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Childhood Disintegration Disorder: Treatment & Medication

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, Early Elementary Education Program, Clinical Affiliate, Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia
Contributor Information and Disclosures

Updated: Nov 23, 2009

Treatment

Medical Care

The principles of treatment for childhood disintegrative disorder are generally supportive in nature but do include specific behavioral interventions to halt behavioral deterioration and to improve communication, self-help, and social skills, thereby stabilizing the child's reality testing scores and global functional level.2

Children who present with markedly impaired attention may improve with very low-dose (and carefully monitored) treatment with stimulants or nonstimulants (eg, atomoxetine) and should show improvement within 4 weeks if these medications are tolerated and effective.17,25

Many children and adolescents (in particular) with childhood disintegrative disorder have difficulty maintaining a regular sleep-wake cycle. This chronic poor sleep may exacerbate aggressive behavior problems, especially intermittent assaultive behaviors in preteens and adolescents. Some individuals experience improvement in their sleep cycle with a short trial of a melatonin agonist such as agomelatine as long as there is no contraindication (seizures).23

Haloperidol and risperidone are the only medications that have been approved by the US Food and Drug Administration (FDA) for the treatment of irritability associated with childhood autism. These medications can be useful in treating associated symptoms of irritability, aggression, and hyperactivity. Citalopram has not been proven effective, and fluoxetine often causes undesirable gastrointestinal side effects in this population.17,26,27,28,29

Some investigators have found memantine to be useful in childhood disintegrative disorder, but more studies, especially randomized placebo-controlled trials, are needed for confirmation.17

Some investigators have found corticosteroids to be helpful, especially in improving language, in childhood disintegrative disorder.11

More randomized placebo-controlled trials are needed to determine if other medication such as antiepileptic mood stabilizers are helpful in childhood disintegrative disorder.30

More randomized placebo-controlled trials are needed to determine if novel interventions such as hyperbaric oxygen are safe and effective.4

Other novel treatments such as secretin initially seemed to show promise but have not been proven to improve behavioral symptoms in childhood disintegrative disorder or other PDD.31

Although other novel treatments, such as cranial manipulation, vitamin B-6 therapy, magnesium therapy, and dimethylglycine therapy, have been used in an attempt to "quiet" the brain, no data have supported the efficacy of these treatments in childhood disintegrative disorder or PDD. In addition, as these treatments involve some degree of harm (fracture, subluxation, dislocation for manipulation, metabolic toxicity caused by high doses of vitamin B-6, magnesium, or dimethylglycine), they are not recommended at this time.32,33

Consultations

  • Neurologist
    • Neurologic consultation is extremely important to exclude neurologic conditions, which, if present, may be reversible.34
    • The neurology consult should include EEG (and sleep EEG), MRI, or PET (see Imaging Studies and Other Tests).
  • Child psychiatrist or behavioral and/or developmental pediatrician
    • Advise consultations with these health professionals in conjunction with the pediatrician, family, and/or caregivers to assist with appropriate educational placement, therapeutic interventions, psychopharmacologic interventions, and psychotherapeutic interventions.
    • Consider specific family support therapy for each individual with childhood disintegrative disorder.
  • Speech therapist: Arrange for a speech pathology consultation, especially if language delay is significant (delay of 25% or more).
  • Childhood intervention specialist: Collaboration of the primary clinician with an early childhood intervention specialist may facilitate appropriate educational placement.

Diet

  • No special diet is known to improve the clinical course or prognosis of childhood disintegrative disorder.35
  • Salicylate-free diets (ie, Feingold diets), diets low in yeast, or diets high in certain megavitamins or minerals (eg, zinc, magnesium, vitamin B-6, vitamin B-12, fatty acids) have not resulted in measurable and predictable improvements; however, some anecdotal reports have shown limited response in individual cases. If a parent wishes to try a special diet, obtaining a nutrition consultation before and after the special diet is tried is recommended to prevent or reverse diet-induced vitamin, mineral, or calorie changes. Particular attention should be placed to ensure adequate (but not excessive) caloric intake to prevent growth retardation.

Activity

  • No specific activity limitations are needed unless sufficient motor deterioration suggests activity restriction, which should be child-specific.

Medication

No known medications address the core symptoms of childhood disintegrative disorder. No specific medications treat this disorder; medications generally only help to address specific symptoms. Only haloperidol and risperidone are FDA-approved to treat autism in children.17,26,27,28

Children who present with markedly impaired attention may improve with very low-dose treatment with stimulants or nonstimulants (eg, methylphenidate, atomoxetine) and should show signs of improvement within 4 weeks if these medications are tolerated and effective. These medications are dosed much lower than is usually given to treat ADHD, with close monitoring. During pharmacotherapy, the clinician must be vigilant for signs of adverse reactions, including insomnia, crying spells, anorexia, weight loss, and frank or worsening psychosis.36

Medications in various classes, including atypical antipsychotics, stimulants, and selective and nonselective serotonin reuptake inhibitors (SSRIs, SNRIs), have been used to treat a wide range of behavioral and mood problems that may occur in children with childhood disintegrative disorder.

If neuroleptic medications are used (eg, atypical antipsychotics [risperidone], haloperidol, molindone), neuroleptic malignant syndrome (NMS) is a significant risk. NMS is a potentially irreversible and life-threatening syndrome that manifests with fever, rigidity, rhabdomyolysis, altered mental status, and lethargy and may progress to coma and respiratory depression without treatment. The treatment for NMS includes immediate cessation of the neuroleptic medication and immediate consultation with an anesthetist for respiratory support and possible treatment with dantrolene.37,38,39,40,41,42,43

Laboratory studies for NMS include creatine phosphokinase, lactic dehydrogenase, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase, BUN, and creatinine level tests.

Antipsychotic agents are also associated with a potential risk of QTc prolongation.

If seizure control is an issue and Depakote or valproate are used along with atypical antipsychotics (especially risperidone), the patient should be closely monitored for abnormal levels of ammonia, which are generally accompanied by alterations in mental status (often nonspecific slowing) and abnormalities of liver function.44,42,43

If atypical antipsychotics are used (eg, risperidone, quetiapine, ziprasidone, aripiprazole), ongoing monitoring should include screening for metabolic syndrome, new-onset diabetes, or diabetic ketoacidosis, both by physical examination (including waist circumference, blood pressure, weight out of proportion to height) and laboratory studies such as serum glucose and, when indicated, hemoglobin H1C.17,26

Some children with childhood disintegrative disorder given corticosteroid treatment have shown improvement of motor, language, and behavioral regression.11

Many children and adolescents (in particular) with childhood disintegrative disorder have difficulty maintaining a regular sleep-wake cycle. This chronic poor sleep may exacerbate aggressive behavior problems, especially intermittent assaultive behaviors in preteens and adolescents. Some individuals experience improvement in their sleep cycle with a short trial of a melatonin agonist such as agomelatine as long as there is no contraindication (seizures).23,26

Some investigators have found memantine to be useful in childhood disintegrative disorder, but more studies, especially randomized placebo-controlled trials, are needed for confirmation.45

More randomized placebo-controlled trials are needed to determine if other medications such as antiepileptic mood stabilizers are helpful in childhood disintegrative disorder.30

More on Childhood Disintegration Disorder

Overview: Childhood Disintegration Disorder
Differential Diagnoses & Workup: Childhood Disintegration Disorder
Treatment & Medication: Childhood Disintegration Disorder
Follow-up: Childhood Disintegration Disorder
References
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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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Further Reading

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Keywords

childhood disintegrative disorder, childhood disintegration disorder, Heller syndrome, dementia infantilis, disintegrative psychosis, language loss, social development regression, emotional development regression, neuroleptic malignant syndrome, NMS, autistic disorder, autism, tantrums, pervasive developmental disorder, Asperger disorder

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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, Early Elementary Education Program, Clinical Affiliate, Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia
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.

Medical Editor

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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing 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.

CME Editor

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.

 
 
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