Motor Stereotypies
Motor Stereotypies
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Author: Harvey S. Singer, MD, Professor Emeritus Johns Hopkins Medicine, Clinical Faculty Kennedy Krieger Institute 
Reviewed: Janaury 2022


The term “motor stereotypies” is used to define a large group of repetitive movements that are: 

  • Involuntary 
  • Rhythmic 
  • Fixed 
  • Purposeless 
  • Prolonged 

These movements occur in a variety of different types and forms. They increase when a child is engrossed in an activity. They stop with distraction. Stereotypies are different from other kinds of movement disorders.  

Primary complex motor stereotypies (PCMS) is a common type of motor stereotypy. 


Disorder Overview


The exact percentage of people with motor stereotypy is not known. However, it is estimated that it affects: 

  • 90% of children with autism spectrum disorder 
  • 20% to 70% of children (simple type) 
  • 2 to 4% of children (complex type) 

Defining Characteristics

There are several characteristics that define the disorder. A motor stereotypy: 

  • Is involuntary. A child does it without conscious choice. 
  • Is rhythmic. It occurs at regular intervals  
  • Is fixed. It occurs in the same pattern every time. 
  • Is purposeless. It is not done to achieve a goal. 
  • Is prolonged. It can continue for multiple seconds, minutes, or hours. 
  • Stops with distraction. Calling or touching the individual stops the movement. 
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Primary and Secondary Forms

There are two distinct stereotypy forms: 

  1. Primary form. This form occurs in an otherwise normally developing child. In this form, the movements themselves are a primary symptom. In other words, they are not caused by another disorder. 
  2. Secondary form. This form usually appears in children or adults with other developmental issues. Most stereotypies that begin in adulthood are secondary. The secondary form is: 
    • Common in children with autism spectrum disorder (ASD) 
    • Sometimes seen in those who have: 
      • Genetic syndromes 
      • Encephalitis 
      • Metabolic disorders 
      • Degenerative conditions 
      • Sensory deficits, such as deafness or blindness 
    • Sometimes induced by drug or medication use 
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Age of Onset

Childhood versions usually begin in the first several years of life. Adult versions can begin at various ages. The age at which stereotypies begin in adults depends on the underlying cause.  

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There are three main types of stereotypic movements. 

1. Simple.

These are common in both children and adults. They usually involve one extremity. Examples include:

  • Leg shaking  
  • Thumb sucking 
  • Nail or lip biting 
  • Hair twirling 
  • Body rocking 
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2. Head nodding.

Examples include: 

  • A “no” movement from side to side 
  • A “yes” movement up and down 
  • A movement from shoulder to shoulder 
  • A figure of eight pattern 
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3. Complex.

These usually involve both sides of the body. Examples include: 

  • Hand shaking, flapping, or waving 
  • Opening and closing the hands 
  • Wiggling the fingers 
  • Flapping the arms 
  • Moving the wrists 
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Other activities may accompany the movements above. These can include: 

  • Opening the mouth 
  • Grimacing 
  • Rocking 
  • Pacing 
  • Making a sound or noise


Motor stereotypies tend to appear in association with certain triggers. Triggers can include periods of: 

  • Engrossment 
  • Excitement 
  • Stress 
  • Fatigue 
  • Boredom 
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Duration and Timing

Movements can last for seconds or minutes. In some people they can last hours. They usually occur multiple times per day.  

Motor stereotypies can usually be quickly stopped by: 

  • Stimulating the senses in another way 
  • Distracting the child by touching them  
  • Distracting the child by calling their name 
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The exact cause of the primary form is unknown. The secondary form is caused by another underlying disorder, such as autism spectrum disorder. 


Other movement disorders are sometimes confused with motor stereotypies. It is important to correctly diagnose movement disorders since a correct diagnosis can lead to proper treatment. Some of these other movement disorders include: 

1. Tics.

Motor tics are quick, rapid movements. They involve either a cluster of simple movements or a more complex sequence of movements. Stereotypies are different from tics:

  • Stereotypies begin at an earlier age than tics  
  • Stereotypies are fixed, rhythmic, consistent, and prolonged in duration 
  • Tics involve an urge or desire to perform 
  • Tics do not abruptly stop with distraction 
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2. Self-injurious behaviors (SIBs).

SIBs are repetitive actions that cause physical injury to the child. They can include: 

  • Biting 
  • Hitting  
  • Scratching 
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3. Compulsions.

Compulsions are performed over and over in a fixed fashion. They must be done a certain number of times. They must be done equally on both sides of the body. They are driven by unconscious ideas or impulses. Examples of common compulsions include: 

  • Handwashing 
  • Touching 
  • Counting 
  • Checking  
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Primary Complex Motor Stereotypies (PCMS) is a common subtype of the disorder. Here are some of its defining characteristics: 

  • It is a primary form of the disorder. It is present in children who are otherwise developing normally. 
  • It involves complex motor stereotypy movements. The movements must also occur on both sides of the body. They may evolve over time. 
  • It lasts for longer than a few moments. It lasts for seconds to minutes, or even up to about an hour. 
  • It has notable triggers. It is associated with periods of engrossment, excitement, stress, fatigue, or boredom. 
  • It can occur multiple times per day. 
  • It has an early age of onset. It typically begins before a child reaches age 3. 
  • It can be stopped with distraction. 

 Children often report at least one of the following:                              

  • They are unaware of the movements  
  • They enjoy doing the movements 
  • They are thinking about a TV program or activity (they are mentally visualizing something) 

 Children with PCMS may also have: 

 Children with PCMS tend not to be bothered by the movements when they are young. However, parents often worry about the disruptions and social stigma they can cause. The movements may affect the quality of life of older children. 

What Causes PCMS?

Researchers have been working to understand what causes PCMS. Some early research suggests a genetic cause. This is based on the finding that an affected child has about a 25% to 40% chance of having a close or distant family member with a similar problem.  

Researchers have also tried to understand exactly how motor stereotypies are controlled by the brain. One study looked at pathways in the brain that are necessary for normal movements. It found that there was an imbalance in connections involving two essential pathways in children with PCMS.  

Chemical messengers transmit signals in the brain. They may also play a role in causing PCMS. 

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Primary Form

Lab tests are usually not used in individuals with the primary form of the disorder. This is because so far, doctors have not identified any differences that can be tested in individuals with primary complex motor stereotypies.  

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Secondary Form

Lab tests are used to evaluate individuals with secondary forms of motor stereotypies. Various tests may help doctors identify the underlying problem. Some of the tests used are: 

  • Blood tests 
  • Urine tests 
  • Genetic tests 
  • Magnetic resonance imaging (MRI), to see pictures of the brain 
  • Electroencephalogram (EEG), to see electric patterns in the brain 
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Education about what to expect from this disorder is important. It can help children and families feel more secure. 

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Behavioral Therapy and Medication

It may be important to consider treatment. This is usually considered if a child’s movements are causing:

  • Frequent comments from the child’s peers or family 
  • Physical problems 
  • Disruptions at school  

Behavioral Therapy 

Finding an effective way to treat motor stereotypies with behavioral therapy can be difficult. A variety of approaches have been used, especially for children with autism spectrum disorder (ASD). Two of the more popular approaches for children with ASD include: 

  • Response blocking 
  • Response redirection  

Effective approaches in children with PCMS have included a combination of: 

  • Awareness training 
  • Differential reinforcement of other behaviors  

In children with PCMS, behavioral therapy may be offered at home by a parent. This approach works best with help from a professional therapist. 

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Some early research has suggested that certain types of drugs might be able to reduce stereotypies in children with autism spectrum disorder. However, more research is needed to learn whether they can really help. Further, the use of the suggested medications are associated with significant side effects.  

There is no formal research on the effect of medication in children with PCMS. However, based on parent reports, a wide range of medications have not been helpful with PCMS.  

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Primary Form 

Simple Type 

Movements in children with primary simple motor stereotypies often resolve over several years.  

Complex Type 

In contrast, children with primary complex motor stereotypies continue to experience movements during their teenage years. In some, the movements can last into adulthood. The number of daily episodes and how long they last, however, typically go down during the teenage years.  

Secondary Form 

The outcome of secondary motor stereotypies can vary widely. They differ based on the type, cause, and severity of the underlying cause.  


Johns Hopkins Motor Stereotypies Behavioral Therapy Program 
Johns Hopkins researchers have developed a behavioral therapy program–The Johns Hopkins Motor Stereotypies Behavioral Therapy Program–for parents to use with their children between the ages of 7 and 17. The program has been demonstrated to be helpful in reducing the severity of motor stereotypies. A two-minute YouTube video gives an overview of the program and highlights examples of this condition. The video program (which will be sent only as a downloadable .mp4 file) provides information about the home-based behavioral therapy for children age 7 and older who have been diagnosed with Primary Complex Motor Stereotypies. The cost is $95.99 and can be purchased online through an order form. 

Childhood Stroke 1


Currently, there are no listings for Motor Stereotypies in Check back often and talk with your healthcare provider to identify upcoming trials.   

If you have an interest in searching for any future trials that may be starting:  

  1. Go to the Home page of 
  2. Under “Status”, click on “Recruiting and not yet recruiting studies”  
  3. Under “Condition or disease”, type Motor Stereotypies in the field. A drop-down list will appear if this disorder is included.  
  4. You can narrow the search by entering a Country name  
  5. Once on the disorder page of trials, narrow your search under “Eligibility Criteria” and click “Age/Age Group/Child (birth to 17)” is a database of privately and publicly funded clinical studies conducted around the world. This is a resource provided by the U.S. National Library of Medicine (NLM), which is an institute within the National Institutes of Health (NIH). Listing a study does not mean it has been evaluated by the U.S. Federal Government. Please read the NLM disclaimer for details.     

Before participating in a study, you are encouraged to talk to your health care provider and learn about the risks and potential benefits.    

The information in the CNF Child Neurology Disorder Directory is not intended to provide diagnosis, treatment, or medical advice and should not be considered a substitute for advice from a healthcare professional. Content provided is for informational purposes only.  CNF is not responsible for actions taken based on the information included on this webpage. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options. 


Augustine F, Rajendran S, Singer HS. Cortical endogenous opioids and their role in facilitating repetitive behaviors in deer mice. Behav Brain Res. 2020 Feb 3; 379:112317. PMID: 31676208. 

Baizabal-Carvallo JF, Jankovic J. Functional (psychogenic) stereotypies. J Neurol. 2017 Jul;264(7):1482-1487. . PMID: 28653211. 

Cardona F, Valente F, Miraglia D, D’Ardia C, Baglioni V, Chiarotti F. Developmental profile and diagnoses in children presenting with motor stereotypies. Front Pediatr. 2016 Nov 23; 4:126. PMID: 27933285.  

Dean SL, Tochen L, Augustine F, Ali SF, Crocetti D, Rajendran S, Blue ME, Mahone EM, Mostofsky SH, Singer HS. The role of the cerebellum in repetitive behavior across species: Childhood stereotypies and deer mice. Cerebellum. 2021 Aug 14. 

Harris KM, Mahone EM, Singer HS. Nonautistic motor stereotypies: Clinical features and longitudinal follow-up. Pediatr Neurol. 2008 Apr;38(4):267-72. PMID: 18358406. 

Harris AD, Singer HS, Horska A, Kline T, Ryan M, Edden RA, Mahone EM. GABA and Glutamate in children with primary complex motor stereotypies: An 1H-MRS Study at 7T. AJNR Am J Neuroradiol. 2016 Mar;37(3):552-7. A4547. PMID: 26542237 

Houdayer E, Walthall J, Belluscio BA, Vorbach S, Singer HS, Hallett M. Absent movement-related cortical potentials in children with primary motor stereotypies. Mov Disord. 2014 Aug;29(9):1134-40. PMID: 24259275;  

Katherine M. Stereotypic movement disorders. Semin Pediatr Neurol. 2018 Apr; 25:19-24. PMID: 29735112.  

Mahone EM, Bridges D, Prahme C, Singer HS. Repetitive arm and hand movements (complex motor stereotypies) in children. J Pediatr. 2004 Sep;145(3):391-5. PMID: 15343197. 

Mahone EM, Ryan M, Ferenc L, Morris-Berry C, Singer HS. Neuropsychological function in children with primary complex motor stereotypies. Dev Med Child Neurol. 2014 Oct;56(10):1001-8. PMID: 24814517.  

Mahone EM, Crocetti D, Tochen L, Kline T, Mostofsky SH, Singer HS. Anomalous Putamen volume in children with complex motor stereotypies. Pediatr Neurol. 2016 Dec; 65:59-63. PMID: 27751663.  

Maltête D. Adult-onset stereotypical motor behaviors. Rev Neurol (Paris). 2016 Aug-Sep;172(8-9):477-482. PMID: 27498241.  

Martino D, Hedderly T. Tics and stereotypies: A comparative clinical review. Parkinsonism Relat Disord. 2019 Feb; 59:117-124. PMID: 30773283.  

Miller JM, Singer HS, Bridges DD, Waranch HR. Behavioral therapy for treatment of stereotypic movements in nonautistic children. J Child Neurol. 2006 Feb;21(2):119-25. . PMID: 16566875. 

Oakley C, Mahone EM, Morris-Berry C, Kline T, Singer HS. Primary complex motor stereotypies in older children and adolescents: Clinical features and longitudinal follow-up. Pediatr Neurol. 2015 Apr;52(4):398-403.e1. PMID: 25661287. 

Péter Z, Oliphant ME, Fernandez TV. Motor stereotypies: A pathophysiological review. Front Neurosci. 2017 Mar 29; 11:171. PMID: 28405185  

Singer HS. Motor stereotypies. Semin Pediatr Neurol. 2009 Jun;16(2):77-81. PMID: 19501335. 

Singer HS. Stereotypic movement disorders. Handb Clin Neurol. 2011; 100:631-9. PMID: 21496612. 

Singer HS. Motor control, habits, complex motor stereotypies, and Tourette syndrome. Ann N Y Acad Sci. 2013 Nov; 1304:22-31. PMID: 24175737. 

Singer HS, Rajendran S, Waranch HR, Mahone EM. Home-based, therapist-assisted, therapy for young children with primary complex motor stereotypies. Pediatr Neurol. 2018 Aug; 85:51-57. PMID: 30049425.  

Specht MW, Mahone EM, Kline T, Waranch R, Brabson L, Thompson CB, Singer HS. Efficacy of parent-delivered behavioral therapy for primary complex motor stereotypies. Dev Med Child Neurol. 2017 Feb;59(2):168-173. PMID: 27259464. 

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