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Treatment of Stereotyped Movement Disorders

Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

The most successful approaches to treating Stereotyped Movement Disorder are behavioral in nature and utilize reward and punishment principles drawn from learning theory to decrease the likelihood that children will engage in inappropriate stereotyped movements while simultaneously increasing their appropriate behaviors. Clinical research suggests that behavioral treatment can reduce symptoms of the disorder by up to 90%, and completely eliminate the disorder in 40 to 70% of affected children.

dice with reward written on itThe most common behavioral method used to treat Stereotyped Movement Disorder is known as "Differential Reinforcement of Other Behaviors" (or DRO). A related technique is known as "Differential Reinforcement of Incompatible/Alternate Behaviors" (or DRI/DRA). Both methods use rewards (reinforcements) in order to increase the likelihood that children will act in a particular manner in the future.

The DRO method works by rewarding children when they act in socially appropriate ways (such as when they talk with a parent or play a game without engaging in stereotyped movements). In contrast, children treated with the DRI/DRA method are rewarded when they behave in ways that are incompatible with the stereotyped behaviors that the treatment seeks to suppress. For example, children who are being treated to decrease thumb twiddling would be rewarded only when engaging in a task that requires a different use of their hands (it is impossible to twiddle your thumbs when you are writing a letter, or otherwise occupying your hands). Were the same children to be rewarded according to the DRO scheme, they would get would get rewards for letter writing, as well as for having a conversation during which no thumb twiddling occurs.

Another useful variation on behavioral reward methods for altering habits is called Functional Communication Training (or FCT). In FCT, children are taught to replace undesired behaviors with appropriate verbal activities. For example, children who engage in hand flapping behavior might be trained to say "Excuse Me" when they want to say something during a discussion. The child's act of concentrating on saying "Excuse Me" (an appropriate behavior) makes it easier for them to not hand flap. If it becomes clear that a child's unwanted behavior occurs more frequently when he or she is anxious, relaxation techniques (e.g., breathing exercises or meditation) can complement the above behavior replacement strategy.

Psychopharmacological treatments can also be used to treat Stereotypic Movement Disorder. Atypical antipsychotic drugs such Risperdal and Clozaril (usually used to treat schiozphrenia and mood disorders) and opiate antagonists such as Naltrexone (usually used to treat heroin and opioid addictions) can lessen children's symptoms, but may also result in unwanted side effects such as apathy, sedation, weight gain, confusion, or even hallucinations (seeing, hearing, smelling, etc. things that are not truly there). It is always a good idea to talk with your doctor about the full range of risks and benefits associated with recommended medications before agreeing to allow your child to take them.