Disintegrative Disorder In Childhood

Disintegrative disorder in childhood is rare, it causes significant loss of previously acquired skills between two and ten years. It is also known as Heller’s syndrome, dementia infantilis, symbiotic psychosis and disintegrative psychosis.

It used to be part of the pervasive developmental disorders, along with autism, Court disorder and Asperger’s disorder in the DSM-IV-TR. However, it disappeared from the DSM-5, and doctors only diagnosed it if the criteria for autism spectrum disorder are also there as “autism spectrum disorder associated with a known medical condition” (disintegrative disorder in children).

This article will tell you about the symptoms of disintegrative disorder in childhood, how doctors diagnose it, what causes it, and the best treatments for these children.

A little history

Around 1905, Sante de Sanctis (1862-1953), an Italian physician, psychologist and psychiatrist, described a picture similar to disintegrative disorder in children. He created the category of early dementia, where he included various disorders that had mental retardation as a symptom.

Later, in 1908, Theodor Heller, an Austrian teacher, described several cases of dissolving psychosis. This consisted of a condition that began around four years, after a period of normal development. Therefore, disintegrative disorder in childhood is also known as Heller’s syndrome.

The name “symbiotic psychosis” is due to Margaret Mahler, who emphasized the contribution of constitutional factors to a kind of child psychosis that appeared between three and six years. She referred to it as symbiotic psychosis.

Diagnosis of disintegrative disorder in childhood

As you read above, the DSM-5 removed this disorder from the list of medical diseases. However, the autism spectrum disorder has the specification “associated with a known medical condition”. This makes it possible to diagnose this condition (if a child meets diagnostic criteria), along with disintegrative disorder in childhood.

The DSM-IV-TR included diagnostic criteria for this disorder. There is apparently normal development during the first two years of life. It manifests itself in the presence of communication, social conditions, play and adaptive behavior that is typical of age.

However, one can see significant loss of skills already achieved from the age of two and up to the age of 10, in at least two of the following areas:

• First, expressive and receptive language
• Social skills or adaptive behavior
• Bowel or bladder control
• Lek
• Motor skills

In addition, there must be changes in two of the following areas. These coincide with the changes that are characteristic of autism: Qualitative change of social interaction and communication or repeated and stereotypical patterns of behavior, interests and activities.

Finally, these symptoms cannot be better explained by the presence of other pervasive developmental disorders or by the presence of schizophrenia to make the diagnosis. This is a prerequisite.

Symptoms of disintegrative disorder in children

• Loss of language-related skills. A child loses the acquired vocabulary and the ability to communicate with others, including the receptive ability.

• Problems in social relationships and adaptive behavior. There is a reduced interaction with peers and family who drive children to isolation. This is due to a complete lack of interest in the environment.
• Loss of motor skills. Children begin to experience difficulty with gross motor skills such as running (or walking, in more severe cases). This usually manifests itself along with clear difficulties with fine motor skills (grasping objects with the hand).
• Inability to control bowel and bladder. Children usually have bowel and bladder control between the ages of two and four. Those with disintegrative disorder in childhood usually lose this ability.
• Qualitative change in social interaction that may manifest itself in deficits in non-verbal communication, inability to establish social relationships, or lack of social or emotional reciprocity, etc.

• Stereotypical behavior and limited interests, such as inflexible adherence to certain routines, intolerance to change, motor ways and stereotypes, and foreign interests (such as taste for the edges of objects, rather than an interest in the object itself).

Cause and treatment of disintegrative disorder in childhood

The etiology, which means the origin, of disintegrative disorder in childhood is not entirely clear. Concrete mechanisms have not yet been found. However, there are some possible causes for the occurrence of this disorder, such as damage to the central nervous system during development and the occurrence of some neurological diseases, such as tuberous sclerosis. However, there is no evidence for this at the moment.

As mentioned above, disintegrative disorder in childhood is a rare disorder (more common in men), and there is no cure for it. Therefore, what doctors can do is offer certain treatments that make it possible to improve the health and quality of life of these children, and to promote the skills they retain.

Interventions

They are usually interdisciplinary:

• Pharmacotherapy can help reduce stereotypical behaviors (self-inflicted in many cases) and the symptoms of other comorbid disorders.
• Nutrition therapy guarantees the supply of nutrients, and this is important because these children often have difficulty chewing and swallowing food.
• Behavioral therapy helps reduce unwanted behaviors, such as stereotyping, and helps improve any retained skills. In fact, in some cases, a child may develop a lost skill.

• Alternative therapies usually come with medical and behavioral treatment. Music and horse therapy are often used and have proven benefits. Not only for children with disintegrative disorder, but also for those with other neurodevelopmental disorders.

By definition, these symptoms occur between two and ten years. They can occur suddenly or insidiously and may be accompanied by prodromal symptoms such as irritability, hyperactivity, anxiety or small loss of some skills.

When there is an established upheaval, they may make some small improvements, but the social, communicative, and behavioral deficiencies are constant and stable throughout life. Thus, any treatment that provides improvement, albeit small, in the symptoms and quality of life of these children is welcome.