC 26633221 Westphal A Schelinski S Volkmar F Pelphrey K February 2013 Revisiting regression in autism Heller s dementia infantilis Includes a translation of Uber Dementia Infantilis J Autism Dev Disord 43 2 265 71 doi 10 1007 s10803 012 1559 z PMID 22677931 S2CID 3924122 Dobbs David 6 July 2016 The most terrifying childhood condition you ve never heard of Spectrum Retrieved 6 May 2017 External links editNIH Medline Retrieved from https en wikipedia org w index php title Childhood disintegrative disorder amp oldid 1204921491, wikipedia, wiki, book, books, library,

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