Simple stereotypic movements are common in infancy and early childhood. Rocking may occur in the transition from sleep to awake, a behavior that usually resolves with age. Complex stereotypies are less common in typically developing children and can usually be suppressed by distraction or sensory stimulation. The individual’s daily routine is rarely affected.

Normal Development as a Differential Diagnosis to Stereotypic Movement Disorder

Stereotypic movements may be a presenting symptom of autism spectrum disorder and should be considered when repetitive movements and behaviors are being evaluated. Deficits of social communication and reciprocity manifesting in autism spectrum disorder are generally absent in stereotypic movement disorder, and thus social interaction, social communication, and rigid repetitive behaviors and interests are distinguishing features. When autism spectrum disorder is present, stereotypic movement disorder is diagnosed only when there is self-injury or when the stereotypic behaviors are sufficiently severe to become a focus of treatment.

Autism Spectrum Disorder as a Differential Diagnosis to Stereotypic Movement Disorder

Typically, stereotypes have an earlier age at onset (before 3 years) than do tics, which have a mean age at onset of 4–6 years. They also are consistent and fixed in their pattern or topography compared with tics, which are variable in their presentation,typically changing in character over time. Stereotypies may involve arms, hands, or the entire body, while tics commonly involve eyes, face, head, and shoulders. Stereotypies are more fixed, rhythmic, and prolonged in duration than tics, which, generally, are brief, rapid, random, and fluctuating. Stereotypies are ego-syntonic (children enjoy them) as opposed to tics, which are usually ego-dystonic. Tics wax and wane in location and time and are uniquely associated with premonitory urge (a physical feeling that precedes many tic movements). Tics and stereotypic movements are both reduced by distraction.

Tic Disorders as Differential Diagnoses to Stereotypic Movement Disorder

Stereotypic movement disorder is distinguished from obsessive-compulsive disorder (OCD) by the absence of obsessions, as well as by the nature of the repetitive behaviors. In OCD the individual feels driven to perform repetitive behaviors in response to an obsession or according to rules that must be applied rigidly, whereas in stereotypic movement disorder the behaviors are seemingly driven but apparently purposeless. Trichotillomania (hair-pulling disorder) and excoriation (skin-picking) disorder are characterized by body-focused repetitive behaviors (i.e., hair pulling and skin picking) that may be seemingly driven but that are not apparently purposeless, and that may not be patterned or rhythmical. Furthermore, onset in trichotillomania and excoriation disorder is not typically in the early developmental period, but rather around puberty or later.

Obsessive-Compulsive and Related Disorders as Differential Diagnoses to Stereotypic Movement Disorder 

The diagnosis of stereotypic movements requires the exclusion of habits, mannerisms, paroxysmal dyskinesias, and benign hereditary chorea. A neurological history and examination are required to assess features suggestive of other disorders, such as myoclonus, dystonia, tics, and chorea. Involuntary movements associated with a neurological condition may be distinguished by their signs and symptoms. For example, repetitive, stereotypic movements in tardive dyskinesia can be distinguished by a history of chronic neuroleptic use and characteristic oral or facial dyskinesia or irregular trunk or limb movements. These types of movements do not result in self-injury. Stereotypies are a common manifestation of a variety of neurogenetic disorders, such as Lesch-Nyhan syndrome, Rett syndrome, fragile X syndrome, Cornelia de Lange syndrome, and Smith-Magenis syndrome. For stereotypic movement disorder that is associated with a known genetic or other medical condition, neurodevelopmental disorder, or environmental factor, record stereotypic movement disorder associated with (name of condition, disorder, or factor) (e.g., stereotypic movement disorder associated with Lesch-Nyhan syndrome).

Other Neurological and Medical Conditions as Differential Diagnoses to Stereotypic Movement Disorder 

Differential Diagnoses to Stereotypic Movement Disorder include
Normal development
Autism spectrum disorder
Tic disorders
Obsessive-Compulsive related disorders
Other conditions

Michigan State University

Stereotypic movement disorder is diagnosed when an individual has repetitive, seemingly driven, and apparently purposeless motor behaviors, such as hand flapping, body rocking, head banging, self-biting, or hitting. The movements interfere with social, academic, or other activities. Motor stereotypes are among the diagnostic characteristics of autism spectrum disorder

Stereotypic Movement Disorder

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., Text revision). https://doi.org/10.1176/appi.books.9780890425596

DSM-5-TR

The essential feature of stereotypic movement disorder is repetitive, seemingly driven, and apparently purposeless motor behavior. These behaviors are often rhythmical movements of the head, hands, or body without obvious adaptive function. The movements may or may not respond to efforts to stop them.


Diagnostic Features of Stereotypic Movement Disorder

The DSM-5-TR outlines a few specifiers to help specify the condition of Stereotypic Movement Disorder for each individual case. These specifiers are as followed: Self-injurious, not self-injurious and severity

Specifiers for Stereotypic Movement Disorder

Young children who are typically developing frequently make simple stereotypical movements (such as rocking; in the US and UK, this ranges from 5% to 18%). Complex stereotypic movements are substantially less frequent (happening in 3%–4% of cases). In samples from high-income nations, between 4% and 16% of people with intellectual developmental disorder (intellectual impairment) engage in stereotypy and self-harm. People with severe intellectual developmental disorders are more at risk. 10% to 15% of people with intellectual developmental disorders who dwell in residential facilities may also self-injure and have stereotypic movement disorder.  In children with severe intellectual developmental disorders, repetitive and constrained behaviors and interests may be risk factors for the onset of self-harm, violence, and destructive conduct.


Prevalence of Stereotypic Movement Disorder 

Onset is in the early developmental period. Stereotypic movements typically begin within the first 3 years of life. Simple stereotypic movements are common in infancy and may be involved in acquisition of motor mastery. In children who develop complex motor stereotypes, approximately 80% exhibit symptoms before age 24 months, 12% between 24 and 35 months, and 8% at 36 months or older. In most typically developing children, the severity and frequency of stereotyped movements diminish over time. Onset of complex motor stereotypies may be in infancy or later in the developmental period. Among individuals with intellectual developmental disorder, the stereotyped, self-injurious behaviors may persist for years, even though the typography or pattern of self-injury may change.


Development and Course of Stereotypic Movement Disorder 

Risk and prognostic factors of Stereotypic Movement disorder include:

Environmental
Genetic and physiological


Risk and Prognostic Factors of Stereotypic Movement Disorder 

Diagnostic issues of Stereotypic Movement disorder include:

Culture-related diagnostic issues

Related Diagnostic Issues of Stereotypic Movement Disorder

Differential Diagnoses to Stereotypic Movement Disorder 

Common comorbidities in children with chronic motor stereotypes include attention-deficit hyperactivity disorder, motor coordination problems, tics/Tourette’s disorder, and anxiety.

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