Department of Psychiatry and Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Dev Med Child Neurol. 2010 Aug;52(8):733-8. doi: 10.1111/j.1469-8749.2010.03627.x. Epub 2010 Feb 24.
To expand the understanding of stereotypic movement disorder (SMD) and its differentiation from tics and autistic stereotypies.
Forty-two children (31 males, mean age 6y 3mo, SD 2y 8mo; 11 females, mean age 6y 7mo, SD 1y 9mo) consecutively diagnosed with SMD, without-self-injurious behavior, intellectual disability, sensory impairment, or an autistic spectrum disorder (ASD), were assessed in a neuropsychiatry clinic. A list of probe questions on the nature of the stereotypy was administered to parents (and to children if developmentally ready). Questionnaires administered included the Stereotypy Severity Scale, Short Sensory Profile, Strengths and Difficulties Questionnaire, Repetitive Behavior Scale--Revised, and the Developmental Coordination Disorder Questionnaire. The stereotyped movement patterns were directly observed and in some cases further documented by video recordings made by parents. The probe questions were used again on follow-up at a mean age of 10 years 7 months (SD 4y 4mo).
Mean age at onset was 17 months. Males exceeded females by 3:1. Family history of a pattern of SMD was reported in 13 and neuropsychiatric comorbidity in 30 (attention-deficit-hyperactivity disorder in 16, tics in 18, and developmental coordination disorder in 16). Obsessive-compulsive disorder occurred in only two. The Short Sensory Profile correlated with comorbidity (p<0.001), the Stereotypy Severity Scale (p=0.009), and the Repetitive Behavior Scale (p<0.001); the last correlated with the Stereotypy Severity Scale (p=0.001). Children (but not their parents) liked their movements, which were usually associated with excitement or imaginative play. Mean length of follow-up was 4 years 8 months (SD 2y 10mo). Of the 39 children followed for longer than 6 months, the behavior stopped or was gradually shaped so as to occur primarily privately in 25. Misdiagnosis was common: 26 were initially referred as tics, 10 as ASD, five as compulsions, and one as epilepsy. Co-occurring facial grimacing in 15 children and vocalization in 22 contributed to diagnostic confusion.
SMD occurs in children without ASD or intellectual disability. The generally favorable clinical course is largely due to a gradual increase in private expression of the movements. Severity of the stereotypy is associated with sensory differences and psychopathology. Differentiation of SMD from tics and ASD is important to avoid misdiagnosis and unnecessary treatment.
扩展对刻板运动障碍（SMD）的认识，并对其与抽动症和自闭症刻板行为进行区分。
在神经精神科诊所，连续评估了 42 名儿童（31 名男性，平均年龄 6 岁 3 个月，标准差 2 岁 8 个月；11 名女性，平均年龄 6 岁 7 个月，标准差 1 岁 9 个月），这些儿童被诊断为患有 SMD，但没有自伤行为、智力障碍、感觉障碍或自闭症谱系障碍（ASD）。向父母（如果儿童发育正常，则向儿童）发放了一份关于刻板行为性质的探究问题清单。发放的问卷包括刻板行为严重程度量表、简短感觉量表、长处和困难问卷、修订后的重复行为量表和发育协调障碍问卷。直接观察刻板运动模式，并在某些情况下由父母录制视频进一步记录。在平均年龄为 10 岁 7 个月（标准差 4 岁 4 个月）时，再次使用这些探究问题进行随访。
发病平均年龄为 17 个月。男性是女性的 3 倍。13 名儿童有 SMD 模式的家族史，30 名儿童有神经精神共病（16 名注意力缺陷多动障碍、18 名抽动症和 16 名发育协调障碍）。只有两名儿童患有强迫症。简短感觉量表与共病（p<0.001）、刻板行为严重程度量表（p=0.009）和重复行为量表（p<0.001）相关；后两者与刻板行为严重程度量表相关（p=0.001）。儿童（而非其父母）喜欢他们的动作，这些动作通常与兴奋或想象性游戏有关。平均随访时间为 4 年 8 个月（标准差 2 岁 10 个月）。在 39 名随访时间超过 6 个月的儿童中，25 名儿童的行为停止或逐渐形成，主要在私下进行。误诊很常见：26 名最初被误诊为抽动症，10 名被误诊为 ASD，5 名被误诊为强迫症，1 名被误诊为癫痫。15 名儿童同时出现面部扭曲和 22 名儿童同时出现发声，这导致了诊断混淆。
SMD 发生在没有 ASD 或智力障碍的儿童中。通常良好的临床病程主要是由于刻板动作逐渐增加了私下表达的机会。刻板行为的严重程度与感觉差异和精神病理学有关。将 SMD 与抽动症和 ASD 区分开来很重要，以避免误诊和不必要的治疗。
