1
|
Olson L, Bishop S, Thurm A. Differential Diagnosis of Autism and Other Neurodevelopmental Disorders. Pediatr Clin North Am 2024; 71:157-177. [PMID: 38423714 PMCID: PMC10904885 DOI: 10.1016/j.pcl.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
This article discusses the diagnostic criteria for autism spectrum disorder (ASD), as well as other neurodevelopmental disorders that may be confused with or co-occur with ASD. Practitioners involved in diagnostic assessment of ASD must be well versed in the features that differentiate ASD from other conditions and be familiar with how co-occurring conditions may manifest in the context of ASD. ASD symptoms present differently across development, underscoring the need for training about typical developmental expectations for youth. Periodic reevaluations throughout development are also important because support needs for individuals with autism change over time.
Collapse
Affiliation(s)
- Lindsay Olson
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, 675 18th Street, San Francisco, CA 94143, USA
| | - Somer Bishop
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, 675 18th Street, San Francisco, CA 94143, USA
| | - Audrey Thurm
- Intramural Research Program, Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, 10 Center Drive, Room 1C250, MSC 1255, Bethesda, MD 20892, USA.
| |
Collapse
|
2
|
Fernandez TV, Williams ZP, Kline T, Rajendran S, Augustine F, Wright N, Sullivan CAW, Olfson E, Abdallah SB, Liu W, Hoffman EJ, Gupta AR, Singer HS. Primary complex motor stereotypies are associated with de novo damaging DNA coding mutations that identify KDM5B as a risk gene. PLoS One 2023; 18:e0291978. [PMID: 37788244 PMCID: PMC10547198 DOI: 10.1371/journal.pone.0291978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/10/2023] [Indexed: 10/05/2023] Open
Abstract
Motor stereotypies are common in children with autism spectrum disorder (ASD), intellectual disability, or sensory deprivation, as well as in typically developing children ("primary" stereotypies, pCMS). The precise pathophysiological mechanism for motor stereotypies is unknown, although genetic etiologies have been suggested. In this study, we perform whole-exome DNA sequencing in 129 parent-child trios with pCMS and 853 control trios (118 cases and 750 controls after quality control). We report an increased rate of de novo predicted-damaging DNA coding variants in pCMS versus controls, identifying KDM5B as a high-confidence risk gene and estimating 184 genes conferring risk. Genes harboring de novo damaging variants in pCMS probands show significant overlap with those in Tourette syndrome, ASD, and those in ASD probands with high versus low stereotypy scores. An exploratory analysis of these pCMS gene expression patterns finds clustering within the cortex and striatum during early mid-fetal development. Exploratory gene ontology and network analyses highlight functional convergence in calcium ion transport, demethylation, cell signaling, cell cycle and development. Continued sequencing of pCMS trios will identify additional risk genes and provide greater insights into biological mechanisms of stereotypies across diagnostic boundaries.
Collapse
Affiliation(s)
- Thomas V. Fernandez
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States America
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States America
| | - Zsanett P. Williams
- Department of Psychiatry, Vanderbilt University School of Nursing, Nashville, TN, United States America
| | - Tina Kline
- Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States America
| | - Shreenath Rajendran
- Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States America
| | - Farhan Augustine
- Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States America
| | - Nicole Wright
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States America
| | - Catherine A. W. Sullivan
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States America
| | - Emily Olfson
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States America
| | - Sarah B. Abdallah
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States America
| | - Wenzhong Liu
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States America
| | - Ellen J. Hoffman
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States America
| | - Abha R. Gupta
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States America
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States America
| | - Harvey S. Singer
- Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States America
| |
Collapse
|
3
|
Improving Performance and Quantifying Uncertainty of Body-Rocking Detection Using Bayesian Neural Networks. INFORMATION 2022. [DOI: 10.3390/info13070338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Body-rocking is an undesired stereotypical motor movement performed by some individuals, and its detection is essential for self-awareness and habit change. We envision a pipeline that includes inertial wearable sensors and a real-time detection system for notifying the user so that they are aware of their body-rocking behavior. For this task, similarities of body rocking to other non-related repetitive activities may cause false detections which prevent continuous engagement, leading to alarm fatigue. We present a pipeline using Bayesian Neural Networks with uncertainty quantification for jointly reducing false positives and providing accurate detection. We show that increasing model capacity does not consistently yield higher performance by itself, while pairing it with the Bayesian approach does yield significant improvements. Disparities in uncertainty quantification are better quantified by calibrating them using deep neural networks. We show that the calibrated probabilities are effective quality indicators of reliable predictions. Altogether, we show that our approach provides additional insights on the role of Bayesian techniques in deep learning as well as aids in accurate body-rocking detection, improving our prior work on this subject.
Collapse
|
4
|
Augustine F, Nebel MB, Mostofsky SH, Mahone EM, Singer HS. Aberrant prefrontal cortical-striatal functional connectivity in children with primary complex motor stereotypies. Cortex 2021; 142:272-282. [PMID: 34303880 DOI: 10.1016/j.cortex.2021.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/24/2020] [Accepted: 05/21/2021] [Indexed: 11/28/2022]
Abstract
Motor stereotypies are rhythmic, repetitive, prolonged, predictable, and purposeless movements that stop with distraction. Although once believed to occur only in children with neurodevelopmental disorders such as autism, the presence and persistence of complex motor stereotypies (CMS) in otherwise typically developing children (primary CMS) has been well-established. Little, however, is known about the underlying pathophysiology of these unwanted actions. The aim of the present study was to use resting-state functional magnetic resonance imaging to evaluate functional connectivity within frontal-striatal circuits that are essential for goal-directed and habitual activity in children with primary complex motor stereotypies. Functional connectivity between prefrontal cortical and striatal regions, considered essential for developing goal-directed behaviors, was reduced in children with primary CMS compared to their typically developing peers. In contrast, functional connectivity between motor/premotor and striatal regions, critical for developing and regulating habitual behaviors, did not differ between groups. This documented alteration of prefrontal to striatal connectivity could provide the underlying mechanism for the presence and persistence of complex motor stereotypies in otherwise developmentally normal children.
Collapse
Affiliation(s)
- Farhan Augustine
- Department of Neurology, Johns Hopkins University School of Medicine, USA; Department of Biological Sciences, University of Maryland Baltimore County, USA.
| | - Mary B Nebel
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, USA; Department of Neurology, Johns Hopkins University School of Medicine, USA
| | - Stewart H Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, USA; Department of Neurology, Johns Hopkins University School of Medicine, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | | | - Harvey S Singer
- Department of Neurology, Johns Hopkins University School of Medicine, USA; Department of Neurology, Kennedy Krieger Institute, Baltimore, MD, USA
| |
Collapse
|
5
|
Abstract
Movement disorders presenting in childhood include tics, dystonia, chorea, tremor, stereotypy, myoclonus, and parkinsonism, each of which can be part of various clinical syndromes with distinct etiologies. Some of these conditions are benign and require only reassurance; others are bothersome and require treatment, or may be clues that herald underlying pathology. Answers lie in the inherent characteristics of the movements themselves, together with the clinical context provided in the history obtained by the examiner. The aim of this review is to present an overview of the categories of involuntary movements, along with examples of common acquired and genetic causes, and an approach to history-taking, examination, and treatment.
Collapse
Affiliation(s)
- Joanna Blackburn
- Division of Child Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Mered Parnes
- Pediatric Movement Disorders Clinic, Section of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, United States.
| |
Collapse
|
6
|
da Silva RL, Stone E, Lobaton E. A Feasibility Study of a Wearable Real-Time Notification System for Self-Awareness of Body-Rocking Behavior. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:3357-3359. [PMID: 31946600 DOI: 10.1109/embc.2019.8857221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Wearable sensors have been shown to be effective for promoting self-awareness, wellness and re-education. In this work, we perform a preliminary study analyzing the real-time detection and annotation of body-rocking behavior in individuals, which is a type of Stereotypical Motor Movement (SMM). We develop a platform for real-time annotation and detection using wireless inertial sensors and an embedded device. The annotations are analyzed in order to study the duration and frequency of the behavior, and they are corrected offline in order to better understand any offsets in the real-time annotation procedure. Finally, we show the feasibility of a real-time feedback system based on a proof of concept algorithm and the necessary computation resources to execute it.
Collapse
|
7
|
Home-Based, Therapist-Assisted, Therapy for Young Children With Primary Complex Motor Stereotypies. Pediatr Neurol 2018; 85:51-57. [PMID: 30049425 PMCID: PMC6195441 DOI: 10.1016/j.pediatrneurol.2018.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/06/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Complex 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. OBJECTIVE We 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. METHODS Eligible 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. RESULTS Thirty-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. CONCLUSIONS Home-based, parent-administered behavioral therapy supplemented by telephone contact with a therapist is effective in reducing complex motor stereotypies in children.
Collapse
|
8
|
Dy ME, Waugh JL, Sharma N, O’Leary H, Kapur K, D’Gama AM, Sahin M, Urion DK, Kaufmann WE. Defining Hand Stereotypies in Rett Syndrome: A Movement Disorders Perspective. Pediatr Neurol 2017; 75:91-95. [PMID: 28838622 PMCID: PMC5624791 DOI: 10.1016/j.pediatrneurol.2017.05.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/28/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Hand stereotypies (HS) are a primary diagnostic criterion for Rett syndrome (RTT) but are difficult to characterize and quantify systematically. METHODS We collected video on 27 girls (2-12 years of age) with classic RTT who participated in a mecasermin trial. The present study focused exclusively on video analyses, by reviewing two five-minute windows per subject to identify the two most common HS. Three raters with expertise in movement disorders independently rated the five-minute windows using standardized terminology to determine the level of agreement. We iteratively refined the protocol in three stages to improve descriptive accuracy, categorizing HS as "central" or "peripheral," "simple" or "complex," scoring each hand separately. Inter-rater agreement was analyzed using Kappa statistics. RESULTS In the initial protocol evaluating HS by video, inter-rater agreement was 20.7%. In the final protocol, inter-rater agreement for the two most frequent HS was higher than the initial protocol at 50%. CONCLUSION Phenotypic variability makes standardized evaluation of HS in RTT a challenge; we achieved only 50% level of agreement and only for the most frequent HS. Therefore, objective measures are needed to evaluate HS.
Collapse
Affiliation(s)
- Marisela E. Dy
- Boston Children’s Hospital,Massachusetts General Hospital,Harvard Medical School
| | - Jeff L. Waugh
- Boston Children’s Hospital,Massachusetts General Hospital,Harvard Medical School
| | - Nutan Sharma
- Boston Children’s Hospital,Massachusetts General Hospital,Harvard Medical School
| | | | - Kush Kapur
- Boston Children’s Hospital,Harvard Medical School
| | | | | | | | - Walter E. Kaufmann
- Boston Children’s Hospital,Harvard Medical School,Greenwood Genetic Center
| |
Collapse
|
9
|
Falco-Walter JJ, Stein M, McNulty M, Romantseva L, Heydemann P. 'Tickling' seizures originating in the left frontoparietal region. EPILEPSY & BEHAVIOR CASE REPORTS 2016; 6:49-51. [PMID: 27579251 PMCID: PMC4992044 DOI: 10.1016/j.ebcr.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/07/2016] [Accepted: 07/09/2016] [Indexed: 11/22/2022]
Abstract
We report a 10-year-old boy with mild developmental delay and epilepsy with new events of right back tickling and emotional upset. These initially appeared behavioral, causing postulation of habit behaviors or psychogenic nonepileptic seizures. Several ictal and interictal EEGs were unrevealing. Continuous EEG revealed only poorly localized frontal ictal activity. Given that his clinical symptoms suggested a parietal localization, double-density EEG electrodes were placed to better localize the epileptogenic and symptomatogenic zones. These revealed evolution of left greater than right frontoparietal discharges consistent with seizures at the time of the attacks. Medical management has significantly reduced the patient's seizures.
Collapse
Affiliation(s)
- Jessica J. Falco-Walter
- Rush University Medical Center, Department of Neurology, Epilepsy Section, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, USA
- Corresponding author at: Rush University Medical Center, Department of Neurology, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, USA. Fax: + 1 312 942 0251.Rush University Medical CenterDepartment of Neurology1725 West Harrison StreetSuite 885ChicagoIL60612USA
| | - Michael Stein
- Rush University Medical Center, Department of Neurology, Epilepsy Section, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, USA
| | - Maggie McNulty
- Rush University Medical Center, Department of Neurology, Epilepsy Section, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, USA
| | - Lubov Romantseva
- Rush University Medical Center, Department of Pediatrics, Section of Child Neurology, 1725 West Harrison Street, Suite 710, Chicago, IL 60612, USA
| | - Peter Heydemann
- Rush University Medical Center, Department of Pediatrics, Section of Child Neurology, 1725 West Harrison Street, Suite 710, Chicago, IL 60612, USA
| |
Collapse
|
10
|
Harris AD, Singer HS, Horska A, Kline T, Ryan M, Edden RAE, Mahone EM. GABA and Glutamate in Children with Primary Complex Motor Stereotypies: An 1H-MRS Study at 7T. AJNR Am J Neuroradiol 2016; 37:552-7. [PMID: 26542237 DOI: 10.3174/ajnr.a4547] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/12/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Complex motor stereotypies are rhythmic, repetitive, fixed, purposeful but purposeless movements that stop with distraction. They can occur in otherwise normal healthy children (primary stereotypies) as well in those with autism spectrum disorders (secondary stereotypies). The underlying neurobiologic basis for these movements is unknown but is thought to involve cortical-striatal-thalamo-cortical pathways. To further clarify potential neurochemical alterations, gamma-aminobutyric acid (GABA), glutamate, glutamine, N-acetylaspartate, and choline levels were measured in 4 frontostriatal regions by using (1)H MRS at 7T. MATERIALS AND METHODS A total of 18 children with primary complex motor stereotypies and 24 typically developing controls, ages 5-10 years, completed MR spectroscopy at 7T. Single voxel STEAM acquisitions from the anterior cingulate cortex, premotor cortex, dorsolateral prefrontal cortex, and striatum were obtained, and metabolites were quantified with respect to Cr by using LCModel. RESULTS The 7T scan was well tolerated by all the participants. Compared with the controls, children with complex motor stereotypies had lower levels of GABA in the anterior cingulate cortex (GABA/Cr, P = .049; GABA/Glu, P = .051) and striatum (GABA/Cr, P = .028; GABA/Glu, P = .0037) but not the dorsolateral prefrontal cortex or the premotor cortex. Glutamate, glutamine, NAA, and Cho levels did not differ between groups in any of the aforementioned regions. Within the complex motor stereotypies group, reduced GABA to Cr in the anterior cingulate cortex was significantly associated with greater severity of motor stereotypies (r = -0.59, P = .021). CONCLUSIONS These results indicate possible GABAergic dysfunction within corticostriatal pathways in children with primary complex motor stereotypies.
Collapse
Affiliation(s)
- A D Harris
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.D.H., A.H., R.A.E.E.) F.M. Kirby Center for Functional Brain Imaging (A.D.H., A.H., R.A.E.E.), Kennedy Krieger Institute, Baltimore, Maryland.
| | - H S Singer
- Department of Neurology (H.S.S., T.K.) Department of Pediatrics (H.S.S.)
| | - A Horska
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.D.H., A.H., R.A.E.E.) F.M. Kirby Center for Functional Brain Imaging (A.D.H., A.H., R.A.E.E.), Kennedy Krieger Institute, Baltimore, Maryland
| | - T Kline
- Department of Neurology (H.S.S., T.K.)
| | - M Ryan
- Department of Neuropsychology (M.R., E.M.M.)
| | - R A E Edden
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.D.H., A.H., R.A.E.E.) F.M. Kirby Center for Functional Brain Imaging (A.D.H., A.H., R.A.E.E.), Kennedy Krieger Institute, Baltimore, Maryland
| | - E M Mahone
- Department of Psychiatry and Behavioral Sciences (E.M.M.), The Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Neuropsychology (M.R., E.M.M.)
| |
Collapse
|
11
|
Stein DJ, Kogan CS, Atmaca M, Fineberg NA, Fontenelle LF, Grant JE, Matsunaga H, Reddy YCJ, Simpson HB, Thomsen PH, van den Heuvel OA, Veale D, Woods DW, Reed GM. The classification of Obsessive-Compulsive and Related Disorders in the ICD-11. J Affect Disord 2016; 190:663-674. [PMID: 26590514 DOI: 10.1016/j.jad.2015.10.061] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/24/2015] [Accepted: 10/23/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND To present the rationale for the new Obsessive-Compulsive and Related Disorders (OCRD) grouping in the Mental and Behavioural Disorders chapter of the Eleventh Revision of the World Health Organization's International Classification of Diseases and Related Health Problems (ICD-11), including the conceptualization and essential features of disorders in this grouping. METHODS Review of the recommendations of the ICD-11 Working Group on the Classification for OCRD. These sought to maximize clinical utility, global applicability, and scientific validity. RESULTS The rationale for the grouping is based on common clinical features of included disorders including repetitive unwanted thoughts and associated behaviours, and is supported by emerging evidence from imaging, neurochemical, and genetic studies. The proposed grouping includes obsessive-compulsive disorder, body dysmorphic disorder, hypochondriasis, olfactory reference disorder, and hoarding disorder. Body-focused repetitive behaviour disorders, including trichotillomania and excoriation disorder are also included. Tourette disorder, a neurological disorder in ICD-11, and personality disorder with anankastic features, a personality disorder in ICD-11, are recommended for cross-referencing. LIMITATIONS Alternative nosological conceptualizations have been described in the literature and have some merit and empirical basis. Further work is needed to determine whether the proposed ICD-11 OCRD grouping and diagnostic guidelines are mostly likely to achieve the goals of maximizing clinical utility and global applicability. CONCLUSION It is anticipated that creation of an OCRD grouping will contribute to accurate identification and appropriate treatment of affected patients as well as research efforts aimed at improving our understanding of the prevalence, assessment, and management of its constituent disorders.
Collapse
Affiliation(s)
- D J Stein
- Department of Psychiatry and MRC Unit on Anxiety and Stress Disorders, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
| | - C S Kogan
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - M Atmaca
- Department of Psychiatry, School of Medicine, Firat (Euphrates) University, Elazig, Turkey
| | - N A Fineberg
- Highly Specialized Obsessive Compulsive and Related Disorders Service, Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, UK; Postgraduate Medical School, University of Hertfordshire, Hatfield, UK; University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - L F Fontenelle
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; "D'Or' Institute for Research and Education, Rio de Janeiro, RJ, Brazil; School of Psychological Sciences, Monash University, Melbourne, Australia
| | - J E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - H Matsunaga
- Department of Neuropsychiatry, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya Hyogo, Japan
| | - Y C J Reddy
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - H B Simpson
- College of Physicians and Surgeons, Columbia University Medical College, New York, NY, USA; Anxiety Disorders Clinic and the Center for OCD and Related Disorders, New York State Psychiatric Institute, New York, NY, USA
| | - P H Thomsen
- Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Aarhus, Denmark
| | - O A van den Heuvel
- Department of Psychiatry, VU University Medical Center (VUmc), Amsterdam, The Netherlands; Department of Anatomy & Neurosciences, VUmc, Amsterdam, The Netherlands
| | - D Veale
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Center for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, UK
| | - D W Woods
- Psychology Department, Texas A&M University, College Station, TX, USA
| | - G M Reed
- Department of Psychology, National Autonomous University of Mexico (UNAM), Mexico, DF, Mexico; National Institute of Psychiatry "Ramón de la Fuente Muñiz", Mexico, DF, Mexico; Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| |
Collapse
|
12
|
Oakley C, Mahone EM, Morris-Berry C, Kline T, Singer HS. Primary complex motor stereotypies in older children and adolescents: clinical features and longitudinal follow-up. Pediatr Neurol 2015; 52:398-403.e1. [PMID: 25661287 DOI: 10.1016/j.pediatrneurol.2014.11.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/28/2014] [Accepted: 11/01/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complex motor stereotypies are rhythmic, repetitive, fixed, and purposeless movements that stop with distraction. Once believed to occur only in children with autism spectrum or other developmental disorders, their presence in otherwise typically developing children (primary) has been well-established. In primary complex motor stereotypies, little information is available about the long-term outcome of these movements or existing comorbidities. METHODS Forty-nine healthy participants (31 boys), ages 9 to 20 years with primary complex motor stereotypies who were previously diagnosed at a pediatric movements disorder clinic, were identified from medical records. Parents or the young adult (if older than age 18), completed a telephone interview evaluating family history, outcome, and comorbidities including attention-deficit hyperactivity disorder, obsessive compulsive disorder, anxiety, and tics/Tourette syndrome. Standardized questionnaires assessing attention-deficit hyperactivity, obsessive compulsive disorder, and anxiety were used to validate parent report of comorbidities. RESULTS Stereotypy onset occurred before age 3 years in 98%. In all but one individual, stereotypies persisted at the time of phone follow-up (follow-up range: 6.8-20.3 years). Positive family history of complex motor stereotypies was identified in 39%. Most participants (92%) had concern for at least one comorbid disorder, including parent-/patient-reported clinically elevated levels of anxiety (73%), attention-deficit hyperactivity (63%), obsessive compulsive disorder (35%), and tics/Tourette syndrome (22%). CONCLUSION Primary motor stereotypies typically begin in early childhood and, although reduced in frequency and duration, persist at least through the teenage years. Repetitive movements are associated with a variety of comorbidities that often have a greater functional impact than the stereotypic behavior.
Collapse
Affiliation(s)
| | - E Mark Mahone
- Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland
| | | | - Tina Kline
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harvey S Singer
- Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|
13
|
Stein DJ, Woods DW. Stereotyped movement disorder in ICD-11. BRAZILIAN JOURNAL OF PSYCHIATRY 2014; 36 Suppl 1:65-8. [PMID: 25388614 DOI: 10.1590/1516-4446-2014-3606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
According to current proposals for ICD-11, stereotyped movement disorder will be classified in the grouping of neurodevelopmental disorders, with a qualifier to indicate whether self-injury is present, similar to the classification of stereotypic movement disorder in DSM-5. At the same time, the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders has proposed a grouping of body-focused repetitive behavior disorders within the obsessive-compulsive and related disorders (OCRD) cluster to include trichotillomania and skin-picking disorder. DSM-5 has taken a slightly different approach: trichotillomania and excoriation (skin picking) disorder are included in the OCRD grouping, while body-focused repetitive behavior disorder is listed under other specified forms of OCRD. DSM-5 also includes a separate category of nonsuicidal self-injury in the section on "conditions for further study." There are a number of unresolved nosological questions regarding the relationships among stereotyped movement disorder, body-focused repetitive behavior disorders, and nonsuicidal self-injury. In this article, we attempt to provide preliminary answers to some of these questions as they relate to the ICD-11 classification of mental and behavioral disorders.
Collapse
Affiliation(s)
- Dan J Stein
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Douglas W Woods
- Psychology Department, Texas A&M University, College Station, TX, USA
| |
Collapse
|
14
|
Poretti A, Christen HJ, Elton LE, Baumgartner M, Korenke GC, Sukhudyan B, Hethey S, Cross E, Steinlin M, Boltshauser E. Horizontal head titubation in infants with Joubert syndrome: a new finding. Dev Med Child Neurol 2014; 56:1016-20. [PMID: 24814865 DOI: 10.1111/dmcn.12489] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2014] [Indexed: 11/30/2022]
Abstract
AIM Head thrusts are well documented in Joubert syndrome and ocular motor apraxia. We provide a detailed clinical characterization of head titubation in 13 young children with Joubert syndrome. METHOD Detailed characterization of head titubation was assessed by targeted clinical evaluation and/or analysis of videos. RESULTS In 12 of 13 children (eight males, five females; median age 6y, range 2mo-15y) head titubation was first recognized in the first 2 months of age and decreased in severity until spontaneous resolution. In all children, the head titubation was horizontal, high frequency (~3Hz), had small amplitude (5-10°), was never present during sleep, and did not interfere with the neurodevelopment during infancy. In the majority of children, emotion, anxiety, and tiredness were worsening factors for head titubation. INTERPRETATION Head titubation is a benign, early presentation of Joubert syndrome. Head titubation in hypotonic infants should prompt a careful search for Joubert syndrome. Awareness of its occurrence in Joubert syndrome may avoid unnecessary investigations.
Collapse
Affiliation(s)
- Andrea Poretti
- Department of Pediatric Neurology, University Children's Hospital, Zurich, Switzerland; Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Behavior Therapy for Stereotypic Movement Disorder in Typically Developing Children: A Clinical Case Series. COGNITIVE AND BEHAVIORAL PRACTICE 2013. [DOI: 10.1016/j.cbpra.2013.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
16
|
Abstract
Complex motor stereotypies are repetitive arm and/or hand flapping, waving and wiggling movements that begin before the age of 3 years, occur repeatedly throughout the day and stop with distraction. These movements are commonly seen in children with autism, but also appear in otherwise normally developing individuals labelled as primary. Although proposed to have a psychological and neurobiological mechanism, evidence suggests that there is an abnormality within the corticostriatal–thalamocortical circuitry or its connecting structures. Animal models include both drug-induced (i.e., via stimulants or cocaine) and spontaneously appearing prototypes. Neurochemical investigations, primarily in rodents, have identified a variety of neurotransmitter alterations, with an emphasis on dopamine or glutamate; however, findings are inconsistent. We hypothesize that, based on its various roles in controlling and modulating movements, the frontal cortex will ultimately be shown to be the prime site of abnormality in this disorder. Future studies investigating both humans and animal models are essential for attaining a greater understanding of the pathobiology underlying motor stereotypies.
Collapse
Affiliation(s)
- Sean Gao
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harvey S Singer
- Division of Pediatric Neurology, Johns Hopkins Hospital, Rubenstein Child Health Building, Suite 2158, 200 N Wolfe Street, Baltimore, MD 21287, USA
| |
Collapse
|
17
|
Ludolph AG, Roessner V, Münchau A, Müller-Vahl K. Tourette syndrome and other tic disorders in childhood, adolescence and adulthood. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:821-288. [PMID: 23248712 DOI: 10.3238/arztebl.2012.0821] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 08/07/2012] [Indexed: 01/18/2023]
Abstract
BACKGROUND Tourette syndrome is a combined motor and vocal tic disorder that begins in childhood and takes a chronic course. It arises in about 1% of all children, with highly varying severity. Transient and usually mild tics are seen in as many as 15% of all children in elementary school. The diagnosis is often delayed by several years. METHODS We selectively reviewed the pertinent literature, including the guidelines of the European Society for the Study of Tourette Syndrome for the diagnosis and treatment of tic disorders. RESULTS Tic disorders usually take a benign course, with spontaneous improvement in adolescence in about 90% of patients. Psychoeducation is the basis of treatment in each case and almost always brings marked emotional relief. Specific treatment is needed only for more severe tics and those that cause evident psychosocial impairment. 80-90% of patients with Tourette syndrome have comorbidities (attention deficit-hyperactivity disorder, obsessive-compulsive disorder, depression, anxiety, emotional dysregulation, autoaggression), which often impair their quality of life more than the tics do and therefore become the main target of treatment. There is little evidence for the efficacy of treatment for tics. Small-scale controlled studies with a brief follow-up period have been carried out for some neuroleptic drugs. Behavior therapy should be tried before drug treatment. A further option for very severely affected adults is deep brain stimulation. CONCLUSION Because of the low level of the available evidence, no definitive recommendations can be made for the treatment of tics.
Collapse
Affiliation(s)
- Andrea G Ludolph
- Department of Child- and Adolescent Psychiatry and Psychotherapy, Ulm University Hospital, Ulm, Germany.
| | | | | | | |
Collapse
|