Multiple-complex Developmental Disorder:
Multiple-complex Developmental Disorder (McDD) represents a distinct group within the autism spectrum based on symptomatology.
Ever since autism was first recognized, its continuity with schizophrenia has been a matter of debate. In fact, until the late 1970s, children with autism were often labeled as having "childhood schizophrenia." In the last thirty years, however, the term "childhood schizophrenia" has been displaced. Diagnostic criteria for autism have been established that rely solely on social, communicative and sensorimotor symptoms, without reference to the thought disorders typical of schizophrenia.
Nevertheless, there are some children who display the severe, early-appearing social and communicative deficits characteristic of autism who ALSO display some of the emotional instability and disordered thought processes that resemble schizophrenic symptoms. Cohen, et al. (1986), coined the term Multiplex Developmental Disorder (MDD) to describe these children, although they are often given a diagnosis of PDD-NOS by clinicians who may be unfamiliar with this terminology. Unlike schizophrenia, MDD symptoms emerge in childhood, sometimes in the first years of life, and persist throughout development.
Multiplex developmental disorder is diagnosed in people who are on both the autism and schizophrenia spectrums. Their intelligence and emotional range run the gamut. There is a high rate of co-morbidity with learning disorders, AD/HD, obsessive-compulsive disorder, depression, bipolar disorder, social anxiety disorder, Tourette's syndrome, personality disorders, epilepsy, and phobias.
McDD is a developmental disorder with symptoms that can be divided into three groups.
A. Regulation of emotion. (Affective symptoms) – two or more of the following.
1. Depressive symptoms such as consistent depressed mood, feelings of sadness or emptiness, thoughts of death, little interest or pleasure in activities, chronic fatigue, feelings of worthlessness or guilt.
2. Manic symptoms such as racing thoughts, irritability, distractibility, psychomotor agitation, impulsivity, sleep disturbances, feelings of grandiosity or extreme self worth, risky behavior.
3. Anxious symptoms such as recurrent panic, intense inappropriate anxiety, dissociation, diffuse tension, paranoia, unusual fears and phobias that are peculiar in content or in intensity.
4. Severely impaired regulation of feelings.
5. Significant and wide emotional variability with or without environmental precipitants.
B. Consistent impairments in social behavior and development (Autistic symptoms) - at least two from (A) and one from (B) or (C).
(A) Qualitative impairment in social interaction.
1. Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
2. Failure to develop peer relationships appropriate to developmental level
3. A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people
4. Lack of social or emotional reciprocity
(B) Qualitative impairments in communication.
1. Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
2. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
3. Stereotyped and repetitive use of language or idiosyncratic language
4. Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
(C) Restricted repetitive and stereotyped patterns of behavior, interests and activities.
1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
2. Apparently inflexible adherence to specific, nonfunctional routines or rituals
3. Stereotyped and repetitive motor mannerisms
4. Persistent preoccupation with parts of objects
C. Impaired cognitive processing (psychotic symptoms) – two or more of the following.
1. Delusions, including fantasies of personal omnipotence, thought insertion, paranoid preoccupations, overengagement 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, or avolition)
4. Disorganized or catatonic behavior such as thought disorder symptoms, easy confusability, inappropriate emotions/facial expressions, uncontrollable laughter, etc.
5. Disorganized speech.
Other possible symptoms. (Does not count for diagnosis)
-Poor sensory integration/moter skills.
-Compulsive behavior and tics.
-Learning disorders.
-Poor judgement/difficulty making decisions.
-Difficulty expressing self.
-Literal concrete thinking.
-Poor concentration.
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