Autism spectrum disorder, very-early onset schizophrenia, and child disintegrative disorder: the challenge of diagnosis. A case-report study

Abstract

BackgroundAutism spectrum disorder (ASD) in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) contains several disorders previously present as distinct diagnoses in the DSM Revised Fourth Edition (DSM-IV-TR). These include child disintegrative disorder (CDD). The latter presents typical features, such as a late regression of developmental acquisitions. However, it also shows symptoms similar to ASD, and psychotic symptoms, such as very-early onset schizophrenia (VEOS), are described in the literature.Case reportIn this case report we deepen the case of P., a child who presents a late regression, at 7 years old, associated with psychotic symptoms in the absence of organic alterations. The child was treated with antipsychotic drug therapy and cognitive behavioral therapy. P. was diagnosed with ASD with acute and late regression associated with psychotic symptoms. During the follow-up, there was a gradual improvement in the clinical conditions. Improvements were possible due to therapeutic intervention (pharmacological and psychotherapeutic) and/or the natural course of the disorder.ConclusionThe diagnostic difficulty of this case reflects a clinical complexity in which it is not easy to distinguish between neurodevelopmental and psychiatric aspects. Clinical cases such as that of P. emphasize the theme of the neurodevelopment continuum model in which neurodevelopmental and psychiatric disturbances can be considered within a pattern of pathological continuity.

Treatment of Aggressive Behavior and Agitation in a 11-Year-Old Boy With Co-occurring Autism and ADHD: A Case Report and Literature Review on the Use of Intravenous Valproate in Emergency Psychiatry

“…It is characterized by restricted interests, repetitive and stereotyped behaviors, and abnormal sensory processing. Neurodevelopmental atypia can be observed early in the development of most children with ASD [1], and it persists life long. Both clinical presentation of symptoms and their severity can vary greatly depending on age, cognitive and language abilities.…”

Treatment of Aggressive Behavior and Agitation in an 11-Year-Old Boy with Co-Occurring Autism and ADHD: A Case Report and Literature Review on the Use of Intravenous Valproate in Emergency Psychiatry

“…Clinical similarities between the two disorders are common, as they share symptoms of inattention and hyperactivity/impulsivity and a high occurrence of at least one psychiatric condition (approximately 80% in ADHD patients and 75% in ASD patients) [ 1 ]. This aspect can complicate the clinical diagnosis [ 2 ] and pharmacological management of ASD [ 3 ]. It has been described that patients with ASD and ADHD experience episodes of psychomotor agitation, with or without aggressive behaviors, more frequently than the general population compared to children with ASD alone, maybe due to a combination of factors, including cognitive dysfunctions, psychiatric disorders, difficulties in communication, and problems adapting to the surrounding environment [ 2 , 3 ].…”

“…This aspect can complicate the clinical diagnosis [ 2 ] and pharmacological management of ASD [ 3 ]. It has been described that patients with ASD and ADHD experience episodes of psychomotor agitation, with or without aggressive behaviors, more frequently than the general population compared to children with ASD alone, maybe due to a combination of factors, including cognitive dysfunctions, psychiatric disorders, difficulties in communication, and problems adapting to the surrounding environment [ 2 , 3 ]. This fact is associated with a resistance to conventional treatments, especially pharmacologically [ 4 , 5 , 6 , 7 ].…”

“…As previously explained, these patients with comorbid ASD–ADHD often experience acute psychomotor agitation, defined as a state of heightened anxiety, irritability, increased motor and verbal activities, uncooperativeness, and threatening gestures, more so than patients with only one of the two neurodevelopmental disorders [ 2 , 8 ]. In principle, an effective psychopharmacological intervention should achieve a reduction in agitation, promote calmness, and restore contact within two hours [ 4 ].…”

“…In principle, an effective psychopharmacological intervention should achieve a reduction in agitation, promote calmness, and restore contact within two hours [ 4 ]. However, pharmacological treatment for acute agitation and aggressive behaviors can be challenging for clinicians [ 3 , 4 , 5 , 6 , 7 , 8 ], and this comorbidity can present unique challenges in terms of diagnosis [ 2 ], treatment [ 11 , 12 , 13 ], and overall management [ 10 ]. Understanding the interplay between these two neurodevelopmental disorders is crucial for providing comprehensive and effective care for those patients who have both conditions.…”