CHILDHOOD ONSET PERVASIVE DEVELOPMENTAL DISORDER

Two male children meeting criteria for Childhood Onset Pervasive Developmental Disorder (COPDD) are described. The current DSM-III category of COPDD may have value in separating these children from others with PDD. The authors suggest that these two children, and other children described in the literature as having dementia infantalis and/or disintegrative psychosis, have a distintegrative disorder resulting in muteness, profound mental retardation and severe autistic symptomatology. The term "pervasive disintegrative disorder" may be appropriate for such children and specific diagnostic criteria are suggested. The disorder appears to be extremely rare, with a prevalence estimate of 0.11 per 10,000.     

The Frequency and Distribution of Spontaneous Attention Shifts between Social and Nonsocial Stimuli in Autistic, Typically Developing, and Nonautistic Developmentally Delayed Infants

Spontaneous shifts of attention were observed in autistic, typically developing, and nonautistic developmentally delayed infants. Three types of attention shifting behaviour were observed; (1) between an object and another object, (2) between an object and a person, and (3) between a person and another person. The two control groups shifted attention more frequently between an object and a person than between an object and another object or between a person and another person. The infants with autism showed a different pattern, shifting attention between an object and another object more than any other type of shift. Furthermore, infants with autism showed fewer shifts of attention between an object and a person, and between person and person, than did the two control groups. They also spent less time overall looking at people and looked more briefly at people and for longer durations at objects, compared to the two control groups. These results indicate an abnormality in social orientation in autism even at the early age of 20 months.     

The Emanuel Miller Memorial Lecture 1997: Change and Continuity in the Development of Children with Autism

The developmental approach to childhood psychopathology identifies deviations from typical patterns of development and stability of individual characteristics over time, and precursors in early life of later functions. The application of this approach to the social, communicative, and cognitive development of children with autism is discussed. Results from a longitudinal study of children with autism and other developmental disorders are described, indicating that children with autism have stable deficits in joint attention, representational play, and responsiveness to the emotions of others, and that early variations in these abilities are important for concurrent and subsequent language development and for peer engagement many years later.     

Transformer les pratiques entre la psychiatrie de l’enfant et de l’adolescent et la psychiatrie de l’adulte pour une réelle prévention

It is estimated that around 20% of children in the general population have a parent affected by a major psychiatric disease such as schizophrenia, bipolar disorder or recurrent major depressive disorder. Nevertheless, we face the “medical paradox” in which these children most at risk, born to an affected parent, are overlooked by our health systems. These children are indeed 15 to 20 times more likely to develop a psychiatric disorder as young adults, and 50% of them present childhood developmental or behavioural problems deserving treatment. Several indicators of brain dysfunctions, or risk endophenotypes, carried by adult patients can be detected early in the life of these children, thus making it possible to differentiate the child at highest risk among the siblings in the same family. These discoveries support the neurodevelopmental hypothesis of schizophrenia, bipolar disorder and recurrent major depression and the partially shared origin of these three disorders. In this selective scientific review, we will discuss data suggesting that, among children at risk, those who progress towards the illness cumulate risk indicators during their early trajectory. This aggregation phenomenon can serve as an empirical ground for the definition of preclinical stages in the risk trajectory and the development of clinical practice guidelines regarding surveillance or prevention in these children. Governmental legislations have already been promulgated in several countries with mitigated success to change the situation for these high-risk children and families. Based on existing scientific data, we thus propose that clinical practice guidelines be delivered by national medical academies so as to bring about the needed changes, improve communication between primary care, and specialized care and foster functional connections between child and adult psychiatry.