Complex Primary Motor Stereotypy

I can not remember when the behaviour began but I am sure that it was around the time that my wife and I started moving in separate directions, in other words it was shortly before we separated. I have had many conversations with my boy, typically adding little inquisitive cues to see where his speech might wander, which has led me to believe that the separation of his parents was a major emotional upset for him – one that is likely to impact him for a very long time (if only in subtle ways).

Some remarks about the phenomenon:

  • It occurs only when he is playing alone, or focused on something by himself. For this reason I will say that it is a radically independent and self-centred behaviour. It has been remarked that sometimes there are others around him (though even this is rare) when it occurs, but even here I have noted that it occurs when the object (more on this “object” later) is not shared, but exclusively his own.
  • Physiologically, it consists simultaneously of (1) finger wriggling, as if there are great surges of energy passing through them, and (2) the head turns downward ever so slightly so that the eyes look upward toward the object (as if looked over the brow or forehead); sometimes it also includes (3) a noise from the mouth that sounds like a series of sharp Ks (/k/), as if he is imitating the sound of a car crash.
  • He describes it as something his “body just does on its own.” He can not describe it as pleasurable or irritable. One time he described it as if it were scratching, but that was a rare description.
  • It only occurs during periods of excitement or play, and not during other emotional states.

Since its emergence I have been studying it and thinking long and hard about it. It has brought me at odds with his teachers and even some of my family members who believed that it may be autism, seizures, tremors, and so on. I did not believe the evidence pointed in any of these directions. For example, many of the tell-tale signs of autism are not present in my son. Also, he does not lose consciousness during these acute phases (as many people suspected) because he can be easily snapped out of it by intervening.

I discovered that Johns Hopkin’s University has been studying this for some time and found that only behavioral therapy can provide any help – and even here it is not promising. No, he will not grow out of it. No, it can not be cured or mitigated by medication.

They describe this cluster of symptoms as “Complex Primary Motor Stereotypies,” which is one of the possible designations under the rubric of Motor Stereotypies (others being: “Common,” rather than “Complex,” and “Secondary,” rather than “Primary”). Complex indicates that it is not something relatively simple such as nail biting. “Primary” indicates that this is the exclusive cluster of symptoms and does not occur alongside something deeper and more biological or neurological (such as head trauma, for example).

Current research indicates that Cognitive Behavioral Therapy and Awareness Training are the best options. However, their research moves away from any link to Obsessive Compulsion Disorder. The problem is that this further delinks the cluster of symptoms from the structure of obsessional neurosis, which may very well be its true home.

For Lacanian psychoanalysts: there is psychosis, ordinary psychosis, phobia, perversion, hysterical neurosis, and obsessional neurosis. And, incidentally, there is no reason to presume that Complex Primary Motor Stereotypies are always under a single clinical structure. Because they are “symptoms” focused they do not describe clinical structure and can therefore not advance any further than that which they isolate: the finger wriggling, etc. I’ll give you a quick example as to why this matters. When I began personal psychoanalysis years ago, my demand was to be cured of my eating disorder. I realized after a few months that my eating disorder wasn’t the problem, it was only a part of a wider and more encompassing structuring pattern of behaviors and thought processes. If I was hung up on only a few foods then I was also hung up on only a few books or bands or artists, and so on.

There is remarkably little (and perhaps none) psychoanalytic research on this phenomenon. It seems to me that such research might not only reveal something truly key in terms of differential diagnosis but it might also offer a more long-lasting and hopeful remedy. For example, the problem of the misdiagnosis of so-called Complex Primary Motor Stereotypy with Obsessive Compulsive Disorder indicates a similar muddy problem for the differential diagnosis of obsessional neurosis and (ordinary) psychosis within psychoanalytic research.

Also, it is clear that my son has suffered some anxiety over the breakup of our family. I will not get into these minute details right now but perhaps I will in the future if I continue to explore this on my blog. However, I do believe that my brother had (and continues to have) similar movements in his hands growing up, which would indicate something genetic. Accompanied by these symptoms in my own child are:

  • orderly arrangement of toys
  • obsession with numbers, dates, ages
  • fixation on certain topics of conversation (currently it is spiderman)
  • picky eating

These latter behaviours may have indeed been inherited, in a sense, from me since I have often described my own behaviour over the years as “Selective X disorder,” where “X” is the activity. For example, I have what some diagnosticians refer to as Selective Eating Disorder. I often joke and refer to other activities in my life, to demonstrate that this is not exclusively about food: I had Selective Reading Disorder (I was only ever interested in one great thinker), Selective Music Disorder (one genre of music or band), and so on. Personal Analysis, under a Lacanian analyst, has revealed and helped in significant ways.

Finally, about the “object.” I noticed that it often occurs with “tiny” objects and not with “large objects,” and that, moreover, it occurs while watching certain “types” of video games or television shows. It does not occur when these objects are shared in interactive ways between Soren and myself, or between Soren and any other person. I also noticed that the behaviour is reduced when I or somebody else is present (and Soren is aware of our presence or gaze). Recently I noticed that he feels compelled to stand up while he does this, and I remind him to sit back down. While sitting, the excitation is diminished, but not considerably.

I believe that it has something to do with excitation which occurs within the body but is not of the (imaginary) body, it is certainly of the order of the real or of the drives. It does not have words and we (Soren and I) as of yet could not find words that Soren felt were adequate to describe it. This would indicate an inability to inhibit the excitation, or, possibly, what Lacanians would call “a foreclosure of the father function.” He seems to not want to accept the inhibition of the excitation and does not seem to be comfortable exchanging the real sensations with signifiers. This explains his anxiety when he is asked to step fixating on Spiderman, etc.

Recently he has become incredibly emotional and jealous and questions my love for him, as well as his mother’s love for him.

Now, at the risk of introducing personal details for which I may not be forgiven, I shall share the situation of the father and of the mother in brief. When Soren was almost three his mother and I remained married and lived together in the same apartment. However, our emotional interaction toward each other (mother and father) decreased considerably due to a problem within the marriage itself. Arguments – and sometimes they were loud – happened frequently. For one year the father lived in intense depression and thought about the future of the marriage before finally leaving it.

For a time, I remained with my son for at least 2 hours daily, and sometimes much more, but interaction certainly diminished. The mother remained with the child, in her own visible depression, over night and in the mornings. I remained with the child in the afternoons. The father was also considerably depressed. The father’s depression eventually subsided when he met somebody new, but it resurfaced here and there. The mother’s remained for almost 3 years.

 

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2 thoughts on “Complex Primary Motor Stereotypy

  1. Hi there. I have found your blog extremely interesting. My son starts school next week and I’ve been doing some research, so that I can give the teachers info on his condition, that being complex primary motor stereotype.

    When he was diagnosed, I had no idea what this was, but just extremely relieved that we had finally got a diagnosis after flagging this up almost 4 years previous when he was about 10 months old. Unlike your son, the behaviours started so early on in his life with hand flapping and then has gradually progressed over the years to a multitude of behaviours clustered together. I was so interested to read that your son seems to do this in times of excitement or when playing alone. This is exactly what we experience too. His behaviours are generally rather large jumping movements with head nodding and finger twitching. At the moment we are looking to go down the root of cognitive behavioural therapy, as this has been the only thing advised.

    Good luck to you and your continued research on this.

    • Hello Sarah,

      Thank you for the comment. I wish you the best. Please don’t rule out contacting Johns Hopkins CMS behavioural therapy DVD and program. It is the best available right now. My research continues and I plan to publish a very provocative letter of research soon. I will post a link to the article on my blog for you.

      Best Regards,

      Duane

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