Childhood disintegrative disorder with seasonal total mutism: A rare clinical presentation


1 Mental Health Research Center, Tehran Institute of Psychiatry-School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran

2 Department of Psychiatry, Isfahan University of Medical Sciences, Isfahan, Iran

3 Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran


Childhood disintegrative disorder (CDD) is a rare autistic-like clinical condition with unknown etiology, in that previously acquired age-appropriate language, social and adaptive abilities deteriorate significantly in 2-10-year-old healthy children, although physical and neurological evaluations display no observable abnormality. Our case is a 22-year-old female born of a consanguineous marriage, with the appearance of CDD symptoms in her fifth year of age following normal mental and physical development during her initial four years of life. Without any precipitating factor, she gradually lost her language abilities, social relational skills, affectionate behavior, adaptive capacities, peer play and meaningful interest in her surrounding, friends and family members over a period of 4 years, reaching a plateau in her ninth year of age. The unique special clinical symptom in this case is a seasonal total mutism, which after the beginning of her CDD symptoms is revealing every year covering the spring. As no additional physical or psychological change accompanies her total seasonal speech loss, it cannot be attributed to any mental condition known as having a seasonal pattern. Because in the literature CDD is presented mostly as case reports with lacking of advanced research data, describing any new case is recommended to improve the knowledge about this rare condition, especially if it displays some new unusual signs, not reported till now.


Landa R. Early communication development and intervention for children with autism. Ment Retard Dev Disabil Res Rev 2007;13:16-25.   Back to cited text no. 1
Charan SH. Childhood disintegrative disorder. J Pediatr Neurosci 2012;7:55-7.   Back to cited text no. 2
[PUBMED]  Medknow Journal  
Homan KJ, Mellon MW, Houlihan D, Katusic MZ. Brief report: Childhood disintegrative disorder: A brief examination of eight case studies. J Autism Dev Disord 2011;41:497-504.   Back to cited text no. 3
Jaydeokar S, Bal G, Shah N. Childhood disintegrative disorder: A case report. Indian J Psychiatry 1997;39:85.   Back to cited text no. 4
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4 th ed. Text revision (DSM-IV-TR). Washington, DC, USA: American Psychiatric Publishing; 2000.   Back to cited text no. 5
Zwaigenbaum L, Szatmari P, Mahoney W, Bryson S, Bartolucci G, MacLean J. High functioning autism and childhood disintegrative disorder in half brothers. J Autism Dev Disord 2000;30:121-6.   Back to cited text no. 6
Mouridsen SE. Childhood disintegrative disorder. Brain Dev 2003;25:225-8.   Back to cited text no. 7
Malhotra S, Gupta N. Childhood disintegrative disorder. J Autism Dev Disord 1999;29:491-8.   Back to cited text no. 8
Malhotra S, Gupta N. Childhood disintegrative disorder. Re-examination of the current concept. Eur Child Adolesc Psychiatry 2002;11:108-14.   Back to cited text no. 9
Muhle R, Trentacoste SV, Rapin I. The genetics of autism. Pediatrics 2004;113:e472-86.   Back to cited text no. 10
Hu-Lince D, Craig DW, Huentelman MJ, Stephan DA. The Autism genome project: Goals and strategies. Am J Pharmacogenomics 2005;5:233-46.   Back to cited text no. 11
Rau JD. Is it autism? Contemp Pediatr 2003;20:54-82.   Back to cited text no. 12
Dinca O, Paul M, Spencer NJ. Systematic review of randomized controlled trials of atypical antipsychotics and selective serotonin reuptake inhibitors for behavioral problems associated with pervasive developmental disorders. J Psychopharmacol 2005;19:521-32.   Back to cited text no. 13
Avasthi A, Khehra N, Gupta N. A follow up study of seasonality in affective disorders: A preliminary study. Indian J Psychiatry 2007;49:49-51.   Back to cited text no. 14
[PUBMED]  Medknow Journal  
Magnusson A. An overview of epidemiological studies on seasonal affective disorder. Acta Psychiatr Scand 2000;101:176-84.   Back to cited text no. 15
Kasper S, Wehr TA, Bartko JJ, Gaist PA, Rosenthal NE. Epidemiological findings of seasonal changes in mood and behavior. A telephone survey of Montgomery County, Maryland. Arch Gen Psychiatry 1989;46:823-33.   Back to cited text no. 16
Winthorst WH, Post WJ, Meesters Y, Penninx BW, Nolen WA. Seasonality in depressive and anxiety symptoms among primary care patients and in patients with depressive and anxiety disorders; results from the Netherlands study of depression and anxiety. BMC Psychiatry 2011;11:198.   Back to cited text no. 17
Gruber NP, Dilsaver SC. Bulimia and anorexia nervosa in winter depression: Lifetime rates in a clinical sample. J Psychiatry Neurosci 1996;21:9-12.   Back to cited text no. 18
Ghadirian AM, Marini N, Jabalpurwala S, Steiger H. Seasonal mood patterns in eating disorders. Gen Hosp Psychiatry 1999;21:354-9.   Back to cited text no. 19
Petridou E, Papadopoulos FC, Frangakis CE, Skalkidou A, Trichopoulos D. A role of sunshine in the triggering of suicide. Epidemiology 2002;13:106-9.   Back to cited text no. 20
Cassidy F, Carroll BJ. Seasonal variation of mixed and pure episodes of bipolar disorder. J Affect Disord 2002;68:25-31.   Back to cited text no. 21
Lee HJ, Kim L, Joe SH, Suh KY. Effects of season and climate on the first manic episode of bipolar affective disorder in Korea. Psychiatry Res 2002;113:151-9.   Back to cited text no. 22
Shapira A, Shiloh R, Potchter O, Hermesh H, Popper M, Weizman A. Admission rates of bipolar depressed patients increase during spring/summer and correlate with maximal environmental temperature. Bipolar Disord 2004;6:90-3.   Back to cited text no. 23
Volpe FM, Del Porto JA. Seasonality of admissions for mania in a psychiatric hospital of Belo Horizonte, Brazil. J Affect Disord 2006;94:243-8.   Back to cited text no. 24
Lee HC, Tsai SY, Lin HC. Seasonal variations in bipolar disorder admissions and the association with climate: A population-based study. J Affect Disord 2007;97:61-9.   Back to cited text no. 25
Nurnberger JI Jr, Adkins S, Lahiri DK, Mayeda A, Hu K, Lewy A, et al. Melatonin suppression by light in euthymic bipolar and unipolar patients. Arch Gen Psychiatry 2000;57:572-9.   Back to cited text no. 26
Wahlund B. Melatonin in psychiatric disorders - subtyping affective disorder. Biol Signals Recept 1999;8:120-5.   Back to cited text no. 27
Saeed SA, Bruce TJ. Seasonal affective disorders. Am Fam Physician 1998;57:1340-6, 1351-2.   Back to cited text no. 28
Guzman A, Tonelli LH, Roberts D, Stiller JW, Jackson MA, Soriano JJ, et al. Mood-worsening with high-pollen-counts and seasonality: A preliminary report. J Affect Disord 2007;101:269-74.   Back to cited text no. 29
Goodwin FK, Jamison KR. Manic-Depressive Illness. 1 st ed. New York, USA: Oxford University Press, Inc.; 1990.   Back to cited text no. 30
Soriano JJ, Ciupagea C, Rohan KJ, Neculai DB, Yousufi SM, Guzman A, et al. Seasonal variations in mood and behavior in Romanian postgraduate students. ScientificWorldJournal 2007;7:870-9.  Back to cited text no. 31