Stereotypic Movement Disorder

A 13-year-old girl makes a facial contortion and fist clench at least 24 times per week when she’s at home. An 11-year-old boy’s hand flaps while he thinks and also holds his hands to his chest, waving his hands like claw fingers but isn’t aware he is doing it, and another 13-year-old girl shows a pattern of skip-running and, after a considerable distance, runs in the opposite direction while her body becomes rigid and her hands form a claw posture (Ricketts et al., 2013). What do all of those situations have in common? They all show stereotypic movement disorders.

What Is, And What Is Not, A Stereotypic Movement Disorder?

A stereotypical movement is defined as a repetitive and purposeless movement that occurs in a specific pattern and is distractible. It happens when there is increased stress, anxiety, excitement, focused concentration and boredom (Mackenzie, 2018). But a stereotypical movement is not a disorder by itself, just a repetitive movement that needs to be differentiated from other types of movements that could look like a stereotypical movement. Another type of sudden and repetitive behaviours a person can present are:

Motor mannerism: a distinctive behavioural trait, also a repetitive movement like a stereotype, but unlike that one, it is not a cause of self-injury, and it doesn’t interfere with the person’s life.
Habit: unlike the previous two, it can be a behaviour as well as a routine that is repeated regularly. It doesn’t cause interference with everyday life or self-harm.
Tic: a sudden, rapid, recurrent, non-rhythmic motor movement or vocalisation associated with a premonitory urge and feeling of relief.
Compulsion: an overwhelming irresistible urge to perform an act or ritual (Barry et al., 2011).

This is not a stereotypic movement disorder. To better understand what it is, a description of the two kinds of stereotypic movements is needed. The primary stereotype is commonly seen as a motor stereotype. They usually happen in children in development. Some of them are: head nodding, rocking, head banging, waving, and arm shaking (Barry et al., 2011).

On the other hand, secondary stereotypes are not considered common. It refers to when there is a diagnosis that comes along the stereotype movements such as intellectual disability delay, sensory delay, Rett syndrome, Lesch-Nyhan, Cornelia de Lange, Angelman syndrome, as well as dementia, schizophrenia. Less common causes are tumours, infections, autoimmune disorders and the use of drugs such as neuroleptics, amphetamines or cocaine (Mackenzie, 2018). In secondary stereotypes, there can be stereotypes like behaviour, vocalisations, and even visual stereotypes (Barry et al., 2011).

Possible Causes, Functions, and Developmental Factors

There is no exact cause of stereotypic movements. Current research suggests that they can result from several factors, such as biological, neurological, environmental and developmental factors. Another hypothesis is that alterations in brain systems implicated in motor control may contribute to the development of stereotyped movements (Peter et al., 2017). They also highlight evidence suggesting possible genetic influences and the effects of environmental conditions. However, no single mechanism has been identified as responsible for all forms of stereotypy.

Although stereotypic behaviours may appear purposeless, their occurrence may be related to developmental and sensorimotor processes. Shafer et al. (2017) propose that reduced sensorimotor integration and lower motor complexity may contribute to repetitive movements, particularly when the motor system is immature or developing. From this perspective, stereotypies may reflect limitations in the ability to produce flexible motor responses rather than completely meaningless behaviour. Developmental factors are also important because stereotypic movements commonly emerge during early childhood (Cardona et al., 2016).

Differential Diagnosis

To diagnose someone with a stereotypic movement disorder, there needs to be a differentiation clinically significant from another behaviour that can come from normal development. Motor stereotypes, for example, are repetitive and predictable movements that are seen before the age of three and can be hand or arm flapping, waving, rocking or finger movements (Cardona et al., 2016; Singer et al., 2018). However, the presence of those movements does not indicate a stereotypic movement disorder.

According to research, one important aspect is that the movements must cause significant interference with daily activities or, in some cases, result in self-injury for a diagnosis (Olson et al., 2024). What should be considered during tests is the frequency, intensity, duration, developmental history, functional impact, and possible associated conditions.

What a differential diagnosis can do in this case is to determine if the repetitive movements are a stereotypic movement disorder, related to another developmental condition like autism or if they are part of a developmental stage in childhood. It needs to be taken into account that even if repetitive behaviours can be seen in stereotypic disorders and developmental conditions, people in the first category don’t show the necessary difficulties in social communication as seen in autism (Olson et al., 2024). Other factors that need to be considered are intellectual disability, sensory impairment, and genetic conditions (Cardona et al., 2016).

Stereotypical Movements and Their Impact on Daily Life

The impact of stereotypical movement disorder can be different in each person. It may depend on how often, how intense, how long and whether they interfere with everyday activities. Some people might not find it significantly negative, just as a small inconvenience. But for others they can be seen as an extra challenge in school or to interact with others. Cardona et al. (2016) remark in their research that stereotypic movements are different in impact for every individual and should not be seen as equally problematic.

It was seen that children who presented primary complex motor stereotypes can have movements that happen frequently and even extend for periods long enough to interrupt their daily routine, making it difficult to focus on studying. Also, another difficult situation is when this happens in public. Visible movements can attract the attention of others, and people might be concerned about social judgment or stigmatisation for the children and their families (Singer et al., 2018). Parents also have the concern if the behaviour will continue or become more severe.

Intervention Approaches

Different approaches were proven in order to reduce stereotypes. Research has mainly focused on children. In some cases, the result is that children enjoy the stereotypical movement, since they are teased by positive emotions like daydreaming or excitement (Barry et al., 2011). But, to get treatment in cases of danger, such as stereotypes having consequences of self-harm or affecting the children’s everyday routines, there needs to be an assessment first.

Since the initial alarm would be given by parents to a professional (psychologist, doctor or psychiatrist), the evaluation is through questions from the parents about the observed behaviour. After that, the professional will consider what the best course of action is. Some of the advertised therapeutic measures advised are:

Parent-directed behavioural therapy: in this option, parents were given a DVD with instructions provided by a psychologist to implement awareness training and reinforced suppression.
Awareness training: in this case, done by a professional, not the parents. The child was shown the repetitive movement, then did it again with lapses of breaks. The reinforcement was done by parents when the child did not do the stereotypical movement (Specht et al., 2017).
Microswitch: a positive reinforcement (something that the child enjoys) is presented when, instead of the stereotype movement, the child does an adaptive movement.
Behavioural techniques, such as modified habit rehearsal, response blocking, and contingency manipulations.
Pharmacological: in cases of danger, pharmacological treatment can be recommended after an evaluation by a professional. But, a situation that also falls into this treatment when the child presents a coexisting condition. But stereotypical pharmacological treatment had no positive results (Barry et al., 2011).

Conclusions

Stereotypical movements are repetitive, frequent and apparently purposeless. Nevertheless, they can be a response to stressful events or a show of excitement. This kind of movement can be common in children but also in people who have another condition such as a stroke, autism, among others. There is not a direct cause of what causes these movements, but a diagnosis can determine if the person presents a stereotyped movement disorder or other behaviours such as motor compulsions, tics or habits. This makes a proper diagnosis essential, particularly when the child has another condition that may be associated with the stereotypies. Behavioural therapy, with active parental involvement, is the primary recommended approach for reducing these behaviours and has shown positive outcomes.

References +

Barry, S., Baird, G., Lascelles, K., Bunton, P., & Hedderly, T. (2011). Neurodevelopmental movement disorders–an update on childhood motor stereotypies. Developmental Medicine & Child Neurology, 53(11), 979-985.
Cardona, F., Valente, F., Miraglia, D., D’Ardia, C., Baglioni, V., & Chiarotti, F. (2016). Developmental profile and diagnoses in children presenting with motor stereotypies. Frontiers in Paediatrics, 4, 126. Mackenzie, K. (2018). Stereotypic Movement Disorders. Seminars in Pediatric Neurology, 25, 19– 24. https://doi.org/10.1016/j.spen.2017.12.004
Olson, L., Bishop, S., & Thurm, A. (2024). Differential Diagnosis of Autism and Other Neurodevelopmental Disorders. Pediatric Clinics of North America, 71(2), 157–177. https://doi.org/10.1016/j.pcl.2023.12.004
Peter Z, Oliphant ME and Fernandez TV (2017) Motor Stereotypies: A Pathophysiological Review. Front. Neurosci. 11:171. doi: 10.3389/fnins.2017.00171
Ricketts, E. J., Bauer, C. C., Van der Fluit, F., Capriotti, M. R., Espil, F. M., Snorrason, I., Ely, L. J., Walther, M. R., & Woods, D. W. (2013). Behaviour Therapy for Stereotypic Movement Disorder in Typically Developing Children: A Clinical Case Series. Cognitive and Behavioural Practice, 20(4), 544– 555. https://doi.org/10.1016/j.cbpra.2013.03.002
Shafer, R. L., Newell, K. M., Lewis, M. H., & Bodfish, J. W. (2017). A cohesive framework for motor stereotypy in typical and atypical development: The role of sensorimotor integration. Frontiers in Integrative Neuroscience, 11, 19.
Singer, H. S., Rajendran, S., Waranch, H. R., & Mahone, E. M. (2018). Home-Based, Therapist-Assisted Therapy for Young Children With Primary Complex Motor Stereotypies. Pediatric Neurology, 85, 51–57. https://doi.org/10.1016/j.pediatrneurol.2018.05.004
Specht, M. W., Mahone, E. M., Kline, T., Waranch, R., Brabson, L., Thompson, C. B., & Singer, H. S. (2017). Efficacy of parent-delivered behavioural therapy for primary complex motor stereotypies. Developmental Medicine & Child Neurology, 59(2), 168–173. https://doi.org/10.1111/dmcn.13164