Stereotypic movement disorder

Stereotypic movement disorder (SMD) is a motor disorder with onset in childhood involving restrictive and/or repetitive, nonfunctional motor behavior (e.g., hand waving or head banging), that markedly interferes with normal activities or results in bodily injury.[1] To be classified as SMD, the behavior in question must not be due to the direct effects of a substance, autism, or another medical condition.[1] The cause of this disorder is not known.[2]

Not to be confused with Stereotypy.
Stereotypic movement disorder
SpecialtyPsychiatry 

Signs and symptoms

Common repetitive movements of SMD include head banging, arm waving, hand shaking, rocking and rhythmic movements, self-biting, self-hitting, and skin-picking;[1] other stereotypies are thumb-sucking, dermatophagia, nail biting, trichotillomania, bruxism and abnormal running or skipping.[3]

Cause

The cause of stereotypic movement disorder is unknown.[4][5]

Diagnosis

Stereotyped movements are common in infants and young children; if the child is not distressed by movements and daily activities are not impaired, diagnosis is not warranted.[1] When stereotyped behaviors cause significant impairment in functioning, an evaluation for stereotypic movement disorder is warranted. There are no specific tests for diagnosing this disorder, although some tests may be ordered to rule out other conditions. SMD may occur with Lesch–Nyhan syndrome, intellectual disability, Autistic Spectrum Disorder, fetal alcohol exposure, or as a result of amphetamine intoxication.[1]

When diagnosing stereotypic movement disorder, DSM-5 calls for specification of:

  • with or without self-injurious behavior;
  • association with another known medical condition or environmental factor;
  • severity (mild, moderate or severe).[1]

Classification

Stereotypic movement disorder is classified in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a motor disorder, in the category of neurodevelopmental disorders.[1]

Differential diagnosis

Other conditions which feature repetitive behaviors in the differential diagnosis include autism spectrum disorders, obsessive–compulsive disorder, tic disorders (e.g., Tourette syndrome), and other conditions including dyskinesias.[1]

Stereotypic movement disorder is often misdiagnosed as tics or Tourette syndrome (TS).[6][7] Unlike the tics of TS, which tend to appear around age six or seven, repetitive movements typically start before age three,[1][8] are more bilateral than tics, and consist of intense patterns of movement for longer runs than tics. Tics are less likely to be stimulated by excitement. Children with stereotypic movement disorder do not always report being bothered by the movements as a child with tics might.[6][8]

Treatment

There is no consistently effective medication for SMD, and there is little evidence for any effective treatment.[6] In non-autistic habit reversal training may be useful [6] as well as decoupling.[9] No treatment is an option when movements are not interfering with daily life.[3]

Prognosis

Prognosis depends on the severity of the disorder. Recognizing symptoms early can help reduce the risk of self-injury, which can be lessened with medications. Stereotypic movement disorder due to head trauma may be permanent.[2]

Epidemiology

Although not necessary for the diagnosis, individuals with intellectual disability are at higher risk for SMD.[1] It is more common in boys, and can happen at any age[2]

References
  1. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 77–80. ISBN 978-0-89042-555-8.
  2. "Stereotypic movement disorder". MedlinePlus. June 15, 2012. Retrieved October 6, 2013.
  3. Ellis CR, Pataki C. "Childhood Habit Behaviors and Stereotypic Movement Disorder". Medscape. Retrieved October 6, 2013.
  4. "Stereotypic movement disorder: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2022-06-18.
  5. "Primary (Non-Autistic) Motor Stereotypies". Johns Hopkins Medicine. Retrieved 2022-06-18.
  6. Singer HS. (2009). "Motor stereotypies" (PDF). Semin Pediatr Neurol. 16 (2): 77–81. doi:10.1016/j.spen.2009.03.008. PMID 19501335.
  7. Ellis CR, Pataki C. "Background: Childhood Habit Behaviors and Stereotypic Movement Disorder". Medscape. Retrieved October 6, 2013.
  8. Freeman, R (December 10, 2010). "Tourette's Syndrome: minimizing confusion". Retrieved October 6, 2013. A blog by Roger Freeman, MD, clinical head of the Neuropsychiatry Clinic, British Columbia's Children's Hospital, professional advisory board member of the Tourette Syndrome Foundation of Canada, and former member of the Tourette Syndrome Association Medical Advisory Board.
  9. Lee, Melissa T.; Mpavaenda, Davis N.; Fineberg, Naomi A. (2019-04-24). "Habit Reversal Therapy in Obsessive Compulsive Related Disorders: A Systematic Review of the Evidence and CONSORT Evaluation of Randomized Controlled Trials". Frontiers in Behavioral Neuroscience. 13: 79. doi:10.3389/fnbeh.2019.00079. ISSN 1662-5153. PMC 6491945. PMID 31105537.

Further reading
  • Freeman RD, Soltanifar A, Baer S (Aug 2010). "Stereotypic movement disorder: easily missed". Dev Med Child Neurol. 52 (8): 733–8. doi:10.1111/j.1469-8749.2010.03627.x. PMID 20187883. S2CID 213050.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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