HOW TO TREAT STEREOTYPIC MOVEMENT DISORDER 2025

HOW TO TREAT STEREOTYPIC MOVEMENT DISORDER 2025

GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF COMMON MENTAL DISORDERS

(Enacted under Decision No. 2058/QĐ-BYT dated May 14, 2020, by the Minister of Health)

Article 33

STEREOTYPIC MOVEMENT DISORDER

CHIEF EDITOR

Associate Professor, PhD Nguyễn Trường Sơn

CO-EDITOR

Associate Professor, PhD Lương Ngọc Khuê

PhD Nguyễn Doãn Phương

CONTRIBUTING AUTHORS

PhD Trần Thị Hà An

MSc Trịnh Thị Vân Anh

PhD Vũ Thy Cầm

MSc Trần Mạnh Cường

PhD Nguyễn Văn Dũng

PhD Vương Ánh Dương

PhD Lê Thị Thu Hà

MSc Trần Thị Thu Hà

MSc Phạm Công Huân

MSc Đoàn Thị Huệ

Specialist Doctor II Nguyễn Thị Minh Hương

MSc Vũ Thị Lan

1. Nguyễn Phương Linh

Specialist Doctor II Nguyễn Thị Phương Loan

MSc Bùi Văn Lợi

MSc Nguyễn Thị Phương Mai

PhD Trần Nguyễn Ngọc

MSc Bùi Nguyễn Hồng Bảo Ngọc

MSc Trương Lê Vân Ngọc

MSc Bùi Văn San

PhD Dương Minh Tâm

MSc Phạm Xuân Thắng

MSc Lê Thị Phương Thảo

MSc Lê Công Thiện

MSc Vương Đình Thủy

Associate Professor, PhD Nguyễn Văn Tuấn

Specialist Doctor II Ngô Văn Tuất

MSc Đặng Thanh Tùng

MSc Vũ Sơn Tùng

MSc Cao Thị Ánh Tuyết

MSc Nguyễn Thị Ái Vân

Specialist Doctor II Hồ Thu Yến

MSc Nguyễn Hoàng Yến

CONTRIBUTORS TO EVALUATION AND FEEDBACK

Associate Professor, PhD Nguyễn Thanh Bình

PhD Vũ Thy Cầm

PhD Nguyễn Hữu Chiến

Specialist Doctor II Võ Thành Đông

PhD Lê Thị Thu Hà

Specialist Doctor II Đỗ Huy Hùng

PhD Nguyễn Mạnh Hùng

MSc Nguyễn Trọng Khoa

Specialist Doctor II Ngô Hùng Lâm

Associate Professor, PhD Phạm Văn Mạnh

Specialist Doctor II Trần Ngọc Nhân

PhD Dương Minh Tâm

MSc Đặng Duy Thanh

PhD Vương Văn Tịnh

Specialist Doctor II Lâm Tứ Trung

PhD Lại Đức Trường

PhD Cao Văn Tuân

Associate Professor, PhD Nguyễn Văn Tuấn

SECRETARIAT TEAM

MSc Đặng Thanh Tùng

MSc Trương Lê Vân Ngọc

BA Đỗ Thị Thư

Article 33

STEREOTYPIC MOVEMENT DISORDER

I. DEFINITION  

Stereotypic movements are intentional, repetitive, often rhythmic actions commonly seen in typically developing children, with increased frequency in those diagnosed with pervasive developmental disorders or intellectual developmental disorders. Per ICD-10, stereotypic movement disorder involves voluntary, repetitive, nonfunctional, rhythmic movements not attributable to an underlying psychiatric or neurological condition.

II. ETIOLOGY  

Causes can be viewed through behavioral, developmental, functional, and neurobiological lenses:  

– Normal Development: Some stereotypic behaviors are typical in young children.  

– Developmental Disorders: Progression from toddlerhood to later childhood may reflect conditions like intellectual disability or pervasive developmental disorders.  

– Genetics: Lesch-Nyhan syndrome (X-linked recessive gene mutation) features intellectual disability, hyperuricemia, spasticity, and self-injurious stereotypies. Nail-biting shows familial patterns.  

– Psychosocial Factors: Head-banging is linked to neglect or abandonment.

III. DIAGNOSIS  

1. Definitive Diagnosis  

– Most prevalent in children with intellectual disability or pervasive developmental disorders.  

– Harmless Stereotypies: Body rocking, head shaking, hair pulling/twisting, finger crossing, hand clapping.  

  – Nail-Biting: Begins as early as age 1, peaks by 12, affects all nails. Most cases are mild and don’t meet ICD-10 criteria. Associated with emotional states (anxiety, boredom); severe cases occur in profound intellectual disability or paranoid schizophrenia.  

– Harmful Stereotypies: Repetitive head-banging, self-slapping, eye-poking, biting hands/lips/body parts. Severe cases may involve self-mutilation, posing life-threatening risks (e.g., secondary infections, sepsis).  

  – Head-Banging: Emerges at 6-12 months, male-to-female ratio 3:1. Rhythmic, persistent striking against cribs or hard surfaces; typically transient but may persist into mid-childhood.  

– ICD-10 Criteria:  

1. Stereotypic movements causing bodily injury or disrupting normal activities.  
2. Duration ≥1 month.  
3. No other ICD-10 behavioral/psychiatric disorder (except intellectual disability) explains it.  

– Subtypes:  

  – F98.40: No self-injury.  

  – F98.41: Self-injurious.  

  – F98.42: Mixed.

2. Ancillary Testing  

– No specific tests; diagnosis relies on clinical observation.  

– Psychological Assessments: Beck/Hamilton depression scales, Zung/Hamilton anxiety scales, RADS (child depression), DASS (anxiety-depression-stress), DENVER II (development), CBCL (child behavior).  

– Routine Tests: Complete blood count, biochemistry, urinalysis, ECG, abdominal ultrasound, chest X-ray.

3. Differential Diagnosis  

– Obsessive-Compulsive Disorder: Ritualistic, distress-driven behaviors.  

– Tic Disorders: Involuntary, often distressing movements.  

– Stereotyped Movement Disorder (Neurological): Linked to specific neurological conditions.

IV. TREATMENT  

1. Treatment Principles  

– Combine behavioral interventions and pharmacotherapy.  

– Address co-occurring conditions (e.g., anxiety, depression, autism).  

– Prevent injury risks.

2. Specific Treatments  

Behavioral Therapy:  

– Most effective, using rewards/punishments: Reduces symptoms in 90% of cases, with 40-70% achieving full remission.  

– Techniques:  

  – Positive Reinforcement: Rewards appropriate behaviors.  

  – Functional Communication Training: Replaces inappropriate stereotypies with suitable verbal actions (e.g., saying “Sorry” instead of arm-flapping during conversation, redirecting focus).  

  – Habit Reversal: Substitutes unwanted repetitions with acceptable alternatives.  

  – Physical/Occupational Therapy: Enhances control and engagement.  

Pharmacotherapy:  

– Targets self-injurious behaviors:  

  – Antipsychotics (Older/Newer): Manage severe stereotypies.  

  – Antidepressants: Address co-occurring emotional issues.  

  – Valproic Acid: Used empirically, lacks robust clinical trial support.  

  – Naltrexone (Opiate Antagonist): May reduce self-injury.  

– Supportive: Neuroprotectants (piracetam, ginkgo biloba, vinpocetine, choline alfoscerate, nicergoline), liver support, cognitive enhancers, nutrition (B vitamins, minerals, digestible diet, IV nutrition if needed).

Risk Prevention:  

– Mitigate injury from severe stereotypies (e.g., head-banging, biting, eye-poking).  

– Treat co-occurring psychiatric/physical conditions.

V. PROGNOSIS AND COMPLICATIONS  

– Duration and course vary widely. ~80% of normal children exhibit purposeful, rhythmic, comforting movements that resolve by age 4.  

– Severe stereotypies may range from brief stress-related episodes to persistent states. Severity depends on frequency, variety, and injury extent. Frequent, severe, self-injurious stereotypies have the poorest prognosis.

VI. PREVENTION  

– No specific preventive measures exist.  

– Early intervention is critical to prevent self-harm.

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