Stereotypy In Children Research Articles

Primarne motoričke stereotipije

Introduction. Motor stereotypies are almost always associated with developmental disorders, such as autism spectrum disorder, intellectual disability, etc. Although they most often occur together with sensory deprivation, they are also recognized as isolated. They occur in children with normal, typical development. These isolated stereotypies are called primary motor stereotypies. Aim. The aim of this paper is to provide a better insight into the specificity of this disorder and to show how it affects people (children), as well as to provide insight into the cause of primary motor stereotypies and possible approaches to treatment. Method. Descriptive method with a review of the literature published in the previous ten years, with a critical review. Inclusion and exclusion criteria were defined. Research on the cause of primary motor stereotypies, primary motor stereotypies themselves, and the treatment of primary motor stereotypies was reviewed. Results. Primary motor stereotypies in children with typical development negatively affect daily activities and disrupt social development, which leads to social stigmatization. Many interventions have been found in children with autism spectrum disorder (stereotypies are one of the main features of autism), but there is very little published research on interventions and treatments for primary motor stereotypies. The root of the problem of primary motor stereotypies is complex and involves certain parts of the cortex and pathways of information transmission. The problem is also the identification of this problem, which further affects the interventions themselves. Conclusion. The cause of primary motor stereotypies is still unknown, and behavioral therapies are the possible treatments for primary motor stereotypies. Based on the available research, there is not much literature on this topic, which provides us with exceptional potential and space for discovering new information and knowledge. With new information, there are many ways to work with these people.

Association of Parental Support with Reduced Stereotypy in Children with Autism Spectrum Disorder: A Cross-Sectional Study.

Background and Objectives: To analyze the influence of parental presence and use of risperidone on social interaction and apathy among patients with Autism Spectrum Disorder (ASD). Materials and Methods: Cross-sectional study in a reference center for patients with ASD in a city in northeastern Brazil. The research was carried out using a sociodemographic questionnaire, the Dimensional Apathy Scale, and the Social Communication Questionnaire (SCQ) with the domains of social interaction, language, stereotypy, and communication. The referred questionnaire was answered by the parents or guardians of the children with ASD according to the DSM V criteria. Data were analyzed via independent t-test using the SPSS software version 20. Results: Interviews were conducted with 51 parents/guardians of autistic children with a mean age of 8.8 years (±2.95) and a predominance of males, 34 (66.7%). Of this total, 49 (96.1%) of the children attended school; 40 (78.4%) children were on medication, of which 38 (74.5%) were on risperidone. Those children on risperidone had a higher score on the SCQ scale (p = 0.049) and on the domain of stereotyped behaviors (p = 0.033), which indicated greater impairment. Another statistically relevant variable was the presence of married parents, whereby children who did not have the presence of married parents had a higher average of stereotyped behaviors compared to those who had married parents. Conclusions: The results showed differences in the means of social interactions for children on risperidone, especially regarding stereotyped behaviors. However, it is not possible to state whether this difference was due to the use of risperidone or whether they used risperidone precisely because of these behaviors. Also important was that children who had the presence of married parents showed fewer stereotyped behaviors. There was no difference in apathetic behavior between children.

Multiple schedules with response interruption and redirection to reduce stereotypy in children with autism spectrum disorder: Generalization and social validity

Although response interruption and redirection (RIRD) and multiple schedule arrangements have sometimes been shown to be effective in reducing stereotypy for individuals with autism spectrum disorder (ASD), important questions remain about optimal methods for facilitating generalization and social validity. In the current study, we sought to extend the literature on stereotypy treatment and MSAs in several ways. First, we programmed for generalization by conducting sessions with two exemplars of two different categories of activities (i.e., school work, toy play) and assessing generalization with novel exemplars and activities and during the participant's typical instructional program. Second, we used RIRD instructions that were contextual models of appropriate behavior relevant to each activity. Third, during the free access component of the multiple schedule, we used a child's play tent as a first step toward teaching participants to engage in stereotypy during private free time. For all three participants with ASD, stereotypy decreased quickly and substantially, with reductions generalizing to novel activities and contexts. An extensive social validity assessment with board-certified behavior analysts indicated high social acceptability of the goals, procedures, and outcomes.

Examining the role of attention problems in motor stereotypy in children with autism spectrum disorder

BackgroundMotor Stereotypy has a similar presentation in individuals with and without autism. Attention dysfunction is common in those with motor stereotypy who do not have autism spectrum disorder (ASD). A possible link between attention dysfunction and motor stereotypy in ASD remains to be examined. We hypothesize a positive relationship between attention problems and motor stereotypy in individuals with ASD and that attention problems account for changes in stereotypy over time. MethodWe examined the relationship between attention problems and motor stereotypy concurrently and over time in a sample of youth with ASD from the Simons Simplex Collection (N = 2568). Caregiver reported measures including the Child Behavior Checklist, Repetitive Behavior Scale-Revised, and Social Responsiveness Scales were used to measure attention problems, motor stereotypy, and autistic traits, respectively. ResultsA hierarchical regression controlling for age, sex, intelligence quotient (IQ), and autistic traits indicated attention problems were significantly associated with motor stereotypy at Time 1 (participant’s initial date intake) for the full sample and at Time 2 (participant’s second data intake) for a follow-up subsample of youth (N = 233). The follow up sample is the subsample of participants with data from a second timepoint. Hierarchical regression with the follow-up sample controlling for age, sex, IQ, autistic traits, and motor stereotypy at Time 1 revealed that the motor stereotypy did not predict change in attention problems over time. ConclusionsFurther investigation into the relationship between attention dysfunction and motor stereotypy could provide insight into developmental challenges indicated by motor stereotypy.

The effects of the demand component of motor response interruption and redirection on vocal stereotypy in adults with autism spectrum disorder

AbstractResponse interruption and redirection (RIRD) often results in a reduction in level of vocal stereotypy in children and adolescents diagnosed with autism spectrum disorder (ASD). However, research is still needed on the effects of RIRD on adults and on the mechanism by which RIRD produces its effects (i.e., punishment vs. differential reinforcement). The current study used an uninterrupted data collection procedure to evaluate the effects of RIRD, and specifically the contingent demand component, in an adult participant. Results showed that motor RIRD was effective in reducing vocal stereotypy when the demand aspect (i.e., redirection) was included but was ineffective when neutral talking (i.e., interruption) was presented. The impact of RIRD on appropriate vocalizations is also discussed.

Increasing physical activity and analyzing parametrically the effects on stereotypy in children with autism spectrum disorder

AbstractA diagnosis of autism spectrum disorder (ASD) and stereotypy engagement is associated with reduced physical activity (PA). Beyond health benefits, researchers have also reported decreases in stereotypy and corresponding increases in on‐task behavior in individuals with ASD following PA. However, the duration of reported PA varies among studies examining these effects and the persistence of any effect is not well understood. Furthermore, no previous study examining these effects has reported difficulty evoking adequate durations of PA. The purposes of this study were to (1) develop an intervention to increase PA engagement, (2) analyze changes in stereotypy and on‐task behavior following PA, and (3) assess persistence of changes as a function of PA duration. Four participants with ASD were observed for 10 min before, between 1 and 15 min during, and 30 min following PA. Results demonstrated that some duration of PA decreased stereotypy and increased on‐task behavior for most participants.

Phonic and Motor Stereotypies in Autism Spectrum Disorder: Video Analysis and Neurological Characterization.

Stereotypies are among the core symptoms of Autism spectrum disorder (ASD) and can cause significant clinical impairment. At present, phonic stereotypies in ASD have been scarcely explored. This study investigates the frequency, variability, and typologies of phonic and motor stereotypies in children with ASD and their association with clinical neurological variables. We examined 35 patients by recording standardized video sessions and administering the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2). Phonic stereotypies were present in 83.0% of the patients. The most prevalent subtypes were noncommunicative vocalizations (60.0%), single syllables (37.1%), and echolalic stereotypies (22.9%). Noncommunicative vocalizations were more frequent in nonverbal patients (OR = 4.629, p = 0.008), while echolalic stereotypies were more represented in verbal patients (OR = 0.279, p = 0.028). Patients with intellectual disability (ID) showed a higher number (F(1,26) = 9.406, p = 0.005) and variability (F(1,25) = 7.174, p = 0.013) of motor stereotypies, with a higher number (F(1,26) = 13.268, p = 0.005) and variability (F(1,26) = 9.490, p = 0.005) of stereotypies involving the head/trunk/shoulders category. Patients with guttural stereotypies showed a higher variability of total motor stereotypies (OR = 1.487, p = 0.032) and self-directed motor stereotypies (OR = 4.389, p = 0.042). These results, combined with a standardized video-analysis, document the frequency and variability of phonic stereotypies among children with ASD. Correlations between specific phonic stereotypies and verbal abilities should be investigated further.

Sleep and stereotypy in children with autism: effectiveness of function-based behavioral treatment

ObjectivesChildren with autism spectrum disorder (ASD) experience high rates of sleep problems, which exacerbate the core symptoms of ASD, including stereotypy (restricted and repetitive behaviors). Conversely, stereotypy can interfere with sleep by actively competing with sleep-facilitative behaviors (eg, lying down quietly). Behavioral interventions informed by functional behavioral assessment (FBA) significantly reduce sleep problems in children with ASD, however, their impact on sleep-interfering stereotypy is not clear. This study investigated the effectiveness of function-based behavioral treatments for sleep problems, including sleep-interfering stereotypy, in children with ASD, the maintenance of these effects, and parents’ satisfaction with the treatment process. MethodsA non-concurrent multiple baselines across participants design was used to evaluate the effectiveness of function-based, individualized treatments for sleep problems and sleep-interfering stereotypy in three children with ASD. For each participant, stereotypy was automatically maintained and interfered with the initiation and/or re-initiation of sleep. Parents implemented multi-component treatments that included a faded bedtime procedure. ResultsTreatment reduced sleep problems in 2/3 participants, and the duration of stereotypy was reduced in all participants. Treatment effects were largely maintained at follow-up, and parent-reported satisfaction was high. ConclusionThese results support prior research demonstrating the effectiveness of FBA-informed behavioral treatments for sleep problems in children with ASD. Further, this study shows that these treatments may be effective in reducing sleep-interfering stereotypy. Future research should more thoroughly investigate the bidirectional relationships between sleep and core symptoms of ASD, and address how these relationships are assessed and treated in the sleep context.

Brief Report: Mobile Technology to Support Parents in Reducing Stereotypy.

Although behavioral interventions have been known to effectively reduce stereotypy in children with ASD, these types of interventions are not accessible to all families. In response to this issue, we evaluated the effects of the iSTIM, an iOS application designed to support parents in the reduction of stereotypy in their child with ASD. We used a series of AB designs to determine the effectiveness of the iSTIM on stereotypy using parents as behavior change agents. The use of iSTIM by the parents led to a reduction in stereotypy for six of seven participants. Our results suggest that the use of technology may be a cost effective and easily accessible method for parents to reduce stereotypy in their child with ASD.

Promising results supporting the use of an inhibitory stimulus control procedure to reduce vocal stereotypy, but more data needed to establish social validity

QCan differential reinforcement of other behavior (DRO) be used to establish inhibitory stimulus control over vocal stereotypy in children with autism?Design: The authors used a changing-criterion ...

The Use of Differential Reinforcement of Other Behaviours to Establish Inhibitory Stimulus Control for the Management of Vocal Stereotypy in Children with Autism

ABSTRACTObjective: This study examined the efficacy of an inhibitory stimulus control procedure (ISCP) for the management of vocal stereotypy in three children with autism. Method: During discrimination training, implemented within a changing criterion design, participants were taught that there were no consequences for vocal stereotypy in the absence of an inhibitory stimulus but that differential reinforcement procedures were in effect in the presence of the stimulus. Functional control of the inhibitory stimulus was subsequently assessed within a reversal design. Results: Inhibitory stimulus control was established during discrimination training, with participants inhibiting vocal stereotypy for 30 min periods in the presence of the inhibitory stimulus. Reductions in vocal stereotypy were maintained in the presence of the inhibitory stimulus and in the absence of further programmed consequences. Discussion: This study extends current knowledge by demonstrating the efficacy of ISCPs paired with reinforcement only, and illustrating the functional control of the inhibitory stimulus.

Home-Based, Therapist-Assisted, Therapy for Young Children With Primary Complex Motor Stereotypies

BackgroundComplex motor stereotypies (CMS) typically begin before age three years and include rhythmic, repetitive, fixed movements that last for seconds to minutes and can be interrupted with distraction. ObjectiveWe evaluated the effectiveness of a home-based, parent-provided therapy accompanied by scheduled telephone calls with a therapist, in five- to seven-year old children with primary CMS. MethodsEligible families received an instructional digital versatile disk (DVD) written instructions, and scheduled telephone contacts with a therapist at baseline (DVD receipt), one, three, and eight weeks later. At each call, parents completed outcome measures and received feedback. Outcome scales Stereotypy Severity Scale (SSS) Motor and Impairment scales and a Stereotypy Linear Analogue Scale (SLAS) were also completed via the Iinternet (REDCap)—at screening, one and two months post-baseline call. At study conclusion, participants were divided into an intent-to-treat (ITT; had at least one call) or a lost-to-follow-up (LTF) group. ResultsThirty-eight children (mean = 6 years ± 11 months) were enrolled. The LTF group (n = 14) had significantly higher scores than the ITT (n = 24) group on all attention-deficit/hyperactivity disorder ratings (P < 0.01), but not stereotypy severity. Primary outcome scores, acquired by telephone and REDCap, showed a significant reduction in SSS Motor and Impairment scores between the initial and the last completed evaluation (P ≤ 0.001). Calculated change ratios were SSS Motor −0.23/−0.30 (cal/REDCap); SSS Impairment −0.31/−0.32; and SLAS −0.54 (REDCap). Clinical improvement was further supported by results from a parent improvement scale and end of study questionnaires. ConclusionsHome-based, parent-administered behavioral therapy supplemented by telephone contact with a therapist is effective in reducing complex motor stereotypies in children.

A Comprehensive Review of Motor Stereotypies in Children

Purpose of Review Stereotypies are common movement disorders seen in developmentally normal children. This review characterizes the clinical features, epidemiology, pathophysiology, and treatment of this condition. This article will provide a comprehensive review of the recent literature associated with stereotypies in developmentally normal children.

Supplementation of omega 3 fatty acids may improve hyperactivity, lethargy, and stereotypy in children with autism spectrum disorders: a meta-analysis of randomized controlled trials.

AimDeficiency of omega 3 fatty acids may be linked to autism spectrum disorder (ASD). Evidence about the potential therapeutic effects of supplementation of omega 3 fatty acids is lacking in ASD patients.MethodsWe searched major electronic databases from inception to June 21, 2017, for randomized clinical trials, which compared treatment outcomes between supplementation of omega 3 fatty acids and placebo in patients with ASD. An exploratory random-effects meta-analysis of the included studies was undertaken.Results and conclusionSix trials were included (n=194). Meta-analysis showed that supplementation of omega 3 fatty acids improved hyperactivity (difference in means =−2.692, 95% confidence interval [CI] =−5.364 to −0.020, P=0.048, studies =4, n=109), lethargy (difference in means =−1.969, 95% CI =−3.566 to −0.372, P=0.016, studies =4, n=109), and stereotypy (difference in means =−1.071, 95% CI =−2.114 to −0.029, P=0.044, studies =4, n=109). No significant differences emerged between supplementation of omega 3 fatty acids and placebo in global assessment of functioning (n=169) or social responsiveness (n=97). Our preliminary meta-analysis suggests that supplementation of omega 3 fatty acids may improve hyperactivity, lethargy, and stereotypy in ASD patients. However, the number of studies was limited and the overall effects were small, precluding definitive conclusions. Future large-scale randomized clinical trials are needed to confirm or refute our findings.

Developmental Profile and Diagnoses in Children Presenting with Motor Stereotypies.

Motor stereotypies represent a typical example of the difficulty in distinguishing non-clinical behaviors (physiological and transient) from symptoms or among different disorders ["primary stereotypies," associated with autistic spectrum disorder (ASD), intellectual disabilities, genetic syndromes, and sensory impairment]. The aim of this study was to obtain an accurate assessment on the relationship between stereotypies and neurodevelopmental disorders. We studied 23 children (3 girls), aged 36-95 months, who requested a consultation due to the persistence or increased severity of motor stereotypies. None of the patients had a previous diagnosis of ASD. The assessment included the Motor Severity Stereotypy Scale (MSSS), the Repetitive Behavior Scale-Revised (RBS-R), the Raven's Colored Progressive Matrices, the Child Behavior CheckList for ages 1½-5 or 4-18 (CBCL), the Social Responsiveness Scale (SRS), and the Autism Diagnostic Observation Schedule-second edition (ADOS 2). All patients were showing motor stereotypies for periods of time varying from 6 to 77 months. The MSSS showed that each child had a limited number of stereotypies; their frequency and intensity were mild. The interference of stereotypies was variable; the impairment in daily life was mild. The RBS-R scores were positive for the subscale of "stereotypic behaviors" in all children. Moreover, several children presented other repetitive behaviors, mainly "ritualistic behavior" and "sameness behavior." All patients showed a normal cognitive level. The CBCL evidenced behavioral problems in 22% of the children: internalizing problems, attention, and withdrawn were the main complaints. On the SRS, all but one of the tested patients obtained clinical scores in the clinical range for at least one area. On the ADOS 2, 4 patients obtained scores indicating a moderate level of ASD symptoms, 4 had a mild level, and 15 showed no or minimal signs of ASD. Motor stereotypies in children with normal cognitive level represent a challenging diagnostic issue for which a finely tailored assessment is mandatory in order to define a precise developmental profile. Thus, careful and cautious use of standardized tests is warranted to avoid misdiagnosis. Furthermore, it is hard to consider motor stereotypies, even the primary ones, exclusively as a movement disorder.

Anomalous Putamen Volume in Children With Complex Motor Stereotypies

BackgroundComplex motor stereotypies in children are repetitive rhythmic movements that have a predictable pattern and location, seem purposeful, but serve no obvious function, tend to be prolonged, and stop with distraction, e.g., arm or hand flapping, waving. They occur in both “primary” (otherwise typically developing) and secondary conditions. These movements are best defined as habitual behaviors and therefore pathophysiologically hypothesized to reside in premotor to posterior putamen circuits. This study sought to clarify the underlying neurobiologic abnormality in children with primary complex motor stereotypies using structural neuroimaging, emphasizing brain regions hypothesized to underlie these atypical behaviors. MethodsHigh-resolution anatomic magnetic resonance images, acquired at 3.0 T, were analyzed in children aged eight to twelve years (20 with primary complex motor stereotypies and 20 typically developing). Frontal lobe subregions and striatal structures were delineated for analysis. ResultsSignificant reductions (P = 0.045) in the stereotypies group were identified in total putamen volume but not in caudate, nucleus accumbens, or frontal subregions. There were no group differences in total cerebral volume. ConclusionsFindings of a smaller putamen provide preliminary evidence suggesting the potential involvement of the habitual pathway as the underlying anatomic site in primary complex motor stereotypies.

Using Response Interruption and Redirection to Reduce Vocal Stereotypy

Response interruption and redirection, commonly referred to as RIR, is an evidence-based intervention that has been demonstrated to quickly reduce moderate to high levels of vocal stereotypy in children with autism spectrum disorder. The RIR intervention is a simple, three-step procedure that can be embedded in classroom instruction with minimal planning. This column describes the procedure and provides a troubleshooting guide to aid practitioners in effectively implementing the RIR behavior management strategy.

Video self-modeling for reducing vocal stereotypy in children with autism spectrum disorder (ASD)

ABSTRACTVideo self-modeling (VSM) is a promising intervention strategy for teaching a variety of novel skills to children with autism spectrum disorders (ASD). The present study provides preliminary effects of VSM on reducing the vocal stereotypy of children with ASD. Two children participated and experimental control was achieved using a multiple-baseline across subjects design. Results were highly encouraging with one of the participants who showed a large reduction of his vocal stereotypy. Also, the intervention gains were successfully generalized across stimuli, people, and settings and maintained at 2-month follow-up assessment. However, for the other participant, the intervention was interrupted prematurely as he showed stressful reactions in relation to the videos that were presented as part of the intervention. Possible mechanisms for the success of this procedure are discussed as well as implications for its use in educational settings and areas for further research.

Effects of Noncontingent Social Interaction on Immediate and Subsequent Engagement in Vocal and Motor Stereotypy in Children With Autism

This study evaluated the effects of noncontingent social interaction (SI) on immediate and subsequent engagement in vocal and motor stereotypy in three children with autism. During SI, a therapist delivered continuous interaction in the form of reading aloud from a Kindle™ e-reader. Results showed that when compared with a no-interaction baseline sequence, SI decreased immediate engagement vocal stereotypy for all three participants without increasing subsequent engagement for any participant. Furthermore, SI also increased immediate engagement in motor stereotypy for one participant, decreased immediate engagement in motor stereotypy for two participants, but did not increase subsequent engagement in motor stereotypy for any participant. Some clinical implications and limitations of the findings are discussed.

Absent movement‐related cortical potentials in children with primary motor stereotypies

The underlying pathophysiologic mechanism for complex motor stereotypies in children is unknown, with hypotheses ranging from an arousal to a motor control disorder. Movement-related cortical potentials (MRCPs), representing the activation of cerebral areas involved in the generation of movements, precede and accompany self-initiated voluntary movements. The goal of this study was to compare cerebral activity associated with stereotypies to that seen with voluntary movements in children with primary complex motor stereotypies. Electroencephalographic (EEG) activity synchronized with video recording was recorded in 10 children diagnosed with primary motor stereotypies and 7 controls. EEG activity related to stereotypies and self-paced arm movements were analyzed for presence or absence of early or late MRCP, a steep negativity beginning about 1 second before the onset of a voluntary movement. Early MRCPs preceded self-paced arm movements in 8 of 10 children with motor stereotypies and in 6 of 7 controls. Observed MRCPs did not differ between groups. No MRCP was identified before the appearance of a complex motor stereotypy. Unlike voluntary movements, stereotypies are not preceded by MRCPs. This indicates that premotor areas are likely not involved in the preparation of these complex movements and suggests that stereotypies are initiated by mechanisms different from voluntary movements. Further studies are required to determine the site of the motor control abnormality within cortico-striatal-thalamo-cortical pathways and to identify whether similar findings would be found in children with secondary stereotypies.