title: Intense Imagery Movements (IIM): More to motor stereotypies than meets the eye.
abstract: OBJECTIVE
  A subgroup of children who present with motor stereotypies in the context of episodes of intense imagery have recently been described in the literature,(1) termed Intense Imagery Movements (IIM). All children report conscious engagement in acts of imagery or imagination, with stereotyped movements occurring simultaneously with limited conscious awareness. This article reports preliminary cognitive data to inform clinical management and guide future research.
  
  
  METHODS
  Intellectual functioning was assessed for ten children with IIM (7 boys, 3 girls; mean age = 10;01, age range = 6;06 to 14;04). In-depth neuropsychological assessments were conducted for four of these cases (3 boys, 1 girls; mean age = 9;05), with standardised questionnaires completed to assess mood, behaviour, attention/concentration, sensory functioning, motor functioning and stereotyped movements.
  
  
  RESULTS
  All children exhibited discrepant intellectual profiles, especially on perceptual reasoning tasks, with significant impairments in processing speed. In-depth neuropsychological assessments indicated impaired performance on tests of attention and inhibition, but strengths in memory or oral expression. Three of the four children had sensory processing impairments, two had features of developmental co-ordination disorder and one had poor general well-being. None of the children had emotional or behavioural problems.
  
  
  CONCLUSIONS
  Children with IIM exhibit uneven intellectual and cognitive profiles, with particular discrepancies in perceptual reasoning skills. The case studies suggest that weaker attention, inhibition and processing speed skills may contribute to engagement in IIM, with good memory and/or language skills potentially contributing to the complexity of imagery abilities. Implications for the identification and management of these children in clinical practice, and future research ideas, are discussed.
authors.affiliation: Tic and Neurodevelopmental Movements (TANDeM), Children's Neurosciences Centre, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: sally.robinson@gstt.nhs.uk.
authors.forename: Sally
authors.initials: S
authors.lastname: Robinson
authors.affiliation: Tic and Neurodevelopmental Movements (TANDeM), Children's Neurosciences Centre, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Woods
authors.affiliation: Department of Pediatrics and Child Neuropsychiatry, University La Sapienza of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cardona
authors.affiliation: Tic and Neurodevelopmental Movements (TANDeM), Children's Neurosciences Centre, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Tammy
authors.initials: T
authors.lastname: Hedderly
mesh_terms: D000293:Adolescent; D001288:Attention; D001364:Awareness; D002648:Child; D003072:Cognition Disorders / Q000523:psychology; D005133:Eye Movements; D005260:Female; D006801:Humans; D007092:Imagination; D007361:Intelligence Tests; D007802:Language; D008297:Male; D008568:Memory; D009069:Movement Disorders / Q000523:psychology*; D009483:Neuropsychological Tests; D013239:Stereotyped Behavior; D011795:Surveys and Questionnaires
keywords: Daydreaming; Fatasizing; Imagination; Stereotypic movement disorder; Tics