Social isolation is a risk factor for self-stimulation that may progress to stereotypic movements with repetitive self-injury. Environmental stress may also trigger stereotypic behavior. Fear may alter physiological state, resulting in increased frequency of stereotypic behaviors.


Environmental Factors of Stereotypic Movement Disorder

Based on the large percentage of cases with a confirmed family history of motor stereotypies, stereotypic movement disorder is thought to be moderately heritable. Children with stereotypies had significantly smaller putamen volumes, which suggests that the underlying anatomical site for complicated motor stereotypies may be premotor to posterior putamen circuits, unique cortical-striatal pathways linked to habitual behaviors.
 Stereotypic behavior is more likely to occur and people with lower cognitive functioning also respond less well to interventions. Individuals with moderate-to-severe/profound intellectual developmental disorder, who because of a specific syndrome, are more likely to exhibit stereotypical movements (like Rett syndrome) or environmental factors (such a setting with little to no stimulation, for example) tend to put people at a higher risk of stereotypies. Repeatedly harming oneself could be a behavioral trait. For example, in Lesch-Nyhan syndrome, there are both stereotypic dystonic movements and self-mutilation of fingers, lip biting, and other forms of self-injury unless the individual is restrained, and in Rett syndrome and Cornelia de Lange syndrome, self-injury may result from the hand-to-mouth stereotypies. Stereotypic behaviors may also result from a painful medical condition (e.g., middle ear infection, dental problems, gastroesophageal reflux).


Genetic and Physiological Factors of Stereotypic Movement Disorder

Risk and prognostic factors of Stereotypic Movement disorder include:

Environmental
Genetic and physiological


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 

Diagnostic issues of Stereotypic Movement disorder include:

Culture-related diagnostic issues

Related Diagnostic Issues of Stereotypic Movement Disorder

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

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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