Developmental regression

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Developmental regression is when a child who has reached a certain developmental stage begins to lose previously acquired milestones. [1] It differs from developmental delay in that a child experiencing developmental delay is either not reaching developmental milestones or not progressing to new developmental milestones, while a child experiencing developmental regression will lose milestones and skills after acquiring them. [2] Developmental regression is associated with diagnoses of autism spectrum disorder, [3] childhood disintegrative disorder, [4] Rett syndrome, [5] Landau-Kleffner syndrome, [6] and neuro-degenerative diseases. [7] The loss of motor, language, and social skills can be treated with occupational therapy, [8] physical therapy, [9] and speech therapy. [10]

Contents

Associated Diagnoses

Developmental regression is typically a symptom of neurological disorder.

Autism Spectrum Disorder

Autism spectrum disorder is a developmental disorder in which a child's communication and social skills are affected. [11] Children with autism spectrum disorder can experience a loss of their previously acquired language and social skills. This is often reported by the child's parents. [3] Children can experience loss of vocabulary and language understanding, as well as no longer make eye contact or play social and imitative games when they previously had. [3] They can also experience a loss of motor and basic skills like toileting or feeding themselves. [3] In autism spectrum disorder, this regression occurs in the first few years of development. [3]

Childhood Disintegrative Disorder

Childhood disintegrative disorder (CDD) is a developmental disorder in which children experience a regression of social language, and motor functioning skills. [4] CDD was merged with autism spectrum disorder in the DSM-V in 2013. [4] Children with CDD can experience a loss of expressive and receptive language skills, social and self-care skills, play skills, and/or motor skills. [4] Regression commonly occurs at around 3 or 4 years old, but after at least two years of normal development and before age 10. [4]

Rett Syndrome

Rett syndrome is a neurodevelopmental disorder caused by a genetic mutation. [5] It occurs almost exclusively in girls. [5] A child with Rett syndrome experiences a loss of previously had intentional hand skills, and can experience a loss of language skills. [5] Children can also experience a loss of social skills and autism-like symptoms. [5] The regression typically occurs between 1–4 years of age. [5]

Landau-Kleffner Syndrome

Landau-Kleffner syndrome is a form of epilepsy associated with a loss of language skills. [6] Those with LKS lose their ability to understand spoken language and to verbally express themselves. [12] LKS typically has an onset of between the ages of 2 and 8 years old. [6]

Neuro-degenerative diseases

Neuro-degenerative diseases (disorders like Batten disease) can result in a child losing previously acquired motor, language, and speech skills. [7]

Signs and symptoms

Children with developmental regression lose developmental milestones they have previously gained. These can be motor, social, or language skills. The loss of motor skills could include loss of the ability to purposefully use hands, [5] loss of the ability to feed oneself, [5] loss of the ability to walk, [5] loss of the ability to bathe oneself, [8] and loss of the ability to dress oneself. [8] The loss of social skills could include loss of the ability/desire to play, [4] loss of the ability to make appropriate eye contact, [11] and loss of interest in playing social games. [3] The loss of language skills could include the loss of a child's ability to understand spoken speech and sounds (receptive language skills) [4] [6] and/or the loss of a child's ability to use words/spoken language (expressive language skills). [4] [5]

Diagnosis

The American Academy of Pediatrics recommends that most children receive a developmental screening at their 9-month, 18 month, and 30 month physical exams. [13] Physicians also screen children for autism spectrum disorder at their 18-month and 2 year appointments. [13] If the screening indicates a potential problem, a physician would then perform a developmental evaluation to identify the specific developmental areas affected and assess the child's needs. [13] Parents can also monitor their children and inform their provider if their child has lost previously reached developmental milestones. [13]

Treatment

For treatment of regression of motor skills, occupational and physical therapy can be used. [5] Occupational therapy can help children regain some of their lost fine motor skills. An occupational therapist can help a child improve their fine motor skills and hand-eye coordination so they can complete basic life tasks like bathing or feeding themselves, and fine motor skill tasks like writing. [8] Physical therapy can be used to treat regression of gross motor skills. Physical therapists can help a child with skills like walking or mobility issues. [9]

Speech therapy is often used for treatment of regression of language skills. [6] Speech therapists will help a child restore as much of their lost language skills as possible, and help a child learn to communicate, potentially with the use of communication aids. [10]

Social skills training can be used to treat a regression of social skills. Children who receive social skills training are taught age-appropriate social skills like problem solving and peer interaction skills. [14]

For regression related to seizures, medication can be used to treat the seizures. [6]

See also

Related Research Articles

<span class="mw-page-title-main">Rett syndrome</span> Genetic brain disorder

Rett syndrome (RTT) is a genetic disorder that typically becomes apparent after 6–18 months of age and almost exclusively in females. Symptoms include impairments in language and coordination, and repetitive movements. Those affected often have slower growth, difficulty walking, and a smaller head size. Complications of Rett syndrome can include seizures, scoliosis, and sleeping problems. The severity of the condition is variable.

The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), was a group of disorders characterized by delays in the development of multiple basic functions including socialization and communication. It was defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the International Classification of Diseases (ICD).

Developmental disorders comprise a group of psychiatric conditions originating in childhood that involve serious impairment in different areas. There are several ways of using this term. The most narrow concept is used in the category "Specific Disorders of Psychological Development" in the ICD-10. These disorders comprise developmental language disorder, learning disorders, motor disorders, and autism spectrum disorders. In broader definitions ADHD is included, and the term used is neurodevelopmental disorders. Yet others include antisocial behavior and schizophrenia that begins in childhood and continues through life. However, these two latter conditions are not as stable as the other developmental disorders, and there is not the same evidence of a shared genetic liability.

Pervasive developmental disorder not otherwise specified (PDD-NOS) is a historic psychiatric diagnosis first defined in 1980 that has since been incorporated into autism spectrum disorder in the DSM-5 (2013).

Childhood disintegrative disorder (CDD), also known as Heller's syndrome and disintegrative psychosis, is a rare condition characterized by late onset of developmental delays—or severe and sudden reversals—in language, social engagement, bowel and bladder, play and motor skills. Researchers have not been successful in finding a cause for the disorder. CDD has some similarities to autism and is sometimes considered a low-functioning form of it. In May 2013, CDD, along with other sub-types of PDD, was fused into a single diagnostic term called "autism spectrum disorder" under the new DSM-5 manual.

Hypotonia is a state of low muscle tone, often involving reduced muscle strength. Hypotonia is not a specific medical disorder, but a potential manifestation of many different diseases and disorders that affect motor nerve control by the brain or muscle strength. Hypotonia is a lack of resistance to passive movement, whereas muscle weakness results in impaired active movement. Central hypotonia originates from the central nervous system, while peripheral hypotonia is related to problems within the spinal cord, peripheral nerves and/or skeletal muscles. Severe hypotonia in infancy is commonly known as floppy baby syndrome. Recognizing hypotonia, even in early infancy, is usually relatively straightforward, but diagnosing the underlying cause can be difficult and often unsuccessful. The long-term effects of hypotonia on a child's development and later life depend primarily on the severity of the muscle weakness and the nature of the cause. Some disorders have a specific treatment but the principal treatment for most hypotonia of idiopathic or neurologic cause is physical therapy and/or occupational therapy for remediation.

A language delay is a language disorder in which a child fails to develop language abilities at the usual age-appropriate period in their developmental timetable. It is most commonly seen in children ages two to seven years-old and can continue into adulthood. The reported prevalence of language delay ranges from 2.3 to 19 percent.

High-functioning autism (HFA) was historically an autism classification where a person exhibits no intellectual disability, but may experience difficulty in communication, emotion recognition, expression, and social interaction.

The following outline is provided as an overview of and topical guide to autism:

Landau–Kleffner syndrome (LKS)—also called infantile acquired aphasia, acquired epileptic aphasia or aphasia with convulsive disorder—is a rare childhood neurological syndrome.

Speech delay, also known as alalia, refers to a delay in the development or use of the mechanisms that produce speech. Speech – as distinct from language – is the actual process of making sounds, using such organs and structures as the lungs, vocal cords, mouth, tongue, teeth, etc. Language delay refers to a delay in the development or use of the knowledge of language.

<span class="mw-page-title-main">Developmental coordination disorder</span> Medical condition

Developmental coordination disorder (DCD), also known as developmental motor coordination disorder, developmental dyspraxia or simply dyspraxia, is a neurodevelopmental disorder characterized by impaired coordination of physical movements as a result of brain messages not being accurately transmitted to the body. Deficits in fine or gross motor skills movements interfere with activities of daily living. It is often described as disorder in skill acquisition, where the learning and execution of coordinated motor skills is substantially below that expected given the individual's chronological age. Difficulties may present as clumsiness, slowness and inaccuracy of performance of motor skills. It is also often accompanied by difficulty with organisation and/or problems with attention, working memory and time management.

Muteness or mutism is defined as an absence of speech while conserving or maintaining the ability to hear the speech of others. Mutism is typically understood as a person's inability to speak, and commonly observed by their family members, caregivers, teachers, doctors or speech and language pathologists. It may not be a permanent condition, as muteness can be caused or manifest due to several different phenomena, such as physiological injury, illness, medical side effects, psychological trauma, developmental disorders, or neurological disorders. A specific physical disability or communication disorder can be more easily diagnosed. Loss of previously normal speech (aphasia) can be due to accidents, disease, or surgical complication; it is rarely for psychological reasons.

The floortime or Developmental, Individual-differences, Relationship-based (DIR) model is a developmental model for assessing and understanding any child's strengths and weaknesses. It has become particularly effective at identifying the unique developmental profiles and developing programs for children experiencing developmental delays due to autism, autism spectrum disorders, or other developmental disorders. This Model was developed by Dr. Stanley Greenspan and first outlined in 1979 in his book Intelligence and Adaptation. Evidence for the efficacy of DIR/Floortime includes results from randomized controlled trials of DIR/Floortime and the DIR/Floortime-based P.L.A.Y. Project; because of various limitations in these studies, the existing evidence is deemed to "weakly support" the efficacy of Floortime.

<span class="mw-page-title-main">Classic autism</span> Neurodevelopmental condition

Classic autism, also known as childhood autism, autistic disorder, (early) infantile autism, infantile psychosis, Kanner's autism,Kanner's syndrome, or (formerly) just autism, is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.

Global developmental delay is an umbrella term used when children are significantly delayed in their cognitive and physical development. It can be diagnosed when a child is delayed in one or more milestones, categorised into motor skills, speech, cognitive skills, and social and emotional development. There is usually a specific condition which causes this delay, such as Fragile X syndrome or other chromosomal abnormalities. However, it is sometimes difficult to identify this underlying condition.

Several factors complicate the diagnosis of Asperger syndrome (AS), an autism spectrum disorder (ASD). Like other ASD forms, Asperger syndrome is characterized by impairment in social interaction accompanied by restricted and repetitive interests and behavior; it differs from the other ASDs by having no general delay in language or cognitive development. Problems in diagnosis include disagreement among diagnostic criteria, the controversy over the distinction between AS and other ASD forms or even whether AS exists as a separate syndrome, and over- and under-diagnosis for non-technical reasons. As with other ASD forms, early diagnosis is important, and differential diagnosis must consider several other conditions.

<span class="mw-page-title-main">Autism spectrum</span> Neurodevelopmental disorder

Autism, formally called autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental disorder characterized by deficits in social communication and social interaction, and repetitive or restricted patterns of behaviors, interests, or activities, which can include hyper- and hyporeactivity to sensory input. Autism is a spectrum disorder, meaning that it can manifest very differently in each person. For example, some are nonspeaking, while others have proficient spoken language. Because of this, there is wide variation in the support needs of people across the autism spectrum.

Currently there is no cure for Rett syndrome. Treatment is directed towards improving function and addressing symptoms throughout life. A multi-disciplinary team approach is typically used to treat the person throughout life. This team may include primary care physician, physical therapist, occupational therapist, speech-language pathologist, nutritionist, and support services in academic and occupational settings.

ADNP syndrome, also known as Helsmoortel-Van der Aa syndrome (HVDAS), is a non-inherited neurodevelopmental disorder caused by mutations in the activity-dependent neuroprotector homeobox (ADNP) gene.

References

  1. ↑ "Developmental Regression". NCBI. Retrieved 2021-03-19.
  2. ↑ "Developmental Delay in Children". Children's Health. Retrieved April 8, 2021.
  3. 1 2 3 4 5 6 Rogers, Sally J. (2004). "Developmental regression in autism spectrum disorders". Mental Retardation and Developmental Disabilities Research Reviews. 10 (2): 139–143. doi: 10.1002/mrdd.20027 . ISSN   1080-4013. PMID   15362172.
  4. 1 2 3 4 5 6 7 8 "Childhood Disintegrative Disorder (Heller's Syndrome) CDD. Patient". patient.info. Retrieved 2021-04-04.
  5. 1 2 3 4 5 6 7 8 9 10 11 "Rett Syndrome Fact Sheet | National Institute of Neurological Disorders and Stroke". www.ninds.nih.gov. Retrieved 2021-03-19.
  6. 1 2 3 4 5 6 "Landau-Kleffner Syndrome". Epilepsy Foundation. Retrieved 2021-04-04.
  7. 1 2 "Batten Disease Fact Sheet | National Institute of Neurological Disorders and Stroke". www.ninds.nih.gov. Retrieved 2021-04-13.
  8. 1 2 3 4 "Occupational Therapy (for Parents) - Nemours KidsHealth". kidshealth.org. Retrieved 2021-04-13.
  9. 1 2 "Chapter 11: Mobility and Gross Motor Abilities - Physical Therapy". A-T Children's Project. Retrieved 2021-04-13.
  10. 1 2 "Aphasia". nhs.uk. 2017-10-24. Retrieved 2021-04-13.
  11. 1 2 "NIMH » Autism Spectrum Disorder". www.nimh.nih.gov. Retrieved 2021-04-04.
  12. ↑ "Landau-Kleffner Syndrome". www.hopkinsmedicine.org. 19 November 2019. Retrieved 2021-04-04.
  13. 1 2 3 4 CDC (2021-02-04). "Developmental Monitoring and Screening | CDC". Centers for Disease Control and Prevention. Retrieved 2021-04-17.
  14. ↑ U.S. Department of Education, Institute of Education Sciences, What Works Clearinghouse (2013). "Early Childhood Education Interventions for Children with Disabilities intervention report: Social skills training" . Retrieved 2021-04-13.{{cite web}}: CS1 maint: multiple names: authors list (link)
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