Efficacy of parent‐delivered behavioral therapy for primary complex motor stereotypies

Abstract

Aim ‘Primary’ complex motor stereotypies (CMS) are persistent, patterned, repetitive, rhythmic movements in young people with typical development. This study evaluated the efficacy of an instructional DVD as a home-based, parent-administered, behavioral therapy for primary CMS. Method Eighty-one children with primary CMS were enrolled. Primary outcome measures included the Stereotypy Severity Scale (SSS) – Motor and Impairment scores, and Stereotypy Linear Analog Scale (SLAS). Mean CMS onset was 13.4 months (SD 13.1). Eligibility required observed CMS. Psychiatric disorders were not exclusionary and a stable medication regimen was required. Intellectual disability, neurological disorder, autism spectrum disorder, and tics were exclusionary. Initial assessments were completed via REDCap before receipt of the DVD. Fifty-four of the 81 children (34 male, 20 female; mean age 8y 2mo, SD 1.42, range 7–14y) completed assessments at 1, 2, or 3 months after receiving the DVD. Results Reductions (baseline to last assessment) in SSS Motor, SSS Impairment, and SLAS scores (all p<0.001) represented change ratios of –15%, –24%, and a –20%, respectively. Greatest relative treatment benefit was observed by younger children (ages 7–8y), and by one month after receipt of DVD, while a parent global assessment scale showed progressive improvement throughout the study. Interpretation An instructional DVD for parent-delivered behavioral therapy was a safe, effective intervention for primary CMS.

Motor Stereotypies: A Pathophysiological Review

“…Cognitive behavioral therapy (CBT), specifically focusing on habit reversal and differential reinforcement, has some evidence of efficacy for primary complex motor stereotypies (Miller et al, 2006; Specht et al, 2017). Since CBT requires active participation of the child, they must demonstrate the cognitive capability to understand and follow advice from a therapist.…”

“…In this study, children were encouraged to exhibit stereotypic movements intentionally to raise awareness and conscientiousness while performing these behaviors, and parents are trained to verbally reward their children when stereotypic behaviors did not occur. This intervention included 54 participants and was found to be beneficial for patients with stereotypies, significantly reducing scores on all motor stereotypy screening scales [Stereotypy Severity Scale (SSS) – Motor and Impairment Scores, Stereotypy Linear Analog Scales (SLAS)] (Specht et al, 2017). …”

“…However, this practice is based mainly on anecdotal evidence (Tan et al, 1997; Oakley et al, 2015), as there have been no formal studies of medications for stereotypies in normally developing children to date. However, there is empirical evidence to support the benefits of both therapist- (Miller et al, 2006) and home-based (Specht et al, 2017) behavioral therapy programs for primary complex motor stereotypies, so this is the favored choice of therapy. Similarly, studies of pharmacotherapies for stereotypies in children with developmental delay have been inconsistent, as reviewed above, so there is no consensus on the best treatment approach for these children, who are often not candidates for behavioral therapies.…”

Current behavioral assessments of movement disorders in children

“…Both normal children and those with disorders such as CP and autism spectrum disorders (ASD) may exhibit stereotypies. Recent studies have applied several subjective assessments of stereotypies . For example, the Stereotypy Severity Scale (SSS), developed by Miller, is a 5‐item, investigator‐reported scale that measures motor function and impairments; the scores of the former and latter categories range from 0 to 18 and from 0 to 50, respectively.…”

Childhood motor stereotypies: questions of definition and management

“…Social communication difficulties can be primary or secondary, while stereotypies can occur in otherwise typically developing children. Specht et al considered autism spectrum disorder to be exclusionary criteria in their cohort.…”