Stereotypic Movement Disorder [childhood disorder]

Many childhood disorders, especially those of a psychiatric form are controversial in nature.  For one, medicating children is a sensitive topic, which some adults highly disagree with.  In addition, no one wants their child to suffer the stereotypes of having a mental disorder and some may even deny their child has a problem. Studies may even be less conclusive because of the limited amount of years in childhood compared to adulthood. 

Stereotypic movement disorder, which consists of seemingly compulsive, repetitive, and nonfunctional behavior, is thought to occur in 2 to 3 percent of children and adolescents (Sadock, 2003).  While most children show some type of repetitive movements in early childhood, children with this disorder have behaviors that interfere with normal functioning or that cause self-inflicted bodily injury (2003). Stein & Christenson (1998) report this disorder is often overlooked and unseen in most psychiatric literature because it occurs most frequently in children with mental retardation; however, this disorder can occur in children of normal intelligence.

 

Because this diagnosis is often overlooked, it is rarely made (AACAP, 1999).  Stereotyped behaviors are seen frequently in other childhood disorders such as autism, but currently a comorbid diagnosis of both autism and stereotypic movement disorder cannot be made.  There is ongoing controversy over whether these stereotypic movements constitute the addition of an extra diagnosis (1999). In addition, the diagnosis criteria can be interrupted in a manner of ways. Freeman (2006) states one of the main diagnostic problems to occur is “The pattern itself can look indistinguishable from autistic stereotypies, but is much more prolonged than tics. Comorbidty (other disorders) are common, including tics, just to confuse everyone.”  Unfortunately, this disorder is likely under-diagnosed, while other similar disorders may be over-diagnosed.

 

To make matters even more difficult, in Stereotypic Movement Disorder there is a fine line between normal and irregular behavior.  Nail biting for instance, can be considered a symptom; but only when it is severe (Sadock, 2003). Other children exhibit behaviors such as head banging for a period of time, but the problem disappears as the child grows older.  Should they be diagnosed with this disorder? How long should you wait before the diagnosis should be made?  Though the DSM criteria lists “the behavior persists for 4 weeks or longer” (Sadock, 2003), when should body rocking or picking at the skin be considered a real danger? 

All of these aforementioned issues make the diagnostic process for Stereotypic Movement Disorder even more difficult.  Though the vast majority of the population has heard of disorders such as autism or schizophrenia, this disorder is widely unknown in individuals outside of the medical profession.  Further research and publications need to be put into place to raise awareness, and the next version of the DSM may benefit from clarification of this diagnosis.

 

References:

American
Academy of Child and Adolescent Psychiatry (AACAP).  (1999). Practice Parameters for The Assessment and Treatment of Children Adolescents, and Adults With Autism And Other Persuasive Developmental Disorders. Retrieved November 29, 2006 from http://www.aacap.org/galleries/PracticeParameters/Autism.pdf

Freeman, Roger.  (2006). Stereotypic Movement Disorder can be confused with tics and TS. Retrieved November 29, 2006 from http://www.tourette-confusion.blogspot.com/

 

Sadock, Benjamin & Sadock, Virginia. (2003). Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry (9th ed.). Philadelphia: Lippincott Williams & Wilkins.

 

Stein, Dan & Christenson, Gary. (1998). Stereotypic movement disorder: A neglected problem.  Psychiatric Annals, vol. 28, p. 304.