Stereotypies in childhood: types and associated disorders.

This movement alteration sometimes occurs in children with autism or intellectual disability.

In some occasions we will have observed how a child made repetitive behaviors or movements that, surely, we will have related directly with tics, manias of the child or with attempts to call the attention. And although in some cases this can be like that, in others it can be a question of infantile stereotypies.

Throughout this article we will talk about stereotypies in childhood, describe how to identify them, as well as how to identify them.We will describe how to identify them, as well as the different classifications, their diagnosis and possible treatments.

What are infantile stereotypies?

The stereotypies or stereotyped movements they are considered as a hyperkinetic alteration of the movement. This means that there is an excess of movements or reactions of the limbs and face. Although this alteration can occur at any age, they are quite common in children and may be due to a stereotyped movement disorder.

In infantile stereotypies, these can be manifested by semi-voluntary, repetitive and rhythmic movements, apparently impulsive or impetuous.They are apparently impulsive or impetuous and are not performed with any specific aim or purpose. In addition, they are called stereotyped because they always follow a fixed pattern and the child always performs them in the same way.

Among these movements are rocking, scratching, nose picking, bruxism, head butting, throwing objects, repetitive vocalizations, biting lips or fingers, clapping for no reason, or any motor reaction that always follows the same pattern.

To be more specific, stereotyped movements have the following characteristics:

• They are semi-voluntary, which means that they can be stopped if the person wishes.
• They are repetitive.
• They can be rhythmic or in the form of muscular contraction.
• They have no purpose or aim.
• They are coordinated.
• They can stop when the person is distracted or starts some other task or activity.

The incidence of this motor disorder is approximately 3 to 9% of the population between 5 and 8 years old, with a higher incidence in children with a diagnosis of Pervasive Developmental Disorder (PDD), within the (PDD), within which it occurs with an incidence of between 40% and 45%.

In children without any type of psychological or motor diagnosis, these movements are usually performed unconsciously as a way of discharging tension, as well as in moments of frustration or boredom.

Differences with the tics and compulsions

Although at first sight they can seem very similar movements, there are fundamental differences between the stereotypical movements, the tics and the compulsions.

In the case of the tics, although these also appear as repetitive movements, unlike stereotypicalunlike the stereotypies these are completely involuntary, of smaller duration and in many occasions the person does not even perceive that he is experiencing them.

On the other hand, compulsions also consist of repetitive movements that require certain coordination. However, these do have a purpose, which is to reduce the sensations of anguish or discomfort caused by the thoughts. or discomfort caused by the obsessive thoughts that accompany them.

When and why do they appear?

Although it has not yet been possible to determine the exact cause of the appearance of stereotypies in children, there are a number of theories that point to the possibility of a psychological or behavioral cause related to the child's learning, as well as to the likelihood that there is a neurobiological basis for the stereotypies. the probability that there is in fact a neurobiological basis for stereotypies..

In any case, the onset of stereotyped movements tends to occur before the child reaches 3 years of age and must be present for at least 4 weeks in order to be diagnosed as such.

These semi-voluntary movements are usually more intense during sleeping hours, when the child feels very stressed, when anxiety levels increase, while performing a task that requires a lot of time and effort.They are often more intense during sleep, when the child feels very stressed, when anxiety levels increase, while performing a task that requires a lot of concentration, when they are tired or bored, or when they are subjected to sensory isolation.

As mentioned above, in a large number of cases, these movements usually decrease in intensity or disappear when the child starts some other activity or task. Knowing this, once the movements are initiated, parents can try to capture the child's attention and involve him/her in some pleasant task so that, in this way, the stereotyped movements cease.

Types of infantile stereotypies

There are different classifications of infantile stereotypies according to whether they are accompanied by other alterations or not, according to the number of Muscle groups involved, or according to how they manifest themselves.

1. Primary/secondary stereotypies

Primary stereotypies are considered when they occur in children without any type of developmental disorder or alteration, while secondary stereotypies occur in children with neurological disorders such as autism, intellectual development disorder or sensorimotor deficits..

In addition, primary stereotypies, which are not associated with any other disorder, tend to have a better prognosis as they usually tend to disappear with time.

2. Motor/phonic stereotypies

In this second subgroup, stereotypies are divided into motor stereotypies, when they are manifested through movements, or phonic stereotypies if they are vocalizations or oral sounds..

3. Simple/complex stereotypies

Finally, when the child performs simple movements or guttural noises they can be classified as simple stereotypies, while more complex and coordinated movements or activities or vocalizations are called complex stereotypies.

How can they be diagnosed?

In those cases in which the child's parents or caregivers perceive a possible presence of mannerisms, it is advisable to to go to a specialist who can make the correct diagnosis of them..

For this, a clinical evaluation of the child is performed by direct observation of the child. However, if there is any doubt about the diagnosis, a series of physical tests such as electroencephalograms, magnetic resonance imaging or even the evaluation by means of a series of specialized questionnaires can be carried out.

In this way, it is also possible to rule out the possibility that the stereotypic movements are part of a larger condition, such as epileptic disorders. such as epileptic disorders, OCD or ADHD..

Is there a treatment?

In the vast majority of cases of childhood stereotypies, it is not necessary to resort to treatment since, even in cases of secondary stereotypies, these are not usually harmful. Moreover, in primary stereotypies, they usually subside with time.

However, in more severe cases in more serious cases or where the child has developed self-injurious or dangerous behaviors or that pose a danger, a therapeutic approach can be made either through psychological intervention or through pharmacological treatment.

As for psychological interventions, there are a large number of specific therapies, such as mechanical restraint therapy or habit reversal, which have proven to be highly effective.which have proven to be highly effective in the treatment of stereotypic movements.

Finally, although it has been shown that pharmacological treatment has a lower success rate, in certain cases it is possible to resort to the administration of drugs such as benzodiazepines, antiepileptics, atypical neuroleptics or selective serotonin reuptake inhibitors (SSRIs), among many others.