Many children make slightly unusual, repetitive and predictable movements—also called pediatric movement disorders—such as hair twirling or body rocking.
Some movement disorders are set off by stressful events, while others occur in tandem with psychological disorders. Still others are primarily physiological in nature. Although the vast majority of cases disappear with time and require no treatment, if the movements become disruptive and affect the ability of a child to function well at home or at school, parents may decide to seek advice and treatment from a pediatrician or a pediatric neurologist.
Our pediatric neurologists at Yale Medicine are experienced at diagnosing and treating movement disorders. We have psychologists, social workers, movement disorder specialists and neurosurgeons available to evaluate patients, and we offer therapy options that are hard to find anywhere else.
What are pediatric movement disorders?
Pediatric movement disorders are neurological conditions that affect the speed, fluency, quality and ease of movement in children. These disorders, also known as stereotypies, can be benign or severe. They can exist independently or as a symptom of another disorder or problem.
“Oftentimes these movements occur in response to a certain situation,” says neurologist Nigel Bamford, MD. “For example, a child might flap his hands excitedly when his father comes home.”
Other children may have tics, which tend to be seen in the eyes, face, head and shoulders; these may include repetitive blinking, odd facial movements and sometimes grunting noises.
Who is at risk for developing pediatric movement disorders?
It's difficult to know exactly how many children have movement disorders. “The true incidence is probably even higher [than current estimates] since these can occur over a few days or weeks, and parents might not notice them,” Dr. Bamford says.
Children with autism often display unusual movements perhaps as a means of communication because their language function is often impaired. But autism itself does not cause these movements.
How are pediatric movement disorders diagnosed?
Parents who have noticed tics or other unusual movements should first try to assess whether or not the movements are distractible and whether they are affecting the child’s social or academic life.
Once a child is brought to a pediatrician or pediatric neurologist, the doctor will interview the child along with the parents. The doctor will first classify the disorder and then determine whether there are underlying issues behind the movements, such as seizures or a genetic disease that could be treated.
A patient history and a careful examination often excludes the diagnosis of epilepsy. On rare occasions, additional tests such as an electroencephalogram (EEG), magnetic resonance imaging (MRI) or blood tests are needed.
“There is no known laboratory test for stereotypies or tics. The diagnosis is made by history and clinical inspection,” Dr. Bamford says. “However, testing is often required to determine exactly why children have other movement disorders.”
When possible, says Dr. Bamford, they treat the underlying disease. “But generally, we focus on treatments that will help correct the movement disturbance.”
How are pediatric movement disorders treated?
While parents should certainly talk to their children about their movements, they should not admonish them, Dr. Bamford says. “Tics are made worse by criticism and negative comments,” he says. “Those heighten children’s anxieties, and the movements may worsen.”
Some children with movement disorders such as tics may also have anxiety, attention deficit hyperactivity disorder (ADHD) and/or obsessive-compulsive behaviors. If a doctor determines that a child also has one of these disorders, the child may require additional treatments or medications. The need for treatment generally depends on how severe the problem is and should always balance potential risks and benefits.
Some children with movement disorders benefit from Cognitive Behavioral Treatment (CBT), a form of talk therapy that increases awareness of habitual thoughts and behaviors and how those are linked. CBT may use substitution methods, which may act to reprogram the brain. CBT is offered at Yale Medicine and, when possible, should be considered before using medications.
In some cases, when it’s determined that a child has a reduced capacity to make dopamine, dopamine replacement therapy can be useful. A course of treatment can lead to slowed movements, stiffness and sometimes tremor, Dr. Bamford says. Dopamine replacement can reduce these symptoms for children who have dopamine-dependent movement disorders including Segawa's disease, tyrosine hydroxylase deficiency and sepiapterin reductase deficiency.
Sometimes a low dose of anti-seizure medication can help patients with movement disorders, even if they are not having seizures.
Another treatment offered at Yale Medicine is deep brain stimulation. After patients under consideration for this treatment pass a series of evaluations by a team of Yale Medicine’s psychologists, social workers, movement disorder specialists and neurosurgeons, a small probe is implanted in the brain that delivers stimulation to centers shown to reduce the unwanted movements.
One underlying condition, Wilson’s disease, is a rare disorder of copper metabolism that causes significant abnormal movement. Patients with Wilson’s disease do very well after receiving copper chelation treatment, which lowers levels of copper in the blood.
What makes Yale Medicine’s approach to pediatric movement disorders unique?
Patients who come to Yale Medicine benefit from the collaboration between physicians and researchers who are specialists in highly relevant and related fields. “We have a comprehensive movement disorder group that consists of specialists like myself and adult movement disorder specialists,” Dr. Bamford says. “We meet on a weekly basis to discuss children’s cases and together determine the root cause of their movements and behaviors.”