What is Stereotypic Movement Disorder and How to Treat It (and Should You Treat It?)
What are stereotypic movements?
Stereotypic movements or motor stereotypies are repetitive and rhythmic body
movements with a fixed pattern that can be seen in some typically developing
children, but are most commonly associated with autism or intellectual
disability (ID). These movements are typically first seen in early childhood
(e.g. before 3 years of age) and can persist into adulthood.
What do motor stereotypies look like?
Stereotypies can be classified as being either common or complex. Common
stereotypies exist in approximately 20% of children and consist of behaviors
such as pencil tapping, hair twisting, nail biting, etc. Complex stereotypies can
include a variety and combination of motor mannerisms such as flapping,
waving, wringing hands, contorting face, etc.
My child engages in stereotypic movements, does that mean he or she
has autism?
Not necessarily. While there is a scarcity of research on stereotypies in
children without developmental disabilities and no clear answers as to what
causes the manifestation of these behaviors in some children, we do know
that these movements can be present in otherwise typically developing
children. Stereotypies can be primary, in that they appear to be purely
physiological, or secondary, meaning that they are present in association with
another neurological condition.
Complex motor stereotypies are often present with other disorders such as
attention-deficit/hyperactivity (ADHD), obsessive-compulsive disorder (OCD),
Tourette’s disorder, or autism.
What should I do if my child has started showing signs of motor
stereotypies?
Visit your child’s pediatrician to determine whether there may be other
developmental issues or underlying causes.
Why do children engage in stereotypies?
Stereotypies can occur when the child is engrossed in an activity, when bored,
stressed, excited or tired. There can be biological and psychological factors
contributing to the presence of these movements. However, most evidence
points to a biological basis for these movements, including a combination of
genetics and how a child’s sensory system is impacted by the level of
stimulation present in the environment.
Can repetitive movements go away on their own?
Some movements may stop, slow down or become less severe over time.
Kids who have more complex movements are more likely to have their
symptoms persist into adulthood.
Can medication help children who engage in stereotypic movements?
There are no established pharmacological treatments for motor stereotypies in
typically developing children. For children with co-existing developmental or
psychological diagnoses, psychopharmacological treatments for Stereotypic
Movement Disorder include the use of atypical antipsychotic drugs such as
Risperdal and Clozaril (usually used to treat schizophrenia and mood
disorders). These can lesson children’s symptoms, but often have unwanted
side effects such as apathy, sedation, weight gain, confusion, etc. Speak with
your child’s pediatrician or psychiatrist regarding the full range of risks and
benefits associated with the recommended medications that are available.
Treatment for Stereotyped Movement Disorders
Based on the scientific research, behavioral interventions are effective in
decreasing the likelihood that children will engage in stereotypic movements.
They work by repeatedly reinforcing different and competing responses so
that they become stronger and take the place of stereotypic movements.
Behavioral treatment has been shown to reduce symptoms by up to 90% and
to completely eliminate them in 40 to 70% of affected children. However,
treatment is intensive and requires the availability of a caregiver to implement
habit reversal procedures on an ongoing basis every day. It is also most likely
to succeed when the child is cooperative and themselves motivated to reduce
the stereotypic movements.
Supporting children to incorporate regular relaxation exercises and
mindfulness-based practices can also help to reduce the overall arousal level
of the nervous system and increase self-awareness. These practices have the
added benefit of reducing overall feelings of stress and anxiety, and improving
overall feelings of well-being, with limited risks or costs involved.
Should motor stereotypies be treated?
While you may have read this blog looking for answers regarding the
treatment of stereotypic movements, I invite you to consider the possibility that
it is not necessary and perhaps counterproductive or even potentially harmful
in some cases to impose treatment on children for these movements. It is
understandable that when your child displays unusual and repetitive motor
movements they become the subject of unwanted attention when out in public
or even with friends or family members. But the way in which these
movements are perceived by others and the potential feelings of
embarrassment associated with this attention, should not be the reason for
undertaking attempts at “treating” them. The autistic community has been
particularly vocal about the harm done by interventions aimed at reducing or
eliminating stereotypic movements. Stay tuned for my next blog which will
examine how the change that must come about is how society views and
responds to these behaviors, rather than attempting to change the individuals
whose brains are wired differently with a tendency to demonstrate these
behaviors.