Objectives: There is still a great interest in repetitive and stereotyped behaviours (RSB) and
self-injurious behaviours (SIB) in children, either in typically developing children
because of their evolution in time and children’s developmental profile, either in
neurodevelopmental disorders, since they cause functional impairment in daily life.
Our study aims to further characterize these behaviours using a standardized protocol
and videotaped play-session.
Background: Twenty children with primary stereotypies (PS; n = 20) and 63 children with secondary
stereotypies (SS) diagnosed with autism spectrum disorder, (ASD; n = 22) developmental
delay/intellectual disability (DD/ID; n = 21), and blindness (VI; n = 20), aged from
2 to 12 years old, were assessed. Characteristics of RSB (family history, age of onset,
frequency, duration, complexity, triggers, and clinical features) were collected by
medical history.
Methods: Repetitive behavior scale-revised (RBS-R) and child behavior checklist (CBCL) were
completed by the children’s caregivers. Frequency, duration, and types of stereotypies
were coded from 20 minutes of a videotaped standardized play-session. Mean age at
evaluation was 53.0 months for ASD (DS: 14.7; range, 30–96), 78.9 months for VI (DS:
31.2; range, 24–132), 70.8 months for DD (DS: 32.4; range, 24–144), 74.2 months for
PS (DS: 28.3; range, 24–144). Family history of stereotypies was identified in 30%
of PS sample. Mean age of onset was before 24 months in 100% of our sample. Symptoms
usually occurred more than once a day, but SIB and RBS were reported at higher scores
on the RBS-R in secondary group. Stereotypies lasted less than 5 minutes in ASD, DD,
and PS groups, and from 5 minutes to 1 hour in the VI sample. PS group showed more
complex motor stereotypies than secondary groups which presented more motor and phonic
ones. Excitement was identified as a trigger in more than 80% in every group. Flapping
and complex upper limbs movements were the most frequent repetitive behaviours in
PS, otherwise self-directed movements (gaze hands, covering ears) were common features
in secondary stereotypies. Children with ASD had the highest frequencies of gait stereotypies,
while self-injurious behaviours were frequent in VI and DD groups.
Conclusion: Few studies have compared primary and secondary stereotypies including a visual impairment
group. Despite similarities, differences in RSB and SIB are evident in primary and
secondary stereotypies. PS show more complex movements, but the secondary group have
more motor and phonic stereotypies. Self-directed stereotypies tend to be common feature
of SS, while SIB seem to be related to low IQ and/or sensory impairment.
