title: Developmental Profile and Diagnoses in Children Presenting with Motor Stereotypies.
abstract: BACKGROUND
  Motor stereotypies represent a typical example of the difficulty in distinguishing non-clinical behaviors (physiological and transient) from symptoms or among different disorders ["primary stereotypies," associated with autistic spectrum disorder (ASD), intellectual disabilities, genetic syndromes, and sensory impairment]. The aim of this study was to obtain an accurate assessment on the relationship between stereotypies and neurodevelopmental disorders.
  
  
  METHODS
  We studied 23 children (3 girls), aged 36-95 months, who requested a consultation due to the persistence or increased severity of motor stereotypies. None of the patients had a previous diagnosis of ASD. The assessment included the Motor Severity Stereotypy Scale (MSSS), the Repetitive Behavior Scale-Revised (RBS-R), the Raven's Colored Progressive Matrices, the Child Behavior CheckList for ages 1½-5 or 4-18 (CBCL), the Social Responsiveness Scale (SRS), and the Autism Diagnostic Observation Schedule-second edition (ADOS 2).
  
  
  RESULTS
  All patients were showing motor stereotypies for periods of time varying from 6 to 77 months. The MSSS showed that each child had a limited number of stereotypies; their frequency and intensity were mild. The interference of stereotypies was variable; the impairment in daily life was mild. The RBS-R scores were positive for the subscale of "stereotypic behaviors" in all children. Moreover, several children presented other repetitive behaviors, mainly "ritualistic behavior" and "sameness behavior." All patients showed a normal cognitive level. The CBCL evidenced behavioral problems in 22% of the children: internalizing problems, attention, and withdrawn were the main complaints. On the SRS, all but one of the tested patients obtained clinical scores in the clinical range for at least one area. On the ADOS 2, 4 patients obtained scores indicating a moderate level of ASD symptoms, 4 had a mild level, and 15 showed no or minimal signs of ASD.
  
  
  CONCLUSIONS
  Motor stereotypies in children with normal cognitive level represent a challenging diagnostic issue for which a finely tailored assessment is mandatory in order to define a precise developmental profile. Thus, careful and cautious use of standardized tests is warranted to avoid misdiagnosis. Furthermore, it is hard to consider motor stereotypies, even the primary ones, exclusively as a movement disorder.
authors.affiliation: Dipartimento di Pediatria e Neuropsichiatria Infantile, Università degli Studi di Roma "La Sapienza" , Rome , Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cardona
authors.affiliation: Dipartimento di Pediatria e Neuropsichiatria Infantile, Università degli Studi di Roma "La Sapienza" , Rome , Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Valente
authors.affiliation: Dipartimento di Pediatria e Neuropsichiatria Infantile, Università degli Studi di Roma "La Sapienza" , Rome , Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Miraglia
authors.affiliation: Università degli Studi Niccolò Cusano , Rome , Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: D'Ardia
authors.affiliation: Dipartimento di Pediatria e Neuropsichiatria Infantile, Università degli Studi di Roma "La Sapienza" , Rome , Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Baglioni
authors.affiliation: Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità , Rome , Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Chiarotti
keywords: DSM 5; autistic spectrum disorder; children; complex motor stereotypies; neurodevelopmental disorders; repetitive behaviors; stereotypies