Stereotypic Movement Disorder - How To Treat It?

We all tend to engage in some repetitive activities at various points in our lives. However, when a person continues to engage in the same activities which are rhythmic but purposeless, resulting in self-injury or injury to others, it is known as stereotypic movement disorder (SMD). In order to qualify as an SMD, the routine movements should continue for at least four weeks and should interfere with the daily functioning.

This disorder is more common in adolescent boys than in girls, and is associated with other mental conditions like autism, intellectual disability (ID), and neurological disorders. The repeated actions tend to aggravate with frustration, boredom, stress, and anger. Some of the common movements include head banging, self-biting, nail biting, rocking, handshaking, waving into the air, putting objects in the mouth, and picking one’s own skin.
There is no known cause for this disease, though head injury and cocaine are said to cause SMD.

Treatment: Suspected children are diagnosed with SMD after a thorough clinical examination and interview with the parents is done. The treatment then includes a two-pronged approach—improving function and preventing injury.

1. The environment is usually made safer so that even if the repetitive actions are being carried out, the damage done to the child is minimised. For instance, for a child who might be banging his/her head repeatedly, a helmet may be used.
2. Antidepressants, in mild doses, may prove to be useful for some children to control their sadness, which is a trigger for the repetitive behaviour. Atypical antipsychotics such as risperidone or aripiprazole are also used for patients who might have associated autism symptoms.
3. Another trigger is stress, which should be reduced for the child. This prevents the onset of repetitive action, which in turn prevents injury. The child is also trained on how to control his/her own emotions. For instance, children with this condition are taught to put their hands in their pocket if they get a strong urge to pick their own skin. This, when done over a period of time, can help control the habit.
4. The child is also taught relaxation techniques, which can help in controlling the urge.
5. Behavioural therapy approach known as differential reinforcement of other behaviours (DRO) is used where socially appropriate behaviours of the child are suitably rewarded. Over a period of time, this becomes a habit, and good behaviours are reinforced.
6. Another behavioural approach called functional communication training (FTC) is used where the child uses alternative actions or verbal responses in place of the repetitive, harmful actions. This again is reinforced to form a habit with time.

All affected people can have significant reduction in symptoms with a combination of medications and counselling and supportive therapy. Early detection and intervention can help in curtailing the progression of the symptoms.