Childhood Habit Behaviors and Stereotypic Movement Disorder Differential Diagnoses

Updated: Dec 04, 2015
  • Author: Cynthia R Ellis, MD; Chief Editor: Caroly Pataki, MD  more...
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DDx

Diagnostic Considerations

Although habit disorders can affect any child, stereotypic movements and stereotypies are most common among children with intellectual disability and other developmental delays. For example, one should be cognizant of a child who has intellectual disability 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 that it will become 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 the signs and symptoms are best accounted for by one of these other disorders, 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 (eg, chorea, dystonic movements, athetosis, myoclonus, hemiballismus, or spasms)
  • Pain
  • Poisoning (eg, with amphetamine or 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

Differential Diagnoses