The mental issue under analysis is stereotypic movement disorder (SMD), which is a motor disorder resulted in a purposeless and repetitive movement of a body part. This issue is important today, as these spontaneous movements can interfere with normal activities, thereby making a person suffering from it partially disabled, and can result in bodily injuries. Besides, this disorder is difficult to cure, therefore, it is important to study it in detail and find out what causes it in order to provide a comprehensive and effective treatment (Wijemanne & Jankovic, 2017).
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Analysis of Stereotypic Movement Disorder
The history of SMD dates back to the beginning of the twentieth century when it was first diagnosed. During that time, all the symptoms of SMD were referred to as a psychiatric disorder. Thus, since that time, these symptoms have been considered both a neurological and psychological issue. Until recently, this disorder was completely incurable. However, by now, with the development of technologies, there has been some progress regarding the research and treatment of this disorder. In 2013, the DSM-5 was published, and SMD was added to its list, particularly to a new sub-category of neurodevelopmental disorders devoted to various motor disorders (Stein & Woods, 2014).
Clinical Picture and Statistics
The basic symptoms of SMD include arm-waving, rhythmic and rock movements, hand trembling, self-hitting and self-biting, headbanging, trichotillomania, abnormal skipping or running, nail-biting, bruxism, and thumb-sucking. In general, stereotypic movements are peculiar to toddlers and infants who are less than three years old. They demonstrate approximately 15-20% of various repetitive movements. Usually, children with SMD show 80% of symptoms when they are less than two years old, 12% when they are two or three years, and 8% when they are more than three years old. However, sometimes, the symptoms of SMD can occur at any age but are easily identified only in adolescence.
SMD can be caused by intellectual disabilities, autism, head trauma, sensory deprivation, blindness or deafness, drug abuse, brain diseases from infections or seizures, obsessive-compulsive disorder, or major psychiatric disorders. Statistics show that approximately 5-10% of people with intellectual disabilities and 15-20% of people with severe intellectual disabilities suffer from SMD. The risk factors include physiological, genetic, and environmental. Social isolation can cause self-stimulation, which, in turn, results in self-injury. Low cognitive functioning is associated with an elevated risk for the development of stereotypic behaviors and a slow response to interventions. Additionally, fear and environmental stressors are also a major risk factor (Wijemanne & Jankovic, 2017).
Currently, there are two principal types of treatment for SMD, namely pharmacological therapy and behavioral therapy. The latter is the primary option, as it is more effective than the former. In behavioral therapy, differential reinforcement is used to reverse the acquired habits. Basically, people learn how to identify their stimuli and develop a response to these stereotypic movements. This therapy also includes self-monitoring, biofeedback, nocturnal control, negative practice, reinforcement, the use of repugnant-tasting substances for nail biting and thumb sucking, and competing responses. This therapy is, in most cases, effective, particularly for infants and toddlers.
However, in some cases, the use of medication is required. In terms of pharmacological therapy, Naltrexone is used to suppress euphoria from the stereotypic movements, and Clomipramine helps inhibit the serotonin reuptake. The prognosis mostly depends on the cause of the disorder and on its severity (Ricketts et al., 2013).
In their research, Houdayer et al. (2014) focus on various dysfunctions in the cerebral activity that cause SMD in children. Admittedly, the underlying mechanism that causes complex motor stereotypes is unknown. Movement-related cortical potentials (MRCPs) which represent the activation of those cerebral areas that are responsible for generating movements accompany and precede voluntary movements.
The purpose of this research was to make a comparison between cerebral activities that are associated with voluntary movements and those associated with motor stereotypes. The authors analyzed the data obtained from an EEG of ten children with primary motor stereotypes. According to the results, no MRCP was observed before motor stereotypes appeared. In comparison with voluntary movements, motor stereotypes do not follow MRCPs.
This shows that the premotor areas do not influence the appearance of these movements and indicates that motor stereotypes are not initiated by the mechanisms responsible for voluntary movements. Additionally, the authors claim that further research is required in order to analyze the findings that would be found in people with secondary stereotypes.
In their research, Mehanna and Jankovic (2013) considered SMD as a consequence of various neurological disorders, particularly cerebrovascular diseases. They state that SMD can occur as a genetic or idiopathic disease as a secondary disease, including multiple systemic and neurological diseases, or as a manifestation of certain neurodegenerative disorders. Particularly, cerebrovascular diseases constitute approximately 20% of all secondary movement disorders, and after approximately 5% of strokes, involuntary movements appear that can result in Parkinsonism and various kinds of hyperkinetic movement disorders.
Additionally, the authors claim that controlling stroke risk factors is crucial in decreasing the chance of the appearance of SMD related to cerebrovascular disease. Symptomatic therapies can significantly improve the quality of life of patients who suffer from post-stroke SMDs.
In their research, Kurian and Dale (2016) focus on various factors that cause SMDs in children. The purpose of their research is to provide an overview of SMDs that occur in childhood, discuss SMD’s main clinical features, and analyze strategies for its prevention and treatment. The authors state that SMDs in childhood comprise a broad range of both acquired and genetic diseases, beginning from slight self-limiting conditions and ending with more virulent cases associated with considerable morbidity and the increase in mortality.
The explanation of the cause of SMD is achieved through the clinical examination, accurate history, laboratory and neuroimaging investigations, and analysis of video footage. Additionally, the authors claim that advances in cell biology and genetic technologies made a great contribution to explaining the reasons for the appearance of SMD in children. Early correct diagnosis can significantly improve the efficaciousness of the existing SMD management strategies.
In conclusion, it can be mentioned that although SMD is difficult to cure, there have been many advances in its treatment recently. The first mentioning of SMD dates back to the beginning of the twentieth century. However, it was only included in the DSM-5 that was released in 2013. The risk factors for SMD consist of three aspects: physiological, genetic, and environmental. SMD is common for all children who are less than two years old, but in the majority of cases, all these involuntary movements disappear after the age of three. SMD includes various unpleasant symptoms such as head banging, hand trembling, or thumb-sucking that can cause other problems.
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The treatment for SMD consists of two types. The first type is a behavioral therapy that helps people take control of their spontaneous movements. The second type is pharmacological therapy, which is used when behavioral therapy is not enough to achieve positive results.
Houdayer, E., Walthall, J., Belluscio, B. A., Vorbach, S., Singer, H. S., & Hallett, M. (2014). Absent movement‐related cortical potentials in children with primary motor stereotypies. Movement Disorders, 29(9), 1134-1140.
Kurian, M. A., & Dale, R. C. (2016). Movement disorders presenting in childhood. CONTINUUM: Lifelong Learning in Neurology, 22(4), 1159-1185.
Mehanna, R., & Jankovic, J. (2013). Movement disorders in cerebrovascular disease. The Lancet Neurology, 12(6), 597-608.
Ricketts, E. J., Bauer, C. C., Van der Fluit, F., Capriotti, M. R., Espil, F. M., Snorrason, I.,… Woods, D. W. (2013). Behavior therapy for stereotypic movement disorder in typically developing children: A clinical case series. Cognitive and Behavioral Practice, 20(4), 544-555.
Stein, D. J., & Woods, D. W. (2014). Stereotyped movement disorder in ICD-11. Revista Brasileira de Psiquiatria, 36(1), 65-68.
Wijemanne, S., & Jankovic, J. (2017). Stereotypies. Movement Disorders Curricula, 407-414.