An anxious appearing mother brings in her 3-year-old son to your clinic. According to her, her son had been progressing well with his developmental milestones until three months back. Since then, she and her husband have noticed a marked restriction in activities. He no longer plays with his other siblings, keeps to himself most of the time, speaks only when spoken to, and remains indifferent to the presence of people around him. You try to engage the child in conversation, but he seems disinterested, and keeps banging his head against the wall. Based on his presentation, you make a diagnosis of:
A. Autism
B. Rett disorder
C. Childhood disintegrative disorder
D. Asperger disorder
E. Oppositional defiant disorder
autism develops before 30 months of age
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Childhood disintegrative disorder is a rare pervasive developmental disorder, which occurs more commonly in males. It is characterized by a period of normal development for at least two years. This is followed by a loss of previously acquired skills in at least two of the following areas: expressive or receptive language, social skills, bowel or bladder control, play and motor skills. These children then start to develop autistic symptoms. The etiology is unknown in most cases, but may be associated with CNS damage at times.
Autism is another type of pervasive developmental disorder, also more frequently seen in males. The onset of symptoms occurs before the age of three years. It is characterized by qualitative impairments in communication and social interaction. These patients also tend to indulge in repetitive, stereotyped behavior, with peculiar preoccupations. Although this child does have autistic symptoms, the distinct presence of normal development till the age of three, followed by the development of symptoms, goes more in favor of childhood disintegrative disorder.