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Thom RP, McDougle CJ. Repetitive Thoughts and Behaviors in Autism Spectrum Disorder: A Symptom-Based Framework for Novel Therapeutics. ACS Chem Neurosci 2023; 14:1007-1016. [PMID: 36867523 DOI: 10.1021/acschemneuro.2c00731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
While the core symptoms of autism spectrum disorder include repetitive thoughts and repetitive behaviors, repetitive phenomena also occur in many other psychiatric disorders. Types of repetitive thoughts include preoccupations, ruminations, obsessions, overvalued ideas, and delusions. Types of repetitive behaviors include tics, stereotypies, compulsions, extrapyramidal symptoms, and automatisms. We provide a description of how to recognize and classify different types of repetitive thoughts and behaviors in autism spectrum disorder, providing clarity on which phenomena should be considered a core feature of autism spectrum disorder and which phenomena are indicative of a comorbid psychiatric disorder. Clinical features that can be used to differentiate types of repetitive thoughts include whether they are distressing and the degree of insight the individual has, while repetitive behaviors can be classified based on whether they are voluntary, goal-directed/purposeful, and rhythmic. We present the psychiatric differential diagnosis of repetitive phenomena within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) framework. Careful clinical consideration of these transdiagnostic features of repetitive thoughts and behaviors can improve diagnostic accuracy and treatment outcomes, and influence future research.
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Affiliation(s)
- Robyn P Thom
- Massachusetts General Hospital, 55 Fruit St, Boston, Massachusetts 02114, United States.,Lurie Center for Autism, 1 Maguire Road, Lexington, Massachusetts 02421, United States.,Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, Massachusetts 02115, United States
| | - Christopher J McDougle
- Massachusetts General Hospital, 55 Fruit St, Boston, Massachusetts 02114, United States.,Lurie Center for Autism, 1 Maguire Road, Lexington, Massachusetts 02421, United States.,Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, Massachusetts 02115, United States
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Bhatoa RS, Malik O, Robinson S, Hedderly T. Clinical management of complex motor stereotypies. Arch Dis Child 2022; 107:861-865. [PMID: 34725047 DOI: 10.1136/archdischild-2021-322624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/20/2021] [Indexed: 11/03/2022]
Abstract
This paper will review complex motor stereotypies and provide a summary of the current proposed treatment pathway.
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Affiliation(s)
- Raj Seraya Bhatoa
- Children's Neurosciences, Tics and Neurodevelopmental Movements Service (TANDeM), Evelina London Children's Hospital, London, UK
| | - Osman Malik
- Children's Neurosciences, Tics and Neurodevelopmental Movements Service (TANDeM), Evelina London Children's Hospital, London, UK
| | - Sally Robinson
- Children's Neurosciences, Tics and Neurodevelopmental Movements Service (TANDeM), Evelina London Children's Hospital, London, UK
| | - Tammy Hedderly
- Children's Neurosciences, Tics and Neurodevelopmental Movements Service (TANDeM), Evelina London Children's Hospital, London, UK
- Child Health Children's Academic Group, King's College London, London, UK
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Developmental Motor Profile in Preschool Children with Primary Stereotypic Movement Disorder. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1427294. [PMID: 30895189 PMCID: PMC6393901 DOI: 10.1155/2019/1427294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 01/15/2019] [Accepted: 01/31/2019] [Indexed: 11/17/2022]
Abstract
Aim Different neuropsychological dysfunctions have been described in children with primary Stereotypic Movement Disorder (SMD), mainly attention or motor coordination problems. Up to now with no study has evaluated psychomotor functions in preschoolers primary SMD. The aim of this observational study was to gather information on the motor profiles of SMD patients in this age range in comparison with typically developing children. Patients and Methods Twenty-six children (four girls) aged 36 to 76 months (mean= 53 ±10) with primary SMD were assessed by a structured evaluation including the Movement Assessment Battery for Children-Second Edition (MABC-2), the Beery-Buktenica Developmental test of Visual-Motor Integration (VMI), the Repetitive Behaviour Scale-Revised (RBS-R), the Motor Severity Stereotypy Scale (MSSS), and the Child Behaviour Checklist (CBCL). The diagnoses of Intellectual Disability or Autism Spectrum Disorder were exclusion criteria from the study. A comparison group of twenty-seven (four girls) typically developing children without stereotypies aged 36 to 59 months (mean= 48 ±7) was also examined. Results The MABC-2 total score was lower than 15th percentile in fifteen children with SMD (58%); the worst performances were observed in Balance and Manual Dexterity subtests. The motor coordination score of VMI was lower than 15th percentile in ten children (38%). The majority of the children with low scores at MABC-2 also had low scores at the motor coordination subscale of VMI. MABC-2 standard scores of the clinical group were significantly lower than those of controls on MABC-2 Total, Balance, and Ball Skills subtests. Conclusion The finding of widespread dysfunction of gross and fine motor abilities in preschoolers with primary SMD seems to delineate a peculiar phenotype and could provide new approaches to the management of this neurodevelopment disorder.
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Asakawa T, Sugiyama K, Nozaki T, Sameshima T, Kobayashi S, Wang L, Hong Z, Chen SJ, Li CD, Ding D, Namba H. Current behavioral assessments of movement disorders in children. CNS Neurosci Ther 2018; 24:863-875. [PMID: 30039925 DOI: 10.1111/cns.13036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 11/30/2022] Open
Abstract
Pediatric movement disorders (PMDs) are common and have recently received increasing attention. As these disorders have special clinical features, the selection of appropriate behavioral assessment tools that can clearly distinguish movement disorders from other diseases (eg, epilepsy and neuromuscular disorders) is crucial for achieving an accurate diagnosis and treatment. However, few studies have focused on behavioral assessments in children. The present report attempts to provide a critical review of the available subjective and objective assessment tests for common PMDs. We believe that the principles of objectification, multi-purpose use, and simplification are also applicable to the selection and development of satisfactory pediatric behavioral assessment tools. We expect that the development of wearable sensors, virtual reality, and augmented reality will lead to the establishment of more reliable and simple tests. In addition, more rigorous randomized controlled trials that have been specifically designed to evaluate behavioral testing in children are also expected in the future.
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Affiliation(s)
- Tetsuya Asakawa
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu-city, Shizuoka, Japan.,Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Shangjie Minhou, Fuzhou, China
| | - Kenji Sugiyama
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu-city, Shizuoka, Japan
| | - Takao Nozaki
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu-city, Shizuoka, Japan
| | - Tetsuro Sameshima
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu-city, Shizuoka, Japan
| | - Susumu Kobayashi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu-city, Shizuoka, Japan
| | - Liang Wang
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Zhen Hong
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China.,Institute of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Shu-Jiao Chen
- Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Shangjie Minhou, Fuzhou, China
| | - Can-Dong Li
- Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Shangjie Minhou, Fuzhou, China
| | - Ding Ding
- Institute of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Hiroki Namba
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu-city, Shizuoka, Japan
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