A clinical study on symptoms, development and course of childhood disintegrative disorders

为研究DSM-IV儿童崩解性精神障碍（CDD）的临床有效性，将ICD-9儿童崩解性精神障碍（DP）诊断为DSM-IV自闭症（AD）（DP-AD）的10例（M=7.7岁，男7例，女3例）、11例（M=6.5岁，男9例，女2例）、7例（M=6.1岁，男5例，女2例）诊断为DSM-IV PDDNOS （DP-PDDNOS）、82例(M=5.9岁；在回归前、回归中、回归后分别对62例（男）、20例（女）AD合并语言丧失（ASL）患者的16、8、24个变量进行比较。在年龄、性别比无显著差异的4组中，经事后比较有12个变量有显著差异。回归前，CDD在1岁左右分离焦虑方面明显强于ASL，手指指指比DP-PDDNOS和ASL更常见，膀胱控制优于DP-AD和ASL。与其他3种患者相比，ASL患者使用双词短语的频率明显更低，失语的时间也更早，在正常关系中，ASL患者比CDD和DP-AD患者更少。在回归过程中，CDD比ASL更频繁地失去手指指向，膀胱控制比DP-AD和ASL更频繁。美国手语的恐惧程度明显低于其他3种。回归后，CDD出现癫痫和刻板印象的频率明显高于ASL。DP-PDDNOS的言语交际障碍明显轻于ASL。智商<35的儿童的自闭倾向和自闭率在四组间无显著差异。虽然CDD在回归前发育较好，回归后更清晰，但在回归后约4年左右，CDD与ASL的发育和自闭症倾向差异消失，与DP-AD和DP-PDDNOS的差异减小。CDD具有临床有效性。其发展结果可能与占自闭症人群20%至40%的ASL没有什么不同。

To study clinical validity of DSM-IV childhood disintegrative disorder (CDD), 10CDD children (M=7.7 years ; 7 male, 3 female), 11 (M=6.5 years ; 9 male, 2female) with ICD-9 disintegrative psychosis (DP) diagnosed as DSM-IV autistic disorder (AD)(DP-AD), 7 (M=6.1 years ; 5 male, 2 female) with DP diagnosed as DSM-IV PDDNOS (DP-PDDNOS), and 82 (M=5.9 years ; 62 male, 20 female) with AD with speech loss (ASL) were compared on 16, 8, and 24 variables before, during, and after regression, respectively. Among the 4 groups without significant difference in age and sex ratio, 12 variables showed a significant difference by post hoc comparisons. Before regression, CDD was significantly stronger in separation anxiety around age one than ASL, more common to use finger pointing than DP-PDDNOS and ASL, and better in bladder control than DP-AD and ASL.ASL was significantly less frequent to use a two-word phrase and earlier to lose speech than the other 3, and less common in normal relationship than CDD and DP-AD.During regression, CDD significantly more frequently lost finger pointing than ASL and bladder control than DP-AD and ASL.ASL showed significantly less commonly fearfulness than the other 3. After regression, CDD showed epilepsy and stereotypy significantly more frequently than ASL.DP-PDDNOS showed significantly milder verbal communication disturbance than ASL.The autistic tendency and rate of children with IQ<35 did not differ significantly among the 4 groups. Although CDD was better in development before regression and clearer in regression, its difference in development and autistic tendency from ASL disappeared and its differences from DP-AD and DP-PDDNOS decreased about 4 years after regression. CDD has clinical validity. Its developmental outcome may not be different from that of ASL occupying 20 to 40 % of the autism population.