Repetitive arm and hand movements (complex motor stereotypies) in children

doi:10.1016/j.jpeds.2004.06.014

The Journal of Pediatrics

Volume 145, Issue 3, September 2004, Pages 391-395

https://doi.org/10.1016/j.jpeds.2004.06.014 Get rights and content

Abstract

Objective

To characterize clinical features, associated problems, and outcomes for children with complex motor stereotypies who do not have mental retardation or pervasive developmental disorders.

Study design

We performed a record review for 40 children (63% male) aged 9 months to 17 years with complex motor stereotypies between 1993 and 2003.

Results

Age at onset was at or before 3 years in 90% of the sample. Symptoms occurred at least once daily in 90%. Excitement was identified as a trigger in 70%. Movements stopped when cued in 98%, and none had stereotypies during sleep. A total of 25% had comorbid attention deficit hyperactivity disorder (ADHD), and 20% had a learning disability. Family history of stereotypies was identified in 25%, tics in 33%, ADHD in 10%, and mood-anxiety disorder in 38%. Pharmacotherapy to target associated conditions was used in 40%, and behavioral therapy was used in 23%. A total of 53% identified symptoms for more than 5 years. Movements resolved in 5% of the children, improved in 33%, were unchanged in 50%, and worsened in 13%.

Conclusions

The clinical course of complex motor stereotypies appears chronic. Better understanding of the clinical features of complex stereotypies in primary care settings is essential for early diagnosis and management.

Section snippets

Study patients

Charts of children seen between 1993 and 2003 in a referral-based pediatric neurology movement-disorders clinic specializing in tic disorders at Johns Hopkins Hospital were reviewed. Records were identified for those otherwise typically developing children referred for evaluation and treatment of persistent repetitive movements involving the arms and hands. Forty-three individuals were identified from approximately 1000 new patient visits. The senior pediatric neurologist (HSS), with expertise

Results

From the record review, 43 children with complex motor stereotypies (ie, those affecting the upper extremities) were identified. Three children were removed from the data set because they failed to meet inclusion criteria: 2 had mood disorders requiring pharmacotherapy, and 1 had a history of hearing loss and possible autism. On presentation, no patient had the diagnosis of motor stereotypies; the majority had been referred for tics, compulsions, or possible seizure activity. A small number of

Discussion

Physiologic stereotypies can be divided into one of 3 major subdivisions on the basis of the type of movements observed: (1) common (eg, body-rocking, thumb-sucking, and nail-biting), which are circumscribed and smooth⁸; (2) head nodding⁹; and (3) complex.² The complex category, which is the focus of this report, differs from the others on the basis of its primary involvement of the arms and hands bilaterally, use of multiple muscle groups, irregular movements, and similarity to movements seen

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: Supported by grant NS-25806, Neurodevelopmental Pathways to Learning Disabilities; Mental Retardation and Developmental Disabilities Research Center, HD-24061, and Friends of Tourette Syndrome Research.

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Original ArticlesRepetitive arm and hand movements (complex motor stereotypies) in children

Abstract

Objective

Study design

Results

Conclusions

Section snippets

Study patients

Results

Discussion

J Pediatr

Eur J Paediatr Neurol

Adv Child Dev Behav

Trends Neurosci

J Am Acad Child Adolesc Psychiatry

Exp Neurol

Prog Neurobiol

Neuroscience

Stereotypies

Original Articles
Repetitive arm and hand movements (complex motor stereotypies) in children