CHICAGO—Home-based, parent-administered behavioral therapy supplemented by telephone contact with a therapist is effective in reducing complex motor stereotypies in children as young as 5, according to a study presented at the 47th Annual Meeting of the Child Neurology Society. “We recommend this combined approach for children ages 5 and older,” said Harvey S. Singer, MD, Professor of Neurology at Johns Hopkins School of Medicine in Baltimore, and colleagues.
Harvey S. Singer, MD
Rhythmic Movements
Motor stereotypies are repetitive, rhythmic, fixed movements that last for seconds or minutes, stop with distraction, and are thought to arise from alterations within habitual motor pathways in the brain. Complex motor stereotypies typically involve the upper extremities (eg, hand flapping and finger wiggling) and begin in early childhood. Pharmacologic therapy has not been effective, but behavioral therapy has benefited patients, Dr. Singer and colleagues said. In one study of 54 children ages 7 to 14, home-based, parent-administered behavioral therapy using an instructional DVD significantly reduced stereotypies versus baseline.
To evaluate the effectiveness of a home-based, parent-provided therapy accompanied by scheduled telephone calls with a therapist in patients ages 5 to 7 with primary complex motor stereotypies, Dr. Singer and colleagues conducted a study with 38 children (24 boys; mean age, 6).
Patients had confirmed complex motor stereotypies with onset before age 3. Patients reported no premonitory urge and had temporary suspension of movement by an external stimulus or distraction. The researchers did not exclude patients due to inattentiveness, hyperactivity, impulsivity, or obsessive-compulsive behaviors. They did exclude patients with autism spectrum disorder, evidence of intellectual disability, seizures or a known neurologic disorder, or motor or vocal tics. Primary outcome measures included the Stereotypy Severity Scale (SSS) Motor and Impairment scores and the Stereotypy Linear Analog Scale (SLAS). Secondary outcomes included Patient Global Impression of Improvement (PGI-I).
Behavioral Therapy
The investigators sent participants a 44-minute instructional DVD about complex motor stereotypies with instructions provided by a behavioral psychologist. Parents were instructed to implement awareness training in the first week and to collect data and reinforce suppression starting in Week 2. Awareness training aims to make the child aware of his or her movements by using videos showing the activity and by the practice of voluntarily starting and stopping the movement.
Fourteen of the 38 participants were lost to follow-up (ie, they completed no post-DVD receipt assessments). The intent-to-treat group included 24 participants (15 boys) who completed at least one phone call with the study psychologist after receiving the DVD. There was no difference in stereotypy severity among those who were lost to follow-up and those in the intent-to-treat group. Those lost to follow-up had higher scores on ADHD ratings, however, which “suggests those with greater ADHD symptomatology at baseline were more likely to drop out,” the researchers said.
Compared with baseline measures, participants in the intent-to-treat group had significant reductions in SSS Motor and SSS Impairment scores at the last available assessment, and outcome measures progressively improved during the study. On the PGI-I, 56.5% of participants were very much or much improved, 30% were improved, and 13% reported no change.
All primary outcome measures significantly decreased. SSS Motor scores decreased by 23% as measured by telephone and 30% as measured online, SSS Impairment scores decreased by 31% measured by telephone and 32% measured online, and SLAS decreased by 54% as measured online. “The similarity between beneficial outcomes on the SSS Motor and SSS Impairment scales suggest a positive impact on both the movements themselves and their functional impact,” Dr. Singer and colleagues said.