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Behavioral Therapy for Treatment of Stereotypic Movements in Nonautistic Children

Division of Pediatric Neurology Johns Hopkins University School of Medicine, Baltimore, MD

Harvey S. Singer, MD

Division of Pediatric Neurology Johns Hopkins University School of Medicine, Baltimore, MD, hsinger{at}jhmi.edu.

Dana D. Bridges, CFNP

Division of Pediatric Neurology Johns Hopkins University School of Medicine, Baltimore, MD

H. Richard Waranch, PhD

Division of Pediatric Neurology Johns Hopkins University School of Medicine, Baltimore, MD

Although typically described in autistic, mentally retarded, and sensory-deprived individuals, motor stereotypies also occur in normal children. In this preliminary report, the behavior modification techniques of habit reversal and differential reinforcement of other behavior were evaluated as a therapeutic modality for the suppression of stereotypic movements in nonautistic subjects. Twelve children, ages 6 to 14 years, with physiologic stereotypies were treated using a standardized treatment protocol. Clinical outcomes were based on differences between assessments obtained at baseline and on telephone follow-up. Evaluation scales included measures of the frequency, intensity, interference, and number of stereotypies (Stereotypy Severity Scale motor portion and Stereotypy Linear Analog Scale) and assessment of global function (Child Global Assessment Scale and Stereotypy Severity Scale global portion). The results were correlated with the child's level of motivation and the number of treatment sessions. After a mean follow-up of 12.1 months, motor stereotypies showed significant improvement on the Stereotypy Linear Analog Scale and Stereotypy Severity Scale total score, P = .009 and P = .046, respectively. Both scales showed a relationship between the number of treatment sessions attended and a reduction in movements. The Child Global Assessment Scale also improved with therapy, but there was no correlation with the number of treatment sessions. Highly motivated patients had greater improvement on the Stereotypy Linear Analog Scale and Stereotypy Severity Scale scales compared with less motivated patients, but motivation had no impact on the Child Global Assessment Scale. The combined use of habit reversal and differential reinforcement of other behavior is beneficial in reducing motor stereotypies in nonautistic children. (J Child Neurol 2006;21:119—125; DOI 10.2310/7010.2006.00025).

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