Childhood Habit Behaviors and Stereotypic Movement Disorder Differential Diagnoses

Author: Cynthia R Ellis, MD; Chief Editor: Caroly Pataki, MD more...

Updated: Apr 30, 2012

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Diagnostic Considerations

Although habit disorders can affect any child, stereotypic movements and stereotypies are most common among children with mental retardation and other developmental delays. For example, one should be cognizant of a child who has mental retardation or developmental delay and who engages in head banging and other repetitive behaviors.

Some habitlike behavior is normal for a developing child. For example, approximately one half of all 2-year-old children engage in thumb sucking. However, if this behavior persists through childhood, the likelihood of it becoming a substantial problem may increase with age. Careful observation of normal developmental behaviors should be considered before a child is evaluated for a severe problem.

The differential diagnosis of stereotypic movement disorder requires the clinician to rule out a number of other psychiatric conditions in which repetitive behaviors are core features. Examples include obsessive-compulsive disorder, trichotillomania, vocal and motor tics, and Tourette disorder. When these disorders best account for symptoms, stereotypic movement disorder is not diagnosed. When rarer forms of repetitive actions are present, epileptic automatisms should be kept in mind.

In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:

Abuse
Bobbing head doll syndrome
Central nervous system (CNS) disease
Congenital blindness or deafness
Developmentally appropriate self-stimulatory behaviors in young children
Environmentally based sensory deprivation
Factitious disorder with predominately physical signs and symptoms
Mannerisms
Myoclonus
Neglect
Neurologically based movement disorder (chorea, dystonic movements, athetosis, myoclonus, hemiballismus, spasms)
Pain
Poisoning (amphetamine, cocaine)
Seizure disorder
Self-mutilation associated with certain psychotic disorders and personality disorders
Self-stimulatory behaviors in individuals with hearing impairment or other sensory deficits
Stereotypic movement disorder

Differential Diagnoses

Proceed to Workup

Contributor Information and Disclosures

Author

Cynthia R Ellis, MD Director of Developmental Medicine, Associate Professor, Department of Pediatrics and Psychiatry, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center

Cynthia R Ellis, MD is a member of the following medical societies: Nebraska Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Connie J Schnoes, MA, PhD Psychologist, Director of Training, Supervising Practitioner, Father Flanagan's Boys' Home, Boys Town

Disclosure: Nothing to disclose.

Holly Jean Roberts, PhD Assistant Professor, Department of Pediatrics, Munroe-Meyer Institute, University of Nebraska Medical Center

Holly Jean Roberts, PhD is a member of the following medical societies: Autism Society of America, National Association of School Psychologists, and Psi Chi

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Robert J Baumann, MD Professor of Neurology and Pediatrics, Department of Neurology, University of Kentucky College of Medicine

Robert J Baumann, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, and Child Neurology Society