D. The repetitive motor behavior is not attributable to the physiological effects of a sub- stance or neurological condition and is not better explained by another neurodevel- opmental or mental disorder (e.g., trichotillomania [hair-pulling disorder], obsessive- compulsive disorder).
Specify it:
Specify if:
Associated with a known medical or genetic condition, neurodevelopmental dis- order, or environmental factor (e.g., Lesch-Nyhan syndrome, intellectual disability [intellectual developmental disorder], intrauterine alcohol exposure)
Coding note: Use additional code to identity the associated medical or genetic condition, or neurodevelopmental disorder.
Specify current severity:
Mild: Symptoms are easily suppressed by sensory stimulus or distraction.
Moderate: Symptoms require explicit protective measures and behavioral modification.
Severe: Continuous monitoring and protective measures are required to prevent seri- ous injury.
For stereotypic movement disorder that is associated with a known medical or genetic condition, neurodevelopmental disorder, or environmental factor, record stereotypic movement disorder associated with (name of condition, disorder, or factor) (e.g., stereo- typic movement disorder associated with Lesch-Nyhan syndrome).
The severity of non-self-injurious stereotypic movements ranges from mild presentations that are easily suppressed by a sensory stimulus or distraction to continuous movements that markedly interfere with all activities of daily living. Self—injurious behaviors range in se- verity along various dimensions, including the frequency, impact on adaptive functioning, and severity of bodily injury (from mild bruising or erythema from hitting hand against body, to lacerations or amputation of digits, to retinal detachment from head banging).
The essential feature of stereotypic movement disorder is repetitive, seemingly driven, and apparently purposeless motor behavior (Criterion A). These behaviors are often rhythmical movements of the head, hands, or body without obvious adaptive function.
The movements may or may not respond to efforts to stop them. Among typically devel- oping children, the repetitive movements may be stopped when attention is directed to them or when the child is distracted from performing them. Among children with neuro- developmental disorders, the behaviors are typically less responsive to such efforts. In other cases, the individual demonstrates self—restraining behaviors (e.g., sitting on hands, wrapping arms in clothing, finding a protective device).
The repertoire of behaviors is variable; each individual presents with his or her own in- dividually patterned, ”signature” behavior. Examples of non-self—injurious stereotypic movements include, but are not limited to, body rocking, bilateral ﬂapping or rotating hand movements, ﬂicking or ﬂuttering fingers in front of the face, arm waving or ﬂapping, and head nodding. Stereotyped self—injurious behaviors include, but are not limited to, re- petitive head banging, face slapping, eye poking, and biting of hands, lips, or other body parts. Eye poking is particularly concerning; it occurs more frequently among children with visual impairment. Multiple movements may be combined (e.g., cocking the head, rocking the torso, waving a small string repetitively in front of the face).
Stereotypic movements may occur many times during a day, lasting a few seconds to several minutes or longer. Frequency can vary from many occurrences in a single day to several weeks elapsing between episodes. The behaviors vary in context, occurring when the individual is engrossed in other activities, when excited, stressed, fatigued, or bored.
Criterion A requires that the movements be “apparently” purposeless. However, some functions may be served by the movements. For example, stereotypic movements might reduce anxiety in response to external stressors.