About Bioline  All Journals  Testimonials  Membership  News

Iranian Journal of Pediatrics
Tehran University of Medical Sciences Press
ISSN: 1018-4406 EISSN: 2008-2150
Vol. 20, Num. 2, 2010, pp. 149-159

Iran Journal of Pediatrics, Vol. 20, No. 2, April-June, 2010, pp. 149-159

Clinical Approach

Clinical approach to motor stereotypies in autistic children

1 Research  Center  for  Psychiatry  and  Behavioral  Sciences,  Hafez  Hospital,  Shiraz  University  of Medical  Sciences, Shiraz, IR Iran  2Department of Psychiatry, Shiraz University of Medical Sciences, Shiraz, IR Iran 

Correspondence Address: Research Center for Psychiatry and Behavioral Sciences, Hafez Hospital, Shiraz University of Medical Sciences, IR Iran


Date of Submission: 29-Dec-2009

Date of Decision: 10-Mar-2010

Date of Acceptance: 15-Mar-2010

Code Number: pe10021


This is an overview of stereotypic behavior in autistic spectrum disorder (ASD). This repetitive, nonfunctional, fixed pattern of behavior is associated with autism severity but it is not specific for ASD. There are a wide range of behaviors mentioned as stereotypies. It usually starts in early childhood and its severity is associated with outcomes and severity of autism in adolescence and adulthood. It is usually co-morbid with other psychiatric problems and its pathophysiology is not exactly known. Management is most likely behavioral. There are some reports regarding efficacy of antipsychotics for its management Further studies should be conducted to improve our knowledge about it and our ability to differentiate it from tics.

Keywords: Motor; Stereotypy; Autism; Clinical Approach; Children


Restricted repetitive behaviors (RRB) and stereotypic behaviors (SB) count among the key symptoms of autism. Movement disorders such as stereotypies indicate the severity and progression rate of Rett disorder [1] , and the severity of autism symptoms and pragmatic competence at later ages [2]. Social involvement of children with autism with their peers increases their adaptive behavior skills and improve outcome of the disorder [3]. Repetitive and stereotyped movements with objects in children with autism spectrum disorders late in the second year of life predict unique variance in the severity of autism symptoms in the fourth year beyond that predicted by social communication measures alone [4]. So, intervention program on cognitive abilities should be focused and started in early ages so that its influence continues into adolescence and adulthood [3].

More studies are required to be conducted to improve knowledge about the pathophysiology of stereotypies in autism [5]. This is a review for definition, classification, epidemiology, and management of motor stereotypies in children with autism.

Definition of Motor Stereotypies

Motor stereotypies are suppressible, repetitive, rhythmical, coordinated, purposeless, fixed, and nonfunctional pattern of movements [Figure - 1] [6],[7].

These movements may happen together and many times in day [7]. The periodic movements are high-frequency. However, rhythmicity is not a characteristic of stereotypy. Stereotypies in autism are associated with severity of autism [8] and lower cognitive development [4]. However, another study did not find association of autism severity and motor stereotypies [6]. The repertoire and manner of movement for each individual is specific. More than one type of stereotypies is usually seen at one moment

Excitement [10] , stimulation, stress, anxiety, boredom, fatigue, sensory isolation, or social demands increase stereotypies [6],[7]. Different types of stereotypic behaviors are displayed in [Table - 1]. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines stereotypies as a repetitive and non functional behavior lasting 4 or more weeks. It also emphasizes that the behavior interferes with normal activity or it may lead to self injury.


The rate of repetitive behaviors in PDD is higher than those with mental retardation [11]. Some authors classified repetitive behaviors into two distinctive groups of 'lower-order' and 'higher-order' sub-groups. The lower-order repetitive behaviors are associated more with developmental delays while the higher-order behaviors are correlated with autism [11]. Another classification classifies stereotypies into two groups of 1) primary or physiological; this type does not have any specific cause for stereotypies such as pencil tapping, hair twisting, and 2) secondary or associated with other conditions such as neurological, sensory problems, with pervasive developmental disorder (PDD), tumor, or infection. For example gazing atypically at objects may be present in PDD [7].

Underlying Disorders

The continuum of repetitive behaviors can be seen in typically developing children [10],[12] and it is not limited to autism spectrum disorders (ASD) [Table - 2] [6],[13].

It also can be seen in children with developmental delay or sensory deprivation [7] syndromes such as Smith-Magenis Syndrome [14] and Cri-du-Chat syndrome [15]. The number and diversity of stereotypies in autism is more than in typically developing children [6]. The rare behavior of atypical gazing at fingers and objects was only observed in autism [6]. Some authors report that self-injurious behavior is a more rigorous type of stereotyped movements and self-injurious behavior is rarely performed in the absence of other stereotyped movements [16].

Autism Spectrum Disorders

Autism is one of the most common types of autism spectrum disorders. These disorders are behavioral syndromes with various degrees of social impairments, verbal, nonverbal and as well as restricted or stereotyped interests and activities. The age of onset is before 3 years. The other types of autism spectrum disorders are Aspeger's syndrome, Rett's disorder, childhood disintegrative disorder, and Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS). Etiology of these disorders is not clearly known [25].

Autism spectrum disorders impact different aspects of the children and also their families, parents, and siblings [26]. The rate of symptoms of ASD in community is considerable [27].

Medications such as antipsychotics and serotonin specific reuptake inhibitors are suggested for management of autism spectrum disorders [28].

Epidemiological Factors

The mothers reported point prevalence of stereotypic movement among 3079 children of 1-15 years age in the primary health care centers referred for vaccination was 2.3% [29]. It usually starts before age 3 years [7],[30]. Boys more than girls are afflicted and its ratio is about 3:2 [7],[10],[31],[32]. Stereotypic behavior levels in 2-, 3-and 4-year-old children with autism or PDD-NOS is more than in the typically developing same-age peers [17]. Even, infants with autism show stereotypic behavior [33]. Forty-four percent of children with autism have at least one subtype of stereotypy [6].

Developmental age is not associated with the presence of repetitive behaviors in autism but lower chronological age is associated more with simple or low-level repetitive behaviors [34].

Stereotypies are more common in children with autism than cognitively-matched non-autistic developmentally disordered children. The occurrence, number, and variety of stereotypies are higher in autism co-occuring with mental retardation (nonverbal Intelligence Quation (IQ) [6].

Key points:

  • One of the key features of autism spectrum disorders is restricted repetitive behaviors (RRB) and stereotypic behaviors.
  • Motor stereotypies are suppressible, repetitive, rhythmical, coordinated, purposeless, fixed, and nonfunctional pattern of movements.
  • Motor stereotypies usually start before age 3 years.
  • Stereotypies can be assessed using Repetitive Behavior Scale-Revised (RBS-R) questionnaire or Repetitive and Restricted Behaviour Scale (RRB).
  • Management for stereotypies is mostly behavioral


Foundation and developmental course of stereotypic behavior in autism is not well known [5]. Frontal white matter and both of the left and right caudate nuclei volume reduction and cortico-striatal-thalamo-cortical circuitry dysfunction is reported in children with stereotypy without autism [35]. Dopaminergic system is involved in stereotypies [36]. Basal ganglia dysfunction is correlated stereotypies in ASD. The higher right caudate and total putamen volume is associated with higher repetitive behaviors [37]. There is a relative hyperplasia of white matter in the cerebellum and brainstem in children with Down syndrome and ASD in comparison to Down syndrome only. Severity of stereotypies is associated with cerebellar white matter volume [38]. Frontal lobe volume has a positive association with stereotypies in autism [39].

Hand stereotypies without bruxism, and the other stereotypies is highly a sign of an MECP2 mutation in Rett syndrome [40]. There is a 25% positive family histories of motor stereotypies [31]. Underlying genetic abnormality for non-autistic motor stereotypies is suggested [31].

Repetitive behaviors do not differentiate high functioning autism and Asperger's disorder [41]. The association of social-communication impairments and stereotypies in literature has been exaggerated in autism [42].

Association of stereotypic behavior and response to growth hormone in adults with autism is suggested [43] and the infusion of oxytocin deceases repetitive behaviors [44]. The repetitive symptoms of ASD are associated with some executive processes including cognitive flexibility, working memory, and response inhibition, while it is not associated with executive processes of planning and fluency [45].

The rate of RRB is negatively associated with non verbal IQ while circumscribed interests are positively associated with non verbal IQ [46].

Lower hours of sleep per night predict stereotypic behavior in autism [47]. Sensory and social reinforcers maintain stereotypy [48].


The co-morbidity of stereotypies with tics, obsessive-compulsive behaviors, and attention deficit hyperactivity disorder (ADHD) (25%) and learning disabilities (20%) is very high [Table - 3] [7].

In a study, nearly 50% of typically developing children with motor stereotypies had ADHD (30%), tics (18%), and obsessive-compulsive behaviors/obsessive-compulsive disorder (10%) [31]. Tic is a stereotyped repetitive involuntary movement or sound [49]. The presence of repetitive behaviors is correlated with hyperactivity in autism [50]. Restrictive or repetitive behaviors in autism are related with obsessive compulsive symptoms in parents of afflicted individuals [51].

Family history of stereotypies in children is 25%, tics 33%, ADHD 10%, and mood-anxiety disorder 8% [10].

Cognitive level is a moderator for expression of stereotypic behaviors in individuals with intellectual disability but not for the autism [52].

Repetitive behaviors predict the presence or absence of autism at a high rate of diagnostic accuracy in adults with intellectual disability [53].

A loss of skill and regression in autism is associated with slightly higher repetitive behaviors [54]. Finally, 17% of older adolescents and adults with autism may have severe catatonic-like symptoms [55]. Of course, association and relationship of stereotypies and catatonia should be studied in future studies [55].

Whom to Investigate

Tics, obsessive compulsive behaviors, unusual sensory responses, social communication difficulties, rhythmic behaviors of sleep, and epileptic automatisms should be differentiated from motor stereotypies [Table - 4] [7].

Of course, sometimes tic, compulsive behaviors, and automatism occur with stereotypies. EEG may help to differentiate seizure from stereotypies.

Autism and obsessive compulisive disorder can be differentiated by types of current repetitive thoughts and behavior.

Thoughts with contamination, sexual, religious, and symmetry, content and behaviors of cleaning, checking, and counting are less likely observed in autism than in obsessive compulsive disorder [22]. Children with OCD focus more than children with ASD on routines and rituals.

Obsession and compulsions in children with OCD are more sophisticated than those with ASD [56]. Some of the points that may help to differentiate stereotypies from other problems are mentioned in the [Table - 2].

Repetitive behavior also occurs in mental retardation [57]. However, autistic individuals more than those with mental retardation show greater severity and higher number of topographies of stereotypy and compulsions [8].

Asperger syndrome and high functioning autism cannot be differentiated regarding repetitive behavior [60].


The three domains of autism improve and this improvement is not associated with age and cognitive function level [61]. This improvement is part of a `natural history' of the development problems [61]. However, remission will not happen for the majority of children with autism [62]. Even in the children with improved language ability, the symptoms of autism were not fading. Severity of repetitive behaviors at the first assessment was in association with severity of autism symptoms and pragmatic competence at later ages [2].

The outcome of stereotypies is not clear [7] and it is usually chronic [10]. Motor stereotypies especially arm/hand movements types are chronic [31]. The severity and frequency of repetitive behaviors in ASD decrease with increase of age [63]. A study reported that it did not change in 50%, and worsened in 13% [10].

Complexity of motor repetitive behaviors in children with autism increases with the increase of age and higher IQ [9]. However, it is not clear whether all stereotyped behaviors need to be treated because some of them do not interfere with explorative and cognitive activities [64].

How to Investigate Children

Stereotypies can be assessed using the recently developed 43-item questionnaire of Repetitive Behavior Scale-Revised (RBS-R) (Bodfish et al, 2000). Its validation has been confirmed in children with autism spectrum disorders [8],[65].

Repetitive and Restricted Behaviour Scale (RRB) is another recently introduced scale for assessment of stereotypies in autism spectrum disorders [66]. RRB includes 35 items that cover whole range of stereotypies. The degree of expression of each behavior is evaluated according to a five-level rating. RRB has been recently translated and back translated into English by author (A. G.). We are studying its Farsi version of psychometric properties. Some items of the RRB are:"repetitive body rocking", "bizarre gait", and "play and leisure rituals". Direct observation, video analysis, and motion sensors may be considered for RBB evaluation [Table - 5].

Management and Treatment

Management for stereotypies is mostly behavioral [55]. The role of medications for treatment of motor stereotypy disorders in typically developing children is not clear and behavioral therapy can be beneficial [Figure - 2] [7],[67].

Positive outcomes were usually reported after behavioral interventions such as "mechanical restraints alone or with other intervention variables", "response blocking alone or with other intervention variables", "non-contingent stimulation", "various contingency manipulations", and "microswitch clusters" [67].

Habit reversal and differential reinforcement of other behavior improve stereotypic behaviors in non-autistic children [68].

Vibroacoustic music decreases stereotypic behaviors in individuals with autism and developmental disabilities [69]. The peer-mediated intervention and social engagement and educating social interaction decrease stereotypic behavior of children with autism [70],[71]. Self-management procedures consisting of self-assessment, self-recording, and self-reinforcement decrease stereotypic behaviors in autism [24]. There is a report that improvement in sleep improves repetitive behaviors in autism spectrum disorder [72].

Instructional prompts reduce time spent in stereotypies [73]. Mother-child warmth relation-ship reduces repetitive behaviors in autism [74]. Antecedent aerobic exercise decreases stereotypic behaviors [75]. There is a report that massage therapy improves autism [76].

A randomized clinical trial showed that medication plus parent training reduces stereotypies in ASD more than medication alone [77]. The results of studies for medication management for RRB in autism are mixed [78].

Antipsychotics reduce stereotypies [79].

Risperidone may improves some sensory problems such as hyperacusia in children with autism [80]. Double-blind, placebo-controlled trial studies indicated that risperidone improves the restricted, repetitive, and stereotypic behavior of autistic children [81],[82]. The synergistic effect of combination of risperidone and pentoxifylline improves behavioral problems and stereotypies in autism [83].

Stimulants reduce hyperactivity and improve attention but they may increase stereo typies [79].

Another randomized, placebo-controlled, crossover study of methylphenidate for ADHD symptoms in preschoolers PDD or intellectual disability (ID) indicated that methylphenidte increased stereotypic behavior in half of children [84]. However, another double-blind crossover study using placebo and two mehylphenidate doses did not indicate worsening stereotypic movements [85]. Secretin does not show any benefit in autism. Alternative treatments have not shown efficacy in well-designed studies [74].

Serotonin reuptake inhibitors (SRIs) such as fluvoxamine and serotonin non-specific reuptake inhibitor of clomipramine improve repetitive behavior in autism [86]. An open-label investigation in adults with autism indicated that sertraline is effective for treatment of their repetitive and aggressive symptoms [87]. A double-blind, placebo-controlled study of fluvoxamine in adults with autism reported that repetitive thoughts and behavior were decreased [88]. Meanwhile, a randomized controlled trial indicated that citalopram was not effective to decrease repetitive behavior in children with ASD [89]. Divalproex is suggested for treatment of repetitive behaviors in ASD [90].

The efficacy of naltrexone on stereotypic behavior in children with ASD was not confirmed in double-blind placebo-controlled trials [91],[92]. Implications for electroconvulsive therapy in children with ASD for management of some behavioral problems is encouraged [93].


The key symptom of stereotypic behaviors is related to severity and progression of ASD.Intervention programs should be undertaken in early ages because stereotypic behaviors impact on later ages and its early detection plays an important role in its management. Considering the classification system directs clinicians for future decision making. Sometimes its management is part of an underlying disease or common co-morbid conditions such as tics, autism and mental retardation. So, sometimes wider assessment may be required to prevent misdiagnosis or incorrect treatment [94].. Its management is most likely behavioral interventions.

The effect of pharmacotherapy on stereotypic behaviors is not well studied. However, anti-psychotics such as risperidone may improve it.


1.Temudo T, Ramos E, Dias K, et al. Movement disorders in Rett syndrome: an analysis of 60 patients with detected MECP2 mutation and correlation with mutation type. Mov Disord. 2008;23 (10):1384-90.  Back to cited text no. 1    
2.Michelotti J, Charman T, Slonims V, et al. Follow-up of children with language delay and features of autism from preschool years to middle childhood. Dev Med Child Neurol. 2002;44(12):812-9.  Back to cited text no. 2    
3.McGovern CW, Sigman M. Continuity and change from early childhood to adolescence in autism. J Child Psychol Psychiatry. 2005; 46(4):401-8.  Back to cited text no. 3    
4.Morgan L, Wetherby AM, Barber A. Repetitive and stereotyped movements in children with autism spectrum disorders late in the second year of life. J Child Psychol Psychiatry. 2008;49(8):826-37.  Back to cited text no. 4    
5.Symons FJ, Sperry LA, Dropik PL, et al. The early development of stereotypy and self-injury: a review of research methods. J Intellect Disabil Res. 2005;49(Pt 2):144-58.  Back to cited text no. 5    
6.Goldman S, Wang C, Salgado MW, et al. Motor stereotypies in children with autism and other developmental disorders. Dev Med Child Neurol. 2009;51(1):30-8.  Back to cited text no. 6    
7.Muthugovindan D, Singer H. Motor stereotypy disorders. Curr Opin Neurol. 2009;22(2):131-6.  Back to cited text no. 7    
8.Bodfish JW, Symons FJ, Parker DE, et al. Varieties of repetitive behavior in autism: comparisons to mental retardation. J Autism Dev Disord. 2000;30(3):237-43.  Back to cited text no. 8    
9.Militerni R, Bravaccio C, Falco C, et al. Repetitive behaviors in autistic disorder. Eur Child Adolesc Psychiatry. 2002;11(5):210-8.  Back to cited text no. 9    
10.Mahone EM, Bridges D, Prahme C, et al. Repetitive arm and hand movements (complex motor stereotypies) in children. JPediatr.2004;145(3):391-5.  Back to cited text no. 10    
11.Carcani-Rathwell I, Rabe-Hasketh S, Santosh PJ. Repetitive and stereotyped behaviours in pervasive developmental disorders. J Child Psychol Psychiatry. 2006;47(6):573-81.  Back to cited text no. 11    
12.Leekam S, Tandos J, McConachie H, et al. Repetitive behaviours in typically developing 2-year-olds. J Child Psychol Psychiatry2007 Nov;48(11):1131-8.  Back to cited text no. 12    
13.Ghanizadeh A, Mohammadi MR, Akhondzadeh S, Shooshtari AA. Clinical symptoms of children with autism spectrum disorder, a clinical sample from Shiraz. Iran J Psychiatry (in Press).  Back to cited text no. 13    
14.Martin SC, Wolters PL, Smith AC. Adaptive and maladaptive behavior in children with Smith-Magenis Syndrome. J Autism Dev Disord2006 May;36(4):541-­52.  Back to cited text no. 14    
15.Collins MS, Cornish K. A survey of the prevalence of stereotypy, self-injury and aggression in children and young adults with Cri du Chat syndrome. J Intellect Disabil Res2002 Feb;46(Pt 2):133-40.  Back to cited text no. 15    
16.Gal E, Dyck MI, Passmore A. The relationship between stereotyped movements and self-injurious behavior in children with developmental or sensory disabilities. Res Dev Disabi12009 Mar-Apr;30(2):342-52.  Back to cited text no. 16    
17.MacDonald R, Green G, Mansfield R, et al. Stereotypy in young children with autism and typically developing children. Res Dev Disabil. 2007;28(3):266-77.  Back to cited text no. 17    
18.Tan A, Salgado M, Fahn S. The characterization and outcome of stereotypical movements in nonautistic children. Mov Disord. 1997; 12(1):47-52.  Back to cited text no. 18    
19.Mendez MF, Mirea A. Adult head-banging and stereotypic movement disorders. Mov Disord. 1998;13(5):825-8.  Back to cited text no. 19    
20.Troster H. Prevalence and functions of stereotyped behaviors in nonhandicapped children in residential care. JAbnorm Child Psychol. 1994;22(1):79-97.  Back to cited text no. 20    
21.Ghanizadeh A. Association of nail biting and psychiatric disorders in children and their parents in a psychiatrically referred sample of children. Child Adolesc Psychiatry Ment Health. 2008;2(l):13.  Back to cited text no. 21    
22.McDougle CJ, Kresch LE, Goodman WK, et al. A case­controlled study of repetitive thoughts and behavior in adults with autistic disorder and obsessive-compulsive disorder. Am J Psychiatry. 1995;152(5):772-7.  Back to cited text no. 22    
23.Mottron L, Mineau S, Martel G, et al. Lateral glances toward moving stimuli among young children with autism: Early regulation of locally oriented perception? Dev Psychopathol.2007;19(1):23-36.  Back to cited text no. 23    
24.Mancina C, Tankersley M, Kamps D, et al. Brief report: reduction of inappropriate vocalizations for a child with autism using a self-management treatment program. J Autism Dev Disord. 2000;30(6):599-606.  Back to cited text no. 24    
25.Ghanizadeh A. Autism: is it all in the head? Altern Ther Health Med. 2009;15(2):8.  Back to cited text no. 25    
26.Ghanizadeh A, Alishahi ML Ashkani H. Helping families for caring children with autistic spectrum disorders. Arch Iran Med. 2009; 12(5)478-82.  Back to cited text no. 26    
27.Ghanizadeh A. A preliminary study on screening prevalence of pervasive developmental disorder in schoolchildren in Iran. J Autism Dev Disord. 2008;38(4):759-63.  Back to cited text no. 27    
28.Ghanizadeh A. Should tactile sensation impairment be considered in pharmacotherapy of pervasive developmental disorders? A case report Neuro Endocrinol Lett. 2008;29(6):877-8.  Back to cited text no. 28    
29.Al-Jawadi AA, Abdul-Rhman S. Prevalence of childhood and early adolescence mental disorders among children attending primary health care centers in Mosul, Iraq: a cross-sectional study. BMC Public Health. 2007;7:274.  Back to cited text no. 29    
30.McConachie H, Le Couteur A, Honey E. Can a diagnosis of Asperger syndrome be made in very young children with suspected autism spectrum disorder? J Autism Dev Disord2005 Apr;35(2):167-76.  Back to cited text no. 30    
31.Harris KM, Mahone EM, Singer HS. Nonautistic motor stereotypies: clinical features and longitudinal follow­up. Pediatr Neural. 2008; 38(4):267-72.  Back to cited text no. 31    
32.Hartley SL, Sikora DM. Sex Differences in Autism Spectrum Disorder: An Examination of Developmental Functioning, Autistic Symptoms, and Coexisting Behavior Problems in Toddlers. J Autism Dev Disord. 2009.39(12):1715-22.  Back to cited text no. 32    
33.Matson JL, Dempsey T, Fodstad JC. Stereotypies and repetitive/restrictive behaviours in infants with autism and pervasive developmental disorder. Dev Neurorehabil. 2009;12(3):122-7.  Back to cited text no. 33    
34.Mooney EL, Gray KM, Tonge BJ. Early features of autism: Repetitive behaviours in young children. Eur Child Adolesc Psychiatry. 2006;15(1):12-8.  Back to cited text no. 34    
35.Kates WR, Lanham DC, Singer HS. Frontal white matter reductions in healthy males with complex stereotypies. Pediatr Neurol. 2005; 32(2):109-12.  Back to cited text no. 35    
36.Miwa H, Morita S, Nakanishi 1, et al. Stereotyped behaviors or punding after quetiapine administration in Parkinson's disease. Parkinso nism Relat Disord. 2004;10(3):177-80.  Back to cited text no. 36    
37.Hollander E, Anagnostou E, Chaplin W, et al. Striatal volume on magnetic resonance imaging and repetitive behaviors in autism. Biol Psychiatry. 2005;58(3):226­-32.  Back to cited text no. 37    
38.Carter JC, Capone GT, Kaufmann WE. Neuroanatomic correlates of autism and stereotypy in children with Down syndrome. Neuroreport. 2008;19(6):653-6.  Back to cited text no. 38    
39.Pierce K, Courchesne E. Evidence for a cerebellar role in reduced exploration and stereotyped behavior in autism. Biol Psychiatry. 2001;49(8):655-64.  Back to cited text no. 39    
40.Temudo T, Oliveira P, Santos M, et al. Stereotypies in Rett syndrome: analysis of 83 patients with and without detected MECP2 mutations. Neurology. 2007;68(15):1183-7.  Back to cited text no. 40    
41.Cuccaro ML, Nations L, Brinkley J, et al. A comparison of repetitive behaviors in Aspergers Disorder and high functioning autism. Child Psychiatry Hum Dev. 2007;37(4):347-60.  Back to cited text no. 41    
42.Mandy WP, Skuse DH. Research review: What is the association between the social-communication element of autism and repetitive interests, behaviours and activities? J Child Psychol Psychiatry. 2008;49(8):795­-808.  Back to cited text no. 42    
43.Hollander E, Novotny S, Allen A, et al. The relationship between repetitive behaviors and growth hormone response to sumatriptan challenge in adult autistic disorder. Neuropsychopharmacology. 2000;22(2):163-­7.  Back to cited text no. 43    
44.Hollander E, Novotny S, Hanratty M, et al. Oxvtocin infusion reduces repetitive behaviors in adults with autistic and Asperger's disorders. Neuropsycho-pharmacology. 2003;28(1):193-8.  Back to cited text no. 44    
45.Lopez BR, Lincoln Al, Ozonoff S, Lai Z. Examining the relationship between executive functions and restricted, repetitive symptoms of Autistic Disorder. J Autism Dev Disord. 2005;35(4):445-60.  Back to cited text no. 45    
46.Bishop SL, Richler J, Lord C. Association between restricted and repetitive behaviors and nonverbal IQ in children with autism spectrum disorders. Child Neuropsychol. 2006;12(4-5):247-67.  Back to cited text no. 46    
47.Schreck KA, Mulick JA, Smith AF. Sleep problems as possible predictors of intensified symptoms of autism. Res Dev Disabil. 2004; 25(1):57-66.  Back to cited text no. 47    
48.Tang JC, Patterson TG, Kennedy CH. Identifying specific sensory modalities maintaining the stereotypy of students with multiple profound disabilities. Res Dev Disabil. 2003;24(6):433-51.  Back to cited text no. 48    
49.Shprecher D, Kurlan R. The management of tics. Mov Disord. 2009;24(1):15-24.  Back to cited text no. 49    
50.Gabriels RL, Cuccaro ML, Hill DE, Ivers BJ, Goldson E. Repetitive behaviors in autism: relationships with associated clinical features. Res Dev Disabil. 2005;26(2):169-81.  Back to cited text no. 50    
51.Abramson RK, Ravan SA, Wright HH, et al. The relationship between restrictive and repetitive behaviors in individuals with autism and obsessive compulsive symptoms in parents. Child Psychiatry Hum Dev. 2005;36(2):155-65.  Back to cited text no. 51    
52.Matson JL, Dempsey T, Lovullo SV, et al. The effects of intellectual functioning on the range of core symptoms of autism spectrum disorders. Res Dev Disabil. 2008;29(4):341-50.  Back to cited text no. 52    
53.Matson JL, Wilkins J, Ancona M. Autism in adults with severe intellectual disability: an empirical study of symptom presentation. J Intellect Dev Disabil. 2008;33(l):36-42.  Back to cited text no. 53    
54.Meilleur AA, Fombome E. Regression of language and non-language skills in pervasive developmental disorders. J Intellect Disabil Res. 2009;53(2):115-24.  Back to cited text no. 54    
55.Stoppelbein L, Greening L, Kakooza A. The importance of catatonia and stereotypies in autistic spectrum disorders. Int Rev Neurobiol. 2006;72:103-18.  Back to cited text no. 55    
56.Zandt F, Prior M, Kyrios M. Repetitive behaviour in children with high functioning autism and obsessive compulsive disorder. J Autism Dev Disord. 2007;37(2):251-9.  Back to cited text no. 56    
57.Matson IL, Hamilton M, Duncan D, et al. Characteristics of stereotypic movement disorder and self-injurious behavior assessed with the Diagnostic Assessment for the Severely Handicapped (DASH-II). Res Dev Disabil. 1997;18(6):457-69.  Back to cited text no. 57    
58.Crosland KA, Zarcone JR, Schroeder S, et al. Use of an antecedent analysis and a force sensitive platform to compare stereotyped movements and motor tics. Am J Merit Retard. 2005;110(3):181-92.  Back to cited text no. 58    
59.Singer HS. Motor stereotypies. Semin Pediatr Neural. 2009;6(2)177-81.  Back to cited text no. 59    
60.South M, Ozonoff S, McMahon WM. Repetitive behavior profiles in Asperger syndrome and high-functioning autism. J Autism Dev Disord2005 Apr;35(2):145-58.  Back to cited text no. 60    
61.Fecteau S, Mottron L, Berthiaume C, et al. Developmental changes of autistic symptoms. Autism. 2003;7(3):255-68.  Back to cited text no. 61    
62.Geschwind DH. Advances in autism. Annu Rev Med. 2009;60:367-80.  Back to cited text no. 62    
63.Esbensen Al, Seltzer MM, Lam KS, et al. Age-related differences in restricted repetitive behaviors in autism spectrum disorders. J Autism Dev Disord. 2009;39(1):57-66.  Back to cited text no. 63    
64.Gritti A, Bove D, Di Sarno AM, et al. Stereotyped movements in a group of autistic children. Funct Neuro12003 Apr-Jun;18(2):89-94.  Back to cited text no. 64    
65.Lam KS, Aman MG. The Repetitive Behavior Scale­Revised: independent validation in individuals with autism spectrum disorders. J Autism Dev Disord. 2007;37(5):855-66.  Back to cited text no. 65    
66.Bourreau Y, Roux S, Gomot M, et al. Validation of the repetitive and restricted behaviour scale in autism spectrum disorders. Fur Child Adolesc Psychiatry. 2009;18(11):675-82.  Back to cited text no. 66    
67.Lancioni GE, Singh NN, O'Reilly MF, et al. An overview of behavioral strategies for reducing hand-related stereotypies of persons with severe to profound intellectual and multiple disabilities: 1995-2007. Res Dev Disabil. 2009;30(1):20-43.  Back to cited text no. 67    
68.Miller IM, Singer HS, Bridges DD, et al. Behavioral therapy for treatment of stereotypic movements in nonautistic children. J Child Neurol. 2006;21(2):119-­25.  Back to cited text no. 68    
69.Lundqvist LO, Andersson G, Viding J. Effects of vibroacoustic music on challenging behaviors in individuals with autism and developmental disabilities. Research in Autism Spectrum Disorders. 2009;3(21:390-400.  Back to cited text no. 69    
70.Lee S, Odom SL, Loftin R. Social engagement with peers and stereotypic behavior of children with autism. Journal of Positive Behavior Interventions. 2007;9(2):67-79.  Back to cited text no. 70    
71.Loftin RL, Odom SL, Lantz IF. Social interaction and repetitive motor behaviors. J Autism Dev Disord. 2008;38(6):1124-35.  Back to cited text no. 71    
72.Malow BA, McGrew SG, Harvey M, Henderson LM, Stone WL. Impact of treating sleep apnea in a child with autism spectrum disorder. Pediatr Neurol. 2006;34(4):325-8.  Back to cited text no. 72    
73.Symons F, Davis M. Instructional conditions and stereotyped behavior: the function of prompts. J Behav Ther Exp Psychiatry. 1994; 25(4):317-24.  Back to cited text no. 73    
74.Smith LE, Greenberg IS, Seltzer MM, et al. Symptoms and behavior problems of adolescents and adults with autism: effects of another-child relationship quality, warmth, and praise. Am J Ment Retard. 2008;113(5):387-402.  Back to cited text no. 74    
75.Elliott RO, Dobbin AR, Rose GD, et al. Vigorous, aerobic exercise versus general motor training activities: effects on maladaptive and stereotypic behaviors of adults with both autism and mental retardation. J Autism Dev Disord. 1994;24(5):565-76.  Back to cited text no. 75    
76.Escalona A, Field T, Singer-Strunck R, et al. Brief report: improvements in the behavior of children with autism following massage therapy. J Autism Dev Disord. 2001;31(5):513-6.  Back to cited text no. 76    
77.Aman MG, McDougle CJ, Scahill L, et al. Medication and Parent Training in Children With Pervasive Developmental Disorders and Serious Behavior Problems: Results From a Randomized Clinical Trial. J Am Acad Child Adolesc Psychiatry. 2009. PMID: 19858761.  Back to cited text no. 77    
78.Soorya L, Kiarashi J, Hollander E. Psychopharmacologic interventions for repetitive behaviors in autism spectrum disorders. Child Adolesc Psychiatr Clin N Am. 2008;17(4):753-71.  Back to cited text no. 78    
79.Malone RP, Gratz SS, Delaney MA, et al. Advances in drug treatments for children and adolescents with autism and other pervasive developmental disorders. CNS Drugs. 2005;19(11):923-34.  Back to cited text no. 79    
80.Ghanizadeh A. Does risperidone improve hyperacusia in children with autism? Psychopharmacol Bull. 2009;42(l):108-10.  Back to cited text no. 80    
81.McDougle CJ, Scahill L, Aman MG, et al. Risperidone for the core symptom domains of autism: results from the study by the autism network of the research units on pediatric psychopharmacology. Am J Psychiatry. 2005;162(6):1142-8.  Back to cited text no. 81    
82.McDougle CJ, Holmes JP, Carlson DC, et al. A double­blind, placebo-controlled study of risperidone in adults with autistic disorder and other pervasive developmental disorders. Arch Gen Psychiatry. 1998;55(7):633-41.  Back to cited text no. 82    
83.Akhondzadeh S, Fallah J, Mohammadi MR, et al. Double­blind placebo-controlled trial of pentoxifylline added to risperidone: Effects on aberrant behavior in children with autism. Prog Neuropsychopharmacol Biol Psychiatry. 2 010; 34(1) :3 2-6.  Back to cited text no. 83    
84.Ghuman JK, Aman MG, Lecavalier L, et al. Randomized, Placebo-Controlled, Crossover Study of Methylphenidate for Attention-Deficit/Hyperactivity Disorder Symptoms in Preschoolers with Developmental Disorders. Journal of Child and Adolescent Psychopharmacology. 2009;19(4):329-39.  Back to cited text no. 84    
85.Quintana H, Birmaher B, Stedge D, et al. Use of methylphenidate in the treatment of children with autistic disorder. J Autism Dev Disord. 1995;25(3):283-­94.  Back to cited text no. 85    
86.McDougle CJ, Kresch LE, Posey DJ. Repetitive thoughts and behavior in pervasive developmental disorders: treatment with serotonin reuptake inhibitors. J Autism Dev Disord. 2000;30(5):427-35.  Back to cited text no. 86    
87.McDougle CJ, Brodkin ES, Naylor ST, et al. Sertraline in adults with pervasive developmental disorders: a prospective open-label investigation. J Clin Psycho­pharmacol. 1998;18(1):62-6.  Back to cited text no. 87    
88.McDougle CJ, Naylor ST, Cohen DJ, et al. A double-blind, placebo-controlled study of fluvoxamine in adults with autistic disorder. Arch Gen Psychiatry. 1996;53(11):1001-8.  Back to cited text no. 88    
89.King BH, Hollander E, Sikich L, et al. Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism. Arch Gen Psychiatry. 2009;66(6):583-90.  Back to cited text no. 89    
90.Hollander E, Soorya L, Wasserman S, et al. Divalproex sodium vs. placebo in the treatment of repetitive behaviours in autism spectrum disorder. Int J Neuropsychopharmacol. 2006;9(2):209-13.  Back to cited text no. 90    
91.Willemsen-Swinkels SH, Buitelaar JK, van Engeland H. The effects of chronic naltrexone treatment in young autistic children: a double-blind placebo-controlled crossover study. Biol Psychiatry, 1996;39(12):1023-31.  Back to cited text no. 91    
92.Willemsen-Swinkels SH, Buitelaar JK, Nijhof GI, et al. Failure of naltrexone hydrochloride to reduce self­injurious and autistic behavior in mentally retarded adults. Double-blind placebo-controlled studies. Arch Gen Psychiatry. 1995;52 (9):766-73.  Back to cited text no. 92    
93.Dhossche DM, Red IM, Wachtel LE. Catatonia and autism: a historical review, with implications for electroconvulsive therapy. JECT.2009;25(1):19-22.  Back to cited text no. 93    
94.Freeman RD, Soltanifar A, Baer S. Stereotypic movement disorder: easily missed. Dev Med Child Neurol. 2010. PMID: 20187883.  Back to cited text no. 94    

Copyright 2010 - Iran Journal of Pediatrics

The following images related to this document are available:

Photo images

[pe10021t3.jpg] [pe10021t5.jpg] [pe10021t1.jpg] [pe10021t4.jpg] [pe10021t2.jpg] [pe10021f2.jpg] [pe10021f1.jpg]
Home Faq Resources Email Bioline
© Bioline International, 1989 - 2024, Site last up-dated on 01-Sep-2022.
Site created and maintained by the Reference Center on Environmental Information, CRIA, Brazil
System hosted by the Google Cloud Platform, GCP, Brazil