Stereotyped movement disorder: symptoms, causes and treatments.

This motor disorder combines psychological and neurological elements and appears in childhood.

Each and every one of us has our own way of seeing the world, perceiving it and interacting with it. We think, relate, express ourselves, speak or even move in different ways. This is because our being and identity arise mainly from the interaction between our biology and our experiences and learning.

However, we are still members of the same species, so that at a Biological level we are subject to and share a genome and the same basic structure, with a growth process that is very similar in most people. Among the multiple systems that arise from this development is our brain.

However, sometimes alterations or problems may occur during this development, capable of altering aspects such as the ability to perform or inhibit our own movements. An example of this can be found in stereotyped movement disorder, a neurodevelopmental problem that we will discuss below.a problem of the neurodevelopment of which we are going to speak next.

Stereotyped movement disorder

It is known as a disorder of stereotyped movements to one of the motor disorders of the neurological development or neurodevelopmentThis disorder is characterized by the presence in a habitual way of repetitive, aimless and apparently guided motor behaviors and conducts that arise in the first phases of the development and that causes an interference in the life of the minor who suffers it, in a period that must include at least four weeks.

Some common movements are nodding, shaking hands and arms or rocking, but it is also possible that the stereotypy in question is an act of self-injury such as hitting oneself or head-butting. This is why some stereotypies can be dangerous and result in injuries, which may even lead to incapacitation.This is why some stereotypies can be dangerous and lead to injuries, which could even be incapacitating or lead to death. In this sense, when making the diagnosis, it is necessary to specify whether it occurs with or without self-injury, and whether protective measures are required to prevent injuries.

As we have seen, stereotyped movement disorder is one of the neurodevelopmental disorders, which are characterized by having their origin in a different nervous development than usual or by the presence of problems, slowing or alterations in the maturation of the nervous system during growth.

These problems have their onset in childhood (in this case it usually appears before the age of three years), and may cause limitations or difficulties in the functionality or adaptation of the subject in comparison with their peers. It is common for the movements to persist during childhood and reach their peak in adolescence. It can also affect socialization and learning, by making them difficult or may generate social rejection.

Symptoms: stereotypies

These movements are called stereotypies, and they are known as a type of hyper are known as a type of hyperkinetic or hyperkinetic movement.. They are partially involuntary movements that appear in a coordinated and generally rhythmic manner. This semi-involuntariness implies that although they are not carried out with a determined purpose at a conscious level but arise in a spontaneous and uncontrolled manner, they can voluntarily come to a standstill.

They generally appear in an impulsive manner and although it may make it difficult to follow actions, it does not prevent the performance of complex movements. Their purpose is not clear, although it is suggested that they may be intended to manage and regulate the child's internal tension. Also, they only occur during wakefulness and in most cases distraction or initiation of an activity may stop the movements.

Differential diagnosis

It is important to note that the diagnosis of stereotyped movement disorder cannot be made if there is another neurodevelopmental disorder that explains these behaviors, or a diagnosed neurological intoxication or disease.

In this regard, it should be noted that it is common for stereotypies to appear in people with intellectual disabilities or autism. in people with intellectual disabilities or autism, in children with psychotic type problems, or in children with neurodevelopmental disorders. or in some cases of infantile obsessive-compulsive disorder, although in these cases the diagnosis of stereotyped movement disorder would not be considered.

Also it is necessary to consider that this disorder is different from the one of complex motor tics, with which it can be confused but in which the movements are less rhythmic and more involuntary and uncontrollable. Another problem with which it can be confused is with the trichotillomania, in which the affected one pulls out his hair compulsively as a method of anxiety management.

Theories about its causes

Even today, the mechanisms that cause this disorder are not fully understood. However, as a neurodevelopmental disorder, its presence is due to a problem derived from the process of maturation and development of the child's brain.. There are different theories as to how it occurs.

One of them establishes a possible alteration at the neurotransmitter level, with a possible excess of dopamine and other catecholamines. At brain level there may also be some kind of degeneration or alteration in temporal areas.

At the psychological level there is also talk of a possible unconscious purpose of these movements, being the result of an attempt to discharge energy caused by tension. Occasionally, some theories have some theories have been linked to the existence of excessive demands from the environment or in the search for pleasure and pain reduction by provoking through self-injury the use of substances that temporarily inhibit pain (something that makes that in nature we can not feel the pain in all its intensity until we can get to safety).

It has also been observed that they seem to be more frequent in environments in which there has been poor stimulation of the child at a physical or social level or, on the contrary, over-stimulation that makes them seek balance through movement. It is more common in people with sensory disabilities or institutionalized..

Treatment

Stereotyped movement disorder can be treated with a multidisciplinary approach, so that stereotypies can be reduced and the possible impact on the functionality and participation in society of the affected subjects can be reduced. The treatment used in each case will depend on the specific symptoms, the age and time of development and the possible causes.

In some cases stereotypies may eventually disappear as the child as the child grows older, but in other cases they remain for life. In any case, beyond the possible difficulty that stereotypies may pose, they are not dangerous (unless they are of a self-injurious type) and in many cases no treatment is ever carried out.

Cognitive-behavioral psychological therapy is mainly used. Some of the strategies used may be differential reinforcement of other behaviors and habit reversal.. Work can be done to try to decrease the self-stimulatory potential of stereotypy by trying to get the patient to stimulate him/herself in another way. In cases of under-stimulated patients it will be advisable to bring the subject closer to an environment with a higher level of stimulation, while in some with excess it could be beneficial to reduce it.

In the case of patients with self-injurious movements, it will also be necessary to modify the environment in such a way as to prevent injury and protect the integrity of the patient. This type of alteration can be a great cause of distress for parents and their environment, so they will benefit from psychoeducation and contact with families with children suffering from the same problem.

Sometimes drugs may also be used, usually benzodiazepines.usually benzodiazepines and other drugs that lower the level of physiological activation. Antidepressants are also often used.

Finally, at the educational level, it will be necessary to take into account the possibility that some learning may be more complex, and adjustments should be made to allow a good development.