Developmental regression in children

Volume 1 Issue 4 October, 2011

Two cases seen in our hospital recently are briefly described. These lead to increased discussions within us on the approach to such cases. The focus in this brief write up is to encourage the readers to inform themselves about autism when faced with such clinical scenarios. Recognizing that information is easily done in today’s age, we have instead touched upon various thought processes in such instances.

Case-1 5 year 3 month old boy, with normal development till 2 year 5 months of age presented with regression of language and complete cessation of speech by 3 years along with few repetitive motor behaviours, poor non verbal communication and impaired social interaction. He shows some inclination to social imitative play and ill sustained eye contact. He also has increased activity levels needing constant supervision and is restless and fidgety since the age of 3 years.

Case-2 5 year old boy, born of second degree consanguineous marriage, had delay in language milestones since birth. He presented with poor social interaction, poor imitative play and repetitive motor behaviours since three months with gradual decline and complete cessation of speech since 20 days associated with significant loss of motor skills.

The two large streams of neurodegenerative disorders one considers in such a situation include: Grey matter diseases and white matter diseases. A good summary of each of these diseases may be obtained from the following sources:
http://www.pediatriconcall.com/fordoctor/Conference_abstracts/NEUROGENETICSDEL/Greymat.asp and also at
http://www.vumc.com/afdelingen/Children-White-Matter-Disorders. On the other hand, the number of children with gradual onset of socio-communication difficulties after an apparent period of ‘normal’ development leading to a diagnosis of Autism and other pervasive developmental disorders has been very common in our hospital. Also, the children with autism are more likely to improve with intensive early interventions. We were faced with different possible courses of action as getting clear diagnosis was going to involve a lot of expense and time. Often awaiting diagnostic clarifications leads to reduced energy towards possible interventions.

A majority of children may not fall into the category of neurodegenerative disorders. Autism Spectrum Disorders (ASD) are an increasingly recognized group of childhood disorders where regression may be seen in nearly a third to half of cases before 3 years of age. Many other children with ASD may show delayed development from the beginning. All regressive disorders may not be ASD, but ASD is more likely to improve substantially with intensive early intervention. Recent studies following up siblings of children with Autism has suggested that regression may be in much higher proportion and may involve subtle losses in motor functions too (John Constantino, The Genetics of Autism, April 2010, UC Davis, MIND lectures available free on iTunes).

Families may end up spending a lot of money ruling out a long list of storage disorders. They may also be losing valuable time when early intervention must be getting started. Secondly, there is also a strong urge to provide reassurance to families amongst the medical profession. Some of the delay in availing intervention can be traced to the family doing nothing because the doctors were reassuring.

A lot of information on autism is available today easily. (www.autismspeaks.org and www.autism-india.org,
www.autismsocietyofindia.org). A global autism convention was held at Bangalore recently. A whole lot of interventions as is practiced in India (and overseas) were presented and discussed. Anyone wishing to have a copy of the book of abstracts may write to autismseminar2011@gmail.com. A book with full text articles from this meeting will be published soon. The scope for establishing specialized training programmes at every taluk level is very high. We urge the readers to develop special education units locally with help of technical inputs available with several organisations within the state. The results will be gratifying indeed.