Multiple complex developmental disorder

Not to be confused with Multisystem developmental disorder.

Multiple complex developmental disorder is a research category, proposed to involve several neurological and psychological symptoms where at least some symptoms are first noticed during early childhood and persist throughout life. It was originally suggested to be a subtype of autistic spectrum disorders (PDD) with co-morbid schizophrenia or another psychotic disorder, however there is some controversy that not everyone with MCDD meets criteria for both PDD and psychosis. The term multiplex developmental disorder was coined by Simon Baron-Cohen in 1986.

Diagnostic Criteria

The current diagnostic criteria for MCDD is a matter of debate due to it not being in the DSM-IV or ICD-10. Various websites contain various diagnostic criteria. At least three of the following categories should be present. Co-occurring clusters of symptoms must also not be better explained by being symptoms of another disorder such as experiencing random mood swings due to autism, cognitive difficulties due to schizophrenia, and so on. The exact diagnostic criteria for MCDD remains unclear but may be a useful diagnosis for people who do not fall into any specific category. It could also be argued that MCDD is a vague and unhelpful term for these patients.

Psychotic Symptoms

Criteria is met for a psychotic disorder.

Some symptoms may include:

1. Delusions, such as thought insertion, paranoid preoccupations, fantasies of personal omnipotence, over engagement with fantasy figures, grandiose fantasies of special powers, referential ideation, and confusion between fantasy and real life.
2. Hallucinations and/or unusual perceptual experiences.
3. Negative symptoms (anhedonia, affective flattening, alogia, avolition)
4. Disorganized behavior and/or speech such as thought disorder, easy confusability, inappropriate emotions/facial expressions, uncontrollable laughter, etc.
5. Catatonic behavior.

Neurotic and Behavioral Symptoms

These symptoms are not due to situations such as, person is depressed because of difficulty making friends. It is normal to experience dysfunctional emotions and behaviors at times. Criteria is met for a neurotic or personality disorder, preferably at least two.

Some symptoms may include:

1. Depression.
2. Mania.
3. Anxiety.
4. Anger.
5. Dissociative symptoms such as depersonalization, derealization, deja vu, etc.
6. Emotional instability.
7. Psychopathic behavior.
8. Narcissism.
9. Paranoia.
10. Obsessive-compulsive behavior.

Autistic Symptoms

Criteria is met for an autistic spectrum disorder.

Some symptoms may include:

1. Difficulty with social skills.
2. Repetitive behaviour and patterns.
3. Sensory integration disorder. (Poor motor skills, poor auditory processing, poor depth perception, etc.)
4. Alexithymia. (Difficulty expressing self, difficulty understanding emotions, literal concrete thinking, etc.)
5. lack of eye contact.
6. Intense, singular interests.
7. Low interest in dress up games during childhood.

Neurological Symptoms

Because these are frequently found in cases of autistic disorders, criteria should be met for multiple neurological disorders, or cause severe symptoms.

Some examples include:

1. Learning difficulties symptoms such as dyslexia, dysgraphia, dyscalcula, NVLD, slow learning, poor memory, etc.
2. AD/HD symptoms such as poor concentration, poor decision making, poor judgement, impulsiveness, difficulty sitting still, etc.
3. Synesthesia.
4. Neurological sleep disorders such as narcolepsy, insomnia, circadian rhythm disorder, etc.
5. Conditions affecting perceptions and/or cognition, such as agnosia, aphasia, etc.
6. Tourette's or Tic disorder.
7. Epilepsy or Seizure disorder.
8. Parkinsonian features such as tremors, stiff movements, etc.
9. Mental retardation.

MCDD savants

Some people with MCDD who also have savant abilities associated with different symptoms may have some advantages despite their disability because their unusual range of symptoms allows them to have a lot of creativity and an alternative thought processes. Several people famous in history have been thought to have features of autism and psychosis but were at the time, undiagnosable.

Causes

Multiple complex developmental disorder is likely to be caused by a number of different various genetic factors. Each individual with MCDD is unique from one another and displays different symptoms. Various neuropsychological disorders can also be found in family members of people with MCDD.

References

PubMed sources

Multiple complex developmental disorder

• Lahuis, E.; Van Engeland, H.; Cahn, W.; Caspers, E.; Van Der Geest, N.; Van Der Gaag, J.; Kemner, C. (Feb 2008). "Smooth pursuit eye movement (SPEM) in patients with multiple complex developmental disorder (MCDD), a subtype of the pervasive developmental disorder". The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry 10 (4 Pt 3): 1–8. doi:10.1080/15622970801901828. ISSN 1562-2975. PMID 18609441.  edit
• Sprong, M.; Becker, E.; Schothorst, F.; Swaab, H.; Ziermans, B.; Dingemans, M.; Linszen, D.; Van Engeland, H. (Feb 2008). "Pathways to psychosis: a comparison of the pervasive developmental disorder subtype Multiple Complex Developmental Disorder and the "at Risk Mental State"". Schizophrenia research 99 (1–3): 38–47. doi:10.1016/j.schres.2007.10.031. ISSN 0920-9964. PMID 18055179.  edit
• Lahuis, E.; Durston, S.; Nederveen, H.; Zeegers, M.; Palmen, J.; Van Engeland, H. (Sep 2008). "MRI-based morphometry in children with multiple complex developmental disorder, a phenotypically defined subtype of pervasive developmental disorder not otherwise specified". Psychological Medicine 38 (9): 1361–1367. doi:10.1017/S0033291707001481. ISSN 0033-2917. PMID 17825125.  edit
• Herba, M.; De Bruin, E.; Althaus, M.; Verheij, F.; Ferdinand, F. (Apr 2008). "Face and emotion recognition in MCDD versus PDD-NOS". Journal of autism and developmental disorders 38 (4): 706–718. doi:10.1007/s10803-007-0438-5. ISSN 0162-3257. PMC 2268724. PMID 17721812. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2268724.  edit
• De Bruin, I.; De Nijs, F.; Verheij, F.; Hartman, A.; Ferdinand, F. (Jul 2007). "Multiple Complex Developmental Disorder Delineated from PDD-NOS". Journal of Autism and Developmental Disorders 37 (6): 1181–1191. doi:10.1007/s10803-006-0261-4. ISSN 0162-3257. PMID 17066306.  edit
• Masi, G. M. (2006). "Children with schizophrenia: clinical picture and pharmacological treatment". CNS drugs 20 (10): 841–866. ISSN 1172-7047. PMID 16999454.  edit
• Sturm, H.; Fernell, E.; Gillberg, C. (Jul 2004). "Autism spectrum disorders in children with normal intellectual levels: associated impairments and subgroups". Developmental medicine and child neurology 46 (7): 444–447. doi:10.1111/j.1469-8749.2004.tb00503.x. ISSN 0012-1622. PMID 15230456.  edit
• Jansen, M.; Gispen-De Wied, C.; Van Der Gaag, J.; Van Engeland, H. (Mar 2003). "Differentiation between Autism and Multiple Complex Developmental Disorder in Response to Psychosocial Stress" (Free full text). Neuropsychopharmacology 28 (3): 582–590. doi:10.1038/sj.npp.1300046. ISSN 0893-133X. PMID 12629541.  edit
• Ad-Dab???bagh, Y.; Greenfield, B. (2001). "Multiple Complex Developmental Disorder: the ???Multiple and Complex??? Evolution of the ???Childhood Borderline Syndrome??? Construct". Journal of the American Academy of Child & Adolescent Psychiatry 40: 954. doi:10.1097/00004583-200108000-00018.  edit
• Jansen, L. G. D. (Nov 2000). "Unresponsiveness to psychosocial stress in a subgroup of autistic-like children, multiple complex developmental disorder". Psychoneuroendocrinology 25 (8): 753–764. doi:10.1016/S0306-4530(00)00020-2. ISSN 0306-4530. PMID 10996471.  edit
• Ad-Dab'Bagh, Y. G. (May 2000). "Inpatient treatment of severe disruptive behaviour disorders with risperidone and milieu therapy". Canadian Journal of Psychiatry 45 (4): 376–382. ISSN 0706-7437. PMID 10813072.  edit
• Kemner, C. V. (Sep 1999). "ERP differences among subtypes of pervasive developmental disorders". Biological psychiatry 46 (6): 781–789. doi:10.1016/S0006-3223(99)00003-7. ISSN 0006-3223. PMID 10494446.  edit
• Buitelaar, Jk; Van, Der (Sep 1998). "Diagnostic rules for children with PDD-NOS and multiple complex developmental disorder". Journal of child psychology and psychiatry, and allied disciplines 39 (6): 911–9. doi:10.1017/S0021963098002820. ISSN 0021-9630. PMID 9758199.  edit
• Lincoln, A. J.; Bloom, D.; Katz, M.; Boksenbaum, N. (1998). "Neuropsychological and Neurophysiological Indices of Auditory Processing Impairment in Children with Multiple Complex Developmental Disorder". Journal of the American Academy of Child & Adolescent Psychiatry 37 (1): 100–112. doi:10.1097/00004583-199801000-00023. PMID 9444906.  edit
• Van, D. (Aug 1995). "A controlled multivariate chart review of multiple complex developmental disorder". Journal of the American Academy of Child and Adolescent Psychiatry 34 (8): 1096–1106. doi:10.1097/00004583-199508000-00021. ISSN 0890-8567. PMID 7665449.  edit
• Towbin, K. E.; Dykens, E. M.; Pearson, G. S.; Cohen, D. J. (1993). "Conceptualizing "Borderline Syndrome of Childhood" and "Childhood Schizophrenia" as a Developmental Disorder". Journal of the American Academy of Child & Adolescent Psychiatry 32 (4): 775–782. doi:10.1097/00004583-199307000-00011. PMID 8340298.  edit

Multiplex developmental disorder

• Scheeringa, M. (Fall 2001). "The differential diagnosis of impaired reciprocal social interaction in children: a review of disorders". Child psychiatry and human development 32 (1): 71–89. doi:10.1023/A:1017511714145. ISSN 0009-398X. PMID 11579660.  edit
• Zalsman, G; Cohen, Dj (1998). "Multiplex developmental disorder". The Israel journal of psychiatry and related sciences 35 (4): 300–6. ISSN 0333-7308. PMID 9988988.  edit
• Paul, R. C. (Jan 1999). "Multiplex developmental disorders. The role of communication in the construction of a self" (Free full text). Child and adolescent psychiatric clinics of North America 8 (1): 189–202, viii. ISSN 1056-4993. PMID 9894036. http://www.nlm.nih.gov/medlineplus/developmentaldisabilities.html.  edit
• Klin, A. M. (Jun 1995). "Multiplex developmental disorder". Journal of developmental and behavioral pediatrics : JDBP 16 (3 Suppl): S7–11. ISSN 0196-206X. PMID 7560130.  edit

Other sources

• Weisbrot, Deborah M.; Carlson, Gabrielle A. (February 2005). ""Diagnostically Homeless": Is it ADHD? Mania? Autism? What to do if no diagnosis fits" (PDF). Current Psychiatry (Montvale, New Jersey: Dowden Health Media) 4 (2): 25–42. ISSN 1537-8276. OCLC 232115063. http://www.currentpsychiatry.com/pdf/0402/0402_Article2.pdf. Retrieved August 28, 2009. 

External links