Childhood Disintegration Disorder 

  • Author: Bettina E Bernstein, DO; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Nov 23, 2009
 

Background

Childhood disintegrative disorder, also known as Heller syndrome, manifests as a loss of previously acquired language and social skills and results in a persistent delay in these areas. For example, a child previously able to speak in 2- or 3-word phrases gradually or abruptly loses the ability to communicate using words or uses only fragments. Social and emotional development also regress, resulting in an impaired ability to relate with others. For example, a child previously able to accept reassurance from his or her parent (eg, a hug) loses the ability to be consoled and even may withdraw from human (tactile) contact.

Childhood disintegrative disorder is very rare, occurring in about 2 per 100,000 children, much rarer than autistic disorder (which affects 20 per 10,000 children) or pervasive developmental disorder, not otherwise specified (PDD-NOS), which occurs in 30 per 10,000 children.[1] Childhood disintegrative disorder generally manifests by the fourth year of life, after a period of at least 2 years of normal development.

Overall, the social, communicative, and behavioral features of childhood disintegrative disorder resemble those of autistic disorder. Affected children have distinct qualitative impairments in social interaction and communication. In addition, restricted, repetitive, or stereotyped patterns of behavior, interests, and activities occur. Motor loss of previously acquired skills (eg, child previously toilet trained soils during the day and night, child previously able to pedal a tricycle or draw shapes can no longer do so) occurs. Additional symptoms may include the onset of difficulty in the transition of waking from sleep. Social interactions become compromised (eg, aggressiveness, tantrums, withdrawal from peers), as does motor function, resulting in poor coordination and possible awkwardness of gait.[2]

Family home movies can be very helpful in early identification of autistic spectrum disorders, including childhood disintegrative disorder.[3]

Typical case study of childhood disintegrative disorder

A 3-year-old boy is referred because his behavior he recently gotten him "expelled" from daycare. He screams and tantrums and no longer accepts hugs from his daycare teacher, with whom he was previously familiar. He has lately become destructive to his toys and does not use them to interact with his peers. His parents report that he was doing "okay" up until the past 3 months. They do not report that he had had any language delays.

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Pathophysiology

Historically, flawed theories have held that "refrigerator mothers" (a term coined based on the presumed emotional frigidity of such mothers toward their children) caused autistic spectrum disorder in their children; these theories have caused unnecessary psychological pain in countless numbers of families.

Current research has yet to reveal a clear-cut pathophysiology for childhood disintegrative disorder; debate within the developmental disabilities field regarding long-term outcome of children with this disorder is ongoing. Some researchers hypothesize that predisposing genetic factors combined with environmental stressors (eg, prenatal or postnatal virus exposure, birth trauma) result in brain deposition of amyloid and disruption of synaptic transmissions, possibly involving interleukin-1 or beta-endorphins. Brain plasticity may be restored if enriched environmental experiences are provided during critical periods of development, potentially mitigating genetic predispositions. However, earlier disruption of psychosocial development can result in even more severe developmental consequences.

Several researchers have proposed the theory that altered or inappropriate immune responses, potentially involving abnormal B-cell activation and neuronal function, may play a role in pathophysiology. This concept is supported by some studies that have found that lithium and hyperbaric oxygen[4] reduce oxidative stress and may increase blood flow to the brain, lending some support to the idea that a possible endophenotype leads to oxidative stress and neuronal injury.[5, 6, 7, 1]

Autoantibodies to myelin basic protein (MBP) in children with childhood disintegrative disorder appear to differ from those in children with nonregressive forms of autism; however, this finding does not yet seem to correlate with disease severity or prognosis.[5]

No gene has yet been isolated as the cause of childhood disintegrative disorder; however, a gene that codes for elongator protein complex 4 (ELP4) has recently been identified on human chromosome 11 and appears to be associated with centrotemporal sharp waves (CTS), the electroencephalographic (EEG) feature typical of rolandic epilepsy (RE). ELP4 is one component of the elongator complex, a group of 6 genes that function in transcription and modification of transfer RNA (including regulating the actin cytoskeleton, cell motility, and migration) and that seem to play a critical role in influencing genes important to neuronal migration, axon growth, motility of growth cones, and related activities.[8]

ELP4 may also play a critical role in the transcription and modification of transfer RNA. Interference with necessary migration, synaptogenesis, and division in the CNS prior to adolescence may result from disruption of transcriptional regulatory and translational modification roles and may cause failure of dendrites to make the proper neuronal connections.[9]

Autism spectrum disorders, including PDD, are generally associated with an increased incidence of seizures. Other idiopathic focal epilepsies occur during sleep. In addition, other epilepsy syndromes are associated with impaired frontal lobe and language function, potentially leading to continuous epileptiform discharges during sleep.[10]

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Epidemiology

Frequency

United States

Childhood disintegrative disorder is very rare (2 per 100,000 children), much rarer than autistic disorder, which affects 20 per 10,000 children.[1]

International

No current studies are large enough to determine the international frequency of childhood disintegrative disorder.

Mortality/Morbidity

  • No mortality or morbidity is caused directly by childhood disintegrative disorder. Indirectly, a comorbid medical condition, such as a neurodegenerative disorder, may increase the risk of mortality and morbidity. The clinician should be alert to the possibility of Landau-Kleffner syndrome (LKS).[11, 12]
  • LKS is a rare condition of unknown etiology that is more common in boys. LKS generally presents with more severe language impairment and later than childhood disintegrative disorder; LKS has a mean age of onset of 5.5 years. Excluding this syndrome is important because it is generally associated with seizure disorder and may respond to treatment with anticonvulsants such as valproic acid or steroids.[11, 12]

Race

No studies have shown that childhood disintegrative disorder is any more or less common in any particular race or culture.

Sex

Childhood disintegrative disorder is slightly more common in males than in females.[1]

Age

Childhood disintegrative disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), occurs only after a period of at least 2 years of normal development, when the child is younger than 10 years.[13, 1] Onset generally occurs in children aged 3-4 years and may be insidious or abrupt.

The average age at diagnosis is 3.9 years, similar to that of autistic disorder (average age of 3.1 years, with a range of 4.1-5.5 years in some studies).[1]

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Contributor Information and Disclosures
Author

Bettina E Bernstein, DO  Assistant Professor, Department of Psychiatry, Philadelphia College of Osteopathic Medicine; Private Practice at the Wynnewood House; Consultant, Child Guidance Resource Centers, Education Program, Clinical Affiliate, Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, Psychiatric Consultant, Ridley School District, Easttown Tredyffrin School District

Bettina E Bernstein, DO is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry and American Psychiatric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Carol Diane Berkowitz, MD  Executive Vice Chair, Department of Pediatrics, Professor, Harbor-University of California at Los Angeles Medical Center

Carol Diane Berkowitz, MD is a member of the following medical societies: Alpha Omega Alpha, Ambulatory Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, American Medical Association, American Pediatric Society, and North American Society for Pediatric and Adolescent Gynecology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

  1. Fombonne E. Epidemiology of pervasive developmental disorders. Pediatr Res. Jun 2009;65(6):591-8. [Medline].

  2. Volkmar FR, State M, Klin A. Autism and autism spectrum disorders: diagnostic issues for the coming decade. J Child Psychol Psychiatry. Jan 2009;50(1-2):108-15. [Medline].

  3. Palomo R, Thompson M, Colombi C, Cook I, Goldring S, Young GS, et al. A case study of childhood disintegrative disorder using systematic analysis of family home movies. J Autism Dev Disord. Nov 2008;38(10):1853-8. [Medline].

  4. Rossignol DA, Rossignol LW, Smith S, Schneider C, Logerquist S, Usman A, et al. Hyperbaric treatment for children with autism: a multicenter, randomized, double-blind, controlled trial. BMC Pediatr. Mar 13 2009;9:21. [Medline].

  5. Libbey JE, Coon HH, Kirkman NJ, Sweeten TL, Miller JN, Stevenson EK, et al. Are there enhanced MBP autoantibodies in autism?. J Autism Dev Disord. Feb 2008;38(2):324-32. [Medline].

  6. Gottesman II, Gould TD. The endophenotype concept in psychiatry: etymology and strategic intentions. Am J Psychiatry. Apr 2003;160(4):636-45. [Medline].

  7. Berry-Kravis E, Sumis A, Hervey C, Nelson M, Porges SW, Weng N, et al. Open-label treatment trial of lithium to target the underlying defect in fragile X syndrome. J Dev Behav Pediatr. Aug 2008;29(4):293-302. [Medline].

  8. Strug LJ, Clarke T, Chiang T, Chien M, Baskurt Z, Li W, et al. Centrotemporal sharp wave EEG trait in rolandic epilepsy maps to Elongator Protein Complex 4 (ELP4). Eur J Hum Genet. Sep 2009;17(9):1171-81. [Medline].

  9. Ortega-Hernandez OD, Kivity S, Shoenfeld Y. Olfaction, psychiatric disorders and autoimmunity: is there a common genetic association?. Autoimmunity. Jan 2009;42(1):80-8. [Medline].

  10. Lillywhite LM, Saling MM, Harvey AS, Abbott DF, Archer JS, Vears DF, et al. Neuropsychological and functional MRI studies provide converging evidence of anterior language dysfunction in BECTS. Epilepsia. Oct 2009;50(10):2276-84. [Medline].

  11. Mordekar SR, Prendergast M, Chattopadhyay AK, Baxter PS. Corticosteroid treatment of behaviour, language and motor regression in childhood disintegrative disorder. Eur J Paediatr Neurol. Jul 13 2008;[Medline].

  12. Russo M, Perry R, Kolodny E, Gillberg C. Heller syndrome in a pre-school boy. Proposed medical evaluation and hypothesized pathogenesis. Eur Child Adolesc Psychiatry. Sep 1996;5(3):172-7. [Medline].

  13. American Psychiatric Association. Childhood Disintegrative Disorder 299.10. In: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. 1994:73-5.

  14. Kurita H, Koyama T, Osada H. Comparison of childhood disintegrative disorder and disintegrative psychosis not diagnosed as childhood disintegrative disorder. Psychiatry Clin Neurosci. Apr 2005;59(2):200-5. [Medline].

  15. Young EC, Diehl JJ, Morris D, et al. The use of two language tests to identify pragmatic language problems in children with autism spectrum disorders. Lang Speech Hear Serv Sch. Jan 2005;36(1):62-72. [Medline].

  16. Enstrom AM, Van de Water JA, Ashwood P. Autoimmunity in autism. Curr Opin Investig Drugs. May 2009;10(5):463-73. [Medline].

  17. Posey DJ, Erickson CA, McDougle CJ. Developing drugs for core social and communication impairment in autism. Child Adolesc Psychiatr Clin N Am. Oct 2008;17(4):787-801, viii-ix. [Medline].

  18. Miller MT, Ventura L, Strömland K. Thalidomide and misoprostol: Ophthalmologic manifestations and associations both expected and unexpected. Birth Defects Res A Clin Mol Teratol. Aug 2009;85(8):667-76. [Medline].

  19. Miller MT, Strömland K, Ventura L, Johansson M, Bandim JM, Gillberg C. Autism with ophthalmologic malformations: the plot thickens. Trans Am Ophthalmol Soc. 2004;102:107-20; discussion 120-1. [Medline].

  20. Tedrus GM, Fonseca LC, Melo EM, Ximenes VL. Educational problems related to quantitative EEG changes in benign childhood epilepsy with centrotemporal spikes. Epilepsy Behav. Aug 2009;15(4):486-90. [Medline].

  21. Watemberg N, Leitner Y, Fattal-Valevski A, Kramer U. Epileptic negative myoclonus as the presenting seizure type in rolandic epilepsy. Pediatr Neurol. Jul 2009;41(1):59-64. [Medline].

  22. Jyonouchi H, Geng L, Ruby A, et al. Evaluation of an association between gastrointestinal symptoms and cytokine production against common dietary proteins in children with autism spectrum disorders. J Pediatr. May 2005;146(5):605-10. [Medline].

  23. Stigler KA, Posey DJ, McDougle CJ. Ramelteon for insomnia in two youths with autistic disorder. J Child Adolesc Psychopharmacol. Oct 2006;16(5):631-6. [Medline].

  24. Cohen IL, Schmidt-Lackner S, Romanczyk R, Sudhalter V. The PDD Behavior Inventory: a rating scale for assessing response to intervention in children with pervasive developmental disorder. J Autism Dev Disord. Feb 2003;33(1):31-45. [Medline].

  25. Biederman J, Hammerness P, Doyle R, Joshi G, Aleardi M, Mick E. Risperidone treatment for ADHD in children and adolescents with bipolar disorder. Neuropsychiatr Dis Treat. Feb 2008;4(1):203-7. [Medline]. [Full Text].

  26. Stigler KA, McDougle CJ. Pharmacotherapy of irritability in pervasive developmental disorders. Child Adolesc Psychiatr Clin N Am. Oct 2008;17(4):739-52, vii-viii. [Medline].

  27. Findling RL. Atypical antipsychotic treatment of disruptive behavior disorders in children and adolescents. J Clin Psychiatry. 2008;69 Suppl 4:9-14. [Medline].

  28. Stigler KA, Diener JT, Kohn AE, Li L, Erickson CA, Posey DJ, et al. Aripiprazole in pervasive developmental disorder not otherwise specified and Asperger's disorder: a 14-week, prospective, open-label study. J Child Adolesc Psychopharmacol. Jun 2009;19(3):265-74. [Medline].

  29. King BH, Hollander E, Sikich L, McCracken JT, Scahill L, Bregman JD, et al. Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism. Arch Gen Psychiatry. Jun 2009;66(6):583-90. [Medline].

  30. Leskovec TJ, Rowles BM, Findling RL. Pharmacological treatment options for autism spectrum disorders in children and adolescents. Harv Rev Psychiatry. 2008;16(2):97-112. [Medline].

  31. Levy SE, Hyman SL. Complementary and alternative medicine treatments for children with autism spectrum disorders. Child Adolesc Psychiatr Clin N Am. Oct 2008;17(4):803-20, ix. [Medline].

  32. Duncan B, McDonough-Means S, Worden K, Schnyer R, Andrews J, Meaney FJ. Effectiveness of osteopathy in the cranial field and myofascial release versus acupuncture as complementary treatment for children with spastic cerebral palsy: a pilot study. J Am Osteopath Assoc. Oct 2008;108(10):559-70. [Medline].

  33. Nye C, Brice A. Combined vitamin B6-magnesium treatment in autism spectrum disorder. Cochrane Database Syst Rev. Oct 19 2005;CD003497. [Medline].

  34. Akshoomoff N, Farid N, Courchesne E, Haas R. Abnormalities on the neurological examination and EEG in young children with pervasive developmental disorders. J Autism Dev Disord. May 2007;37(5):887-93. [Medline].

  35. Murch S. Diet, immunity, and autistic spectrum disorders. J Pediatr. May 2005;146(5):582-4. [Medline].

  36. Posey DJ, Aman MG, McCracken JT, Scahill L, Tierney E, Arnold LE, et al. Positive effects of methylphenidate on inattention and hyperactivity in pervasive developmental disorders: an analysis of secondary measures. Biol Psychiatry. Feb 15 2007;61(4):538-44. [Medline].

  37. Carlson T, Reynolds CA, Caplan R. Case report: valproic Acid and risperidone treatment leading to development of hyperammonemia and mania. J Am Acad Child Adolesc Psychiatry. Mar 2007;46(3):356-61. [Medline].

  38. Chakraborty N, Johnston T. Aripiprazole and neuroleptic malignant syndrome. Int Clin Psychopharmacol. Nov 2004;19(6):351-3. [Medline].

  39. Chungh DS, Kim BN, Cho SC. Neuroleptic malignant syndrome due to three atypical antipsychotics in a child. J Psychopharmacol. Jul 2005;19(4):422-5. [Medline].

  40. Nielsen J, Bruhn AM. Atypical neuroleptic malignant syndrome caused by olanzapine. Acta Psychiatr Scand. Sep 2005;112(3):238-40; discussion 240. [Medline].

  41. Segura-Bruna N, Rodriguez-Campello A, Puente V, Roquer J. Valproate-induced hyperammonemic encephalopathy. Acta Neurol Scand. Jul 2006;114(1):1-7. [Medline].

  42. Soares-Fernandes JP, Machado A, Ribeiro M, et al. Hippocampal involvement in valproate-induced acute hyperammonemic encephalopathy. Arch Neurol. Aug 2006;63(8):1202-3. [Medline].

  43. Stewart JT. Treatment of valproate-induced hyperammonemia. J Am Geriatr Soc. Jun 2005;53(6):1080. [Medline].

  44. [Guideline] Kagan-Kushnir T, Roberts SW, Snead OC 3rd. Screening electroencephalograms in autism spectrum disorders: evidence-based guideline. J Child Neurol. Mar 2005;20(3):197-206. [Medline].

  45. Chez MG, Burton Q, Dowling T, Chang M, Khanna P, Kramer C. Memantine as adjunctive therapy in children diagnosed with autistic spectrum disorders: an observation of initial clinical response and maintenance tolerability. J Child Neurol. May 2007;22(5):574-9. [Medline].

  46. Agarwal V, Sitholey P, Mohan I. Childhood Disintegrative Disorder, an atypical presentation: a case report. J Autism Dev Disord. Dec 2005;35(6):873-4. [Medline].

  47. Bradstreet JJ, Smith S, Granpeesheh D, El-Dahr JM, Rossignol D. Spironolactone might be a desirable immunologic and hormonal intervention in autism spectrum disorders. Med Hypotheses. 2007;68(5):979-87. [Medline].

  48. Buitelaar JK, Van der Gaag R, Klin A, Volkmar F. Exploring the boundaries of pervasive developmental disorder not otherwise specified: analyses of data from the DSM-IV Autistic Disorder Field Trial. J Autism Dev Disord. Feb 1999;29(1):33-43. [Medline].

  49. Burd L, Ivey M, Barth A, Kerbeshian J. Two males with childhood disintegrative disorder: a prospective 14-year outcome study. Dev Med Child Neurol. Oct 1998;40(10):702-7. [Medline].

  50. Burd L, Stenehjem A, Franceschini LA, Kerbeshian J. A 15-year follow-up of a boy with pyridoxine (vitamin B6)-dependent seizures with autism, breath holding, and severe mental retardation. J Child Neurol. Nov 2000;15(11):763-5. [Medline].

  51. Connolly AM, Chez M, Streif EM, Keeling RM, Golumbek PT, Kwon JM. Brain-derived neurotrophic factor and autoantibodies to neural antigens in sera of children with autistic spectrum disorders, Landau-Kleffner syndrome, and epilepsy. Biol Psychiatry. Feb 15 2006;59(4):354-63. [Medline].

  52. Coskun M, Karakoc S, Kircelli F, Mukaddes NM. Effectiveness of mirtazapine in the treatment of inappropriate sexual behaviors in individuals with autistic disorder. J Child Adolesc Psychopharmacol. Apr 2009;19(2):203-6. [Medline].

  53. de Bruin EI, Verheij F, Ferdinand RF. WISC-R subtest but no overall VIQ-PIQ difference in Dutch children with PDD-NOS. J Abnorm Child Psychol. Apr 2006;34(2):263-71. [Medline].

  54. Eack SM, E Mermon D, Montrose DM, Miewald J, Gur RE, Gur RC, et al. Social Cognition Deficits Among Individuals at Familial High Risk for Schizophrenia. Schizophr Bull. Apr 14 2009;[Medline].

  55. Elie D, Poirier M, Chianetta J, Durand M, Grégoire C, Grignon S. Cognitive effects of antipsychotic dosage and polypharmacy: a study with the BACS in patients with schizophrenia and schizoaffective disorder. J Psychopharmacol. Jan 22 2009;[Medline].

  56. Erickson CA, Mullett JE, McDougle CJ. Open-Label Memantine in Fragile X Syndrome. J Autism Dev Disord. Jul 16 2009;[Medline].

  57. Fisch GS. Syndromes and epistemology I: Autistic spectrum disorders. Am J Med Genet A. Jun 1 2005;135(2):117-9. [Medline].

  58. Gonzalez NM, Alpert M, Shay J, et al. Autistic children on followup: change of diagnosis. Psychopharmacol Bull. 1993;29(3):353-8. [Medline].

  59. Gorker I, Tuzun U. Autistic-like findings associated with a urea cycle disorder in a 4-year-old girl. J Psychiatry Neurosci. Mar 2005;30(2):133-5. [Medline].

  60. Green D, Flanagan D. Understanding the autistic dental patient. Gen Dent. Mar-Apr 2008;56(2):167-71. [Medline].

  61. Harvey PD, Keefe RS, Patterson TL, Heaton RK, Bowie CR. Abbreviated neuropsychological assessment in schizophrenia: prediction of different aspects of outcome. J Clin Exp Neuropsychol. May 2009;31(4):462-71. [Medline].

  62. Hendry CN. Childhood disintegrative disorder: should it be considered a distinct diagnosis?. Clin Psychol Rev. Jan 2000;20(1):77-90. [Medline].

  63. Hill SK, Sweeney JA, Hamer RM, Keefe RS, Perkins DO, Gu H, et al. Efficiency of the CATIE and BACS neuropsychological batteries in assessing cognitive effects of antipsychotic treatments in schizophrenia. J Int Neuropsychol Soc. Mar 2008;14(2):209-21. [Medline].

  64. Kanemura H, Aihara M. Growth disturbance of frontal lobe in BCECTS presenting with frontal dysfunction. Brain Dev. Jan 23 2009;[Medline].

  65. Keck PE Jr, Hsu HA, Papadakis K, Russo J Jr. Memantine efficacy and safety in patients with acute mania associated with bipolar I disorder: a pilot evaluation. Clin Neuropharmacol. Jul-Aug 2009;32(4):199-204. [Medline].

  66. Keefe RS, Harvey PD, Goldberg TE, Gold JM, Walker TM, Kennel C, et al. Norms and standardization of the Brief Assessment of Cognition in Schizophrenia (BACS). Schizophr Res. Jul 2008;102(1-3):108-15. [Medline].

  67. Kellendonk C, Simpson EH, Kandel ER. Modeling cognitive endophenotypes of schizophrenia in mice. Trends Neurosci. Jun 2009;32(6):347-58. [Medline].

  68. Kim SH, Markham JA, Weiler IJ, Greenough WT. Aberrant early-phase ERK inactivation impedes neuronal function in fragile X syndrome. Proc Natl Acad Sci U S A. Mar 18 2008;105(11):4429-34. [Medline].

  69. Kirkman NJ, Libbey JE, Sweeten TL, Coon HH, Miller JN, Stevenson EK, et al. How relevant are GFAP autoantibodies in autism and Tourette Syndrome?. J Autism Dev Disord. Feb 2008;38(2):333-41. [Medline].

  70. Kolasinska M, Rabe-Jablonska J. [Communication and speech disorders and their relationship with psychic development and mental disorders in 8 year old children from the Lodz area]. Psychiatr Pol. Mar-Apr 2005;39(2):357-70. [Medline].

  71. Koyama T, Kurita H. Cognitive profile difference between normally intelligent children with Asperger's disorder and those with pervasive developmental disorder not otherwise specified. Psychiatry Clin Neurosci. Dec 2008;62(6):691-6. [Medline].

  72. Koyama T, Tachimori H, Osada H, Takeda T, Kurita H. Cognitive and symptom profiles in Asperger's syndrome and high-functioning autism. Psychiatry Clin Neurosci. Feb 2007;61(1):99-104. [Medline].

  73. McDougle CJ, Stigler KA, Erickson CA, Posey DJ. Atypical antipsychotics in children and adolescents with autistic and other pervasive developmental disorders. J Clin Psychiatry. 2008;69 Suppl 4:15-20. [Medline].

  74. Nicolai J, Aldenkamp AP, Huizenga JR, Teune LK, Brouwer OF. Cognitive side effects of valproic acid-induced hyperammonemia in children with epilepsy. J Clin Psychopharmacol. Apr 2007;27(2):221-4. [Medline].

  75. Parmeggiani A, Posar A, Antolini C, Scaduto MC, Santucci M, Giovanardi-Rossi P. Epilepsy in patients with pervasive developmental disorder not otherwise specified. J Child Neurol. Oct 2007;22(10):1198-203. [Medline].

  76. Ronesi JA, Huber KM. Metabotropic glutamate receptors and fragile x mental retardation protein: partners in translational regulation at the synapse. Sci Signal. Feb 5 2008;1(5):pe6. [Medline].

  77. Scahill L, McDougle CJ, Williams SK, Dimitropoulos A, Aman MG, McCracken JT, et al. Children's Yale-Brown Obsessive Compulsive Scale modified for pervasive developmental disorders. J Am Acad Child Adolesc Psychiatry. Sep 2006;45(9):1114-23. [Medline].

  78. Simpson D, Curran MP. Ramelteon: a review of its use in insomnia. Drugs. 2008;68(13):1901-19. [Medline].

  79. Solomon M, Ono M, Timmer S, Goodlin-Jones B. The effectiveness of parent-child interaction therapy for families of children on the autism spectrum. J Autism Dev Disord. Oct 2008;38(9):1767-76. [Medline].

  80. Sponheim E. Changing criteria of autistic disorders: a comparison of the ICD-10 research criteria and DSM-IV with DSM-III-R, CARS, and ABC. J Autism Dev Disord. Oct 1996;26(5):513-25. [Medline].

  81. Steinlein OK. Epilepsy-aphasia syndromes. Expert Rev Neurother. Jun 2009;9(6):825-33. [Medline].

  82. Thakur V, Rupar CA, Ramsay DA, Singh R, Fraser DD. Fatal cerebral edema from late-onset ornithine transcarbamylase deficiency in a juvenile male patient receiving valproic acid. Pediatr Crit Care Med. May 2006;7(3):273-6. [Medline].

  83. Volkmar FR. Childhood disintegrative disorder: issues for DSM-IV. J Autism Dev Disord. Dec 1992;22(4):625-42. [Medline].

  84. Volkmar FR, Rutter M. Childhood disintegrative disorder: results of the DSM-IV autism field trial. J Am Acad Child Adolesc Psychiatry. Aug 1995;34(8):1092-5. [Medline].

  85. Zaidi AN. Rhabdomyolysis after correction of hyponatremia in psychogenic polydipsia possiblycomplicated by ziprasidone. Ann Pharmacother. Oct 2005;39(10):1726-31. [Medline].

  86. Zwaigenbaum L, Szatmari P, Mahoney W, et al. High functioning autism and Childhood Disintegrative Disorder in half brothers. J Autism Dev Disord. Apr 2000;30(2):121-6. [Medline].

 
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