Multiplex Developmental Disorder

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 earliest childhood, often in the first years of life, and persist throughout development. Diagnostic criteria for MDD include:

1. Impaired social behavior/sensitivity, similar to that seen in autism, such as:
   • Social disinterest
   • Detachment, avoidance of others, or withdrawal
   • Impaired peer relations
   • Highly ambivalent attachments
   • Limited capacity for empathy or understanding what others are thinking or feeling
2. Affective symptoms, including:
   • Impaired regulation of feelings
   • Intense, inappropriate anxiety
   • Recurrent panic
   • Emotional lability, without obvious cause
3. Thought disorder symptoms, such as:
   • Sudden, irrational intrusions on normal thoughts
   • Magical thinking
   • Confusion between reality and fantasy
   • Delusions such as paranoid thoughts or fantasies of special powers

Children who show evidence of symptoms from ALL THREE of these categories may be classified as having MDD.

Currently, MDD is a research category, with no specific educational or treatment implications. Because we know so little about this disorder, it is premature to suggest special interventions. Children with MDD symptoms should be treated with individualized special educational programs developed in collaboration with parents, teachers, and a multidisciplinary team to address their unique strengths and needs. Parents should consult with a local child psychiatrist to determine whether medication may be useful in treating the accompanying affective and thought disorder symptoms.