Stereotypic movement disorder: easily missed
Stereotypic movement disorder: easily missed
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DOI：
10.1111/j.1469-8749.2010.03627.x
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发表时间：
2010-08-01
影响因子：
3.8
通讯作者：
Baer, Susan
中科院分区：
文献类型：
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作者：
Freeman, Roger D.;Soltanifar, Atefeh;Baer, Susan
目的加深对刻板运动障碍（SMD）的认识，并探讨其与抽动症和孤独症刻板的区别男性31例，平均年龄6岁3个月，SD 2岁8个月; 11例女性，平均年龄6 y 7 mo，SD 1 y 9 mo），连续诊断为SMD，无自伤行为、智力残疾、感觉障碍或自闭症谱系障碍（ASD），在神经精神病学诊所接受了评估。向父母（以及发育准备好的儿童）提供了一系列关于刻板印象性质的探索问题。所用的问卷包括刻板印象严重程度量表、短感觉特征、优势和困难问卷、重复行为量表-修订版和发育协调障碍问卷。直接观察到定型的运动模式，在某些情况下还通过父母的录像记录下来。在平均年龄为10岁7个月（SD 4 y 4 mo）的随访中再次使用探针问题。男性以3：1的比例超过女性。13例患者有SMD家族史，30例患者有神经精神共病（注意力缺陷多动障碍16例，抽搐18例，发育协调障碍16例）。强迫症只发生在两个。短感觉轮廓与合并症（p < 0.001）、刻板印象严重程度量表（p=0.009）和重复行为量表（p < 0.001）相关;重复行为量表与刻板印象严重程度量表相关（p=0.001）。孩子们（但不是他们的父母）喜欢他们的动作，这些动作通常与兴奋或想象力的游戏有关。平均随访时间为4年8个月（SD 2年10个月）。在39名随访超过6个月的儿童中，25名儿童的行为停止或逐渐形成，主要是私下发生。误诊是常见的：26个最初被称为抽搐，10个ASD，5个强迫症，1个癫痫。15名儿童同时出现面部鬼脸和22名儿童同时出现发声导致诊断混淆。一般有利的临床过程在很大程度上是由于逐渐增加的私人表达的运动。刻板印象的严重程度与感觉差异和精神病理学有关。因此，对SMD与抽动症、房间隔缺损的鉴别诊断，有助于避免误诊和不必要的治疗。
AimTo expand the understanding of stereotypic movement disorder (SMD) and its differentiation from tics and autistic stereotypies.MethodForty-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).ResultsMean 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.InterpretationSMD 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.