After weeks of waiting, today was our appointment for Olivia at Children’s Hospital with a Pediatric Neurologist.
(This fall, I noticed Olivia was experiencing what I thought were facial tics. Our doctor sent us to a Pediatrician, who ordered an EEG, which led to our appointment today with a Pediatric Neurologist. Earlier this week, I posted about her worsening symptoms.)
The Pediatric Neurologist believes that Olivia is experiencing stereotypy.
Until yesterday, I had never heard the term stereoytpy. But, a reader actually emailed me yesterday after reading my post about Olivia’s tics, (or what I assumed were tics,) and told me that her daughter had the same symptoms and was diagnosed by a Pediatric Neurologist with stereotypy. She wrote to tell me not to worry, that stereotypy can occur in healthy children.
Here is how Wikipedia defines Stereotypy:
A stereotypy (pronounced /ˈstɛriː.ɵtаɪpi/) is a repetitive or ritualistic movement, posture, or utterance, found in patients with mental retardation, autism spectrum disorders, tardive dyskinesia and stereotypic movement disorder. Stereotypies may be simple movements such as body rocking, or complex, such as self-caressing, crossing and uncrossing of legs, and marching in place. Several causes have been hypothesized for stereotypy, and several treatment options are available.
Stereotypy is sometimes called stimming in autism, under the hypothesis that it self-stimulates one or more senses. Related terms include punding and tweaking to describe repetitive behavior that is a side effect of some drugs.
Distinction from tics:
Like tics, stereotypies are patterned and periodic, and are made worse by fatigue, stress, and anxiety. Unlike tics, stereotypies usually begin before the age of three, involve more of the body, are more rhythmic and less random, and are associated more with engrossment in another activity rather than premonitory urges. Examples of early tics are things like blinking and throat clearing, while arm flapping is a more common stereotypy. Stereotypies do not have the ever-changing, waxing and waning nature of tics, and can remain constant for years. Tics are usually suppressible for brief periods; in contrast, children rarely consciously attempt to control a stereotypy, although they can be distracted from one.
There are several possible explanations for stereotypy, and different stereotyped behaviors may have different explanations. A popular explanation is stimming, which hypothesizes that a particular stereotyped behavior has a function related to sensory input. Other explanations include hypotheses that stereotypy discharges tension or expresses frustration, that it communicates a need for attention or reinforcement or sensory stimulation, that it is learned or neuropathological or some combination of the two, or that it is normal behavior with no particular explanation needed.
The doctor assured us that while stereotypy does present in children with other disorders such as autism, it is also common in typically developing children. (Her own daughter experienced stereotypy.)
She said that as Olivia gets older, she may learn to inhibit her stereotypies and do them more when she is alone. She may stop doing them altogether.
The neurologist is referring Olivia to a pediatric psychiatrist who specializes in stereotypy, tics and Tourette’s, as well as ADHD, etc.
I am glad that we will be able to receive some sort of follow up care. Neurology doesn’t treat stereotypy and considers it benign.
I am so grateful that my daughter doesn’t require medication or treatment! But, considering our family history, I do prefer to have her receive some sort of longer term follow up with a specialist. (Olivia’s brother Jackson has ADHD, ODD and Anxiety, and one of Olivia’s cousins is on the Autism Spectrum.)
I just prefer to stay as educated and aware of what my children are experiencing as possible. Even if there isn’t anything I “can do,” knowledge just makes me feel better.
I have been reading tonight about stereotypy, and indeed it does seem to occur often in developmentally healthy children.
Here is an excerpt from an informative article I found and it describes how stereotypies can affect children who do not have mental retardation or pervasive developmental disorders:
“…The stereotypies seen in these children were associated especially with periods of engrossment such as when playing a game or participating in an activity, but also at times of excitement, stress, fatigue, and boredom. They usually lasted in the range of seconds to minutes (but could go on for hours in some cases) and appeared many times per day. In practically all cases, the stereotypies could be suppressed by sensory stimuli or distraction…
Stereotypies usually develop in early life, mostly before 2 years of age, whereas tics begin to occur in children at age 6 7 years. Unlike tics, which rapidly change from one thing to another (blinks, grimaces, twists, shrugs), stereotypies are prolonged episodes of the same iterated movement.
People with a tic disorder often will stop their tics during engrossing activities, but individuals with stereotypies often will start their repetitive movements during such periods. Distraction usually interrupts stereotypies but not tics.
Many of the children in the study had a comorbidity, including ADHD (15%), obsessive-compulsive disorder or obsessive-compulsive behavior (20%), tics (13%), learning disability (4%), or had an early language or motor developmental delay that resolved itself (12%).
The biologic basis for stereotypies remains unclear, although some evidence suggest that there is a dysfunction in the circuitry between the cortex and the striatum, Dr. Singer said (Pediatr. Neurol. 2005;32:109-12).
If a child’s stereotypy doesn’t interfere with his activity, Dr. Singer said that he doesn’t recommend any particular therapy…”
I didn’t expect to leave the hospital feeling relieved. Going in, I felt hopeless.
Watching my daughter get lost in repetitive movements, her body clenched and her face contorted, is incredibly upsetting. It interrupts her constantly throughout her day and some episodes go on and on.
But knowing that these episodes are not damaging her brain, that they aren’t seizures and I didn’t leave the hospital with a prescription for medication, is such a relief.
Life isn’t perfect. Life isn’t typical. We all have our unique challenges, experiences and blessings.
As difficult as it is to watch my daughter clench and contort her face and her body, even as I hold her or we walk down the street, I am trying to have peace that this is just part of the plan the Lord has for her life.
I need to have faith and let Olivia thrive in the life God has planned for her.
THANK YOU again for all your loving support! Your comments, messages and prayers mean so much to us!!!
UPDATE ON OLIVIA
Olivia is now four years old. She is a happy, energetic, and extremely friendly little girl who keeps us in constant laughter.
Olivia still has her stereotypies. They have not lessened — she still experiences them regularly and is now aware that she has them. There are certain situations and stimuli that always brings on her stereotypic movements, such as driving in a car, waiting in a line up, being in the shower or getting out of the bath/shower, and getting bored. Stress and fatigue do seem to make them worse, but are not as much of a factor as the stimulation around her.
I can “call her out” of a stereotypy by calling her name firmly. She will then “come back” and look at me as if she just came from another place. But, unless I continue to hold her hand and engage her, she will immediately go back into her stereotypic movements.
Olivia will sometimes go for an hour or more and not have any stereotypic movements, but at other times they are far more frequent.
It isn’t easy to watch my daughter struggle with stereotypic movement disorder. It is hard when people stare at her, kids and adults alike, confused by what they are seeing, or ask me if she is special needs.
But, even though I feel a slight panic sometimes when I see my daughter “go away” into a place I don’t understand as she experiences her stereotypies, I constantly thank God. My daughter is alive. She is not experiencing seizures or anything that is hurting her. She is happy. She is here. And I am so very very grateful.
If your child is experiencing stereotypic movements or tics, please don’t despair. Yes, it is hard. I know the pain and panic I felt when I first realized something was going on with Olivia. We want the best for our children. We want to keep them from all suffering.
But we can’t. Life sometimes hurts. And a diagnosis of stereotypy or tics??? Well — it isn’t the end of their world or yours. As Julia’s cousin told Olivia, it is just a part of who she is.
Written by Janice, co-founder of 5 Minutes for Mom.