Sometimes “Happy Hands” Are Just “Happy Hands”

Primary Complex Motor StereotypiesComplex Motor Stereotypies
Written By Braiins

Image Credit: Amy Shamblen

Hand flapping, arm waving, finger wriggling, toe-walking.   We carefully type these terms into the computer and wait with bated-breath to find out...is it autism? Does it have a name? 

As the results populate on screen, you’ll initially come across a number of autism-related articles, pages discussing stimming behaviour, and when to be concerned.  Filtering deeper though, you might find a long, curious, and unfamiliar term: Primary Complex Motor Stereotypies (PCMS).  For many parents, this long mouthful of a name helps explain and ease their minds that sometimes, “happy hands” are just “happy hands”, and that these movements and behaviours, are an expression of their children’s joy and feelings - an endearing part of who they are and nothing more. 

So what are Primary Complex Motor Stereotypies? It describes the rhythmic and repetitive movements that some of our children (also youths and adults) perform, that classically include arm flapping, hand waving, finger movements, body tensing, characteristic facial contortions (and  expressions), jumping and bouncing, pacing, toe-walking, breath holding, and vocalizations.  These behaviours can often be done in combination or alone.  Properly defined, Primary Complex Motor Stereotypies are the patterned behaviour of purposeless, rhythmic movements, that stop with distraction and can be part of normal development in neurotypical children (C. Oakley, et al, .2015).  It is different from other types of motor stereotypies (specifically Secondary Complex Motor Stereotypies), because it is purely physiological (a body system function), and not linked to other disorders or conditions - neurological, developmental, or otherwise.  Simply put, stimming-like behaviours can be a normal part of everyday life and development for neurotypical children, who don’t have other impairments, or fit the Autism Spectrum Disorder (ASD) profile in any other ways.

For so long, these kind of patterned behaviours have been part of the accepted symptomology of autism, recognized as stimming behaviour - a method of self-regulation or self-soothing for autistic children (and others) that help them during moments of boredom, anxiety, fear, or heightened emotions.  As a prominent clinical feature of the developmental disorder (McCarty, M.J. et al. 2021), the stimming association with autism is familiar and strong.  And though it should never be a negative - ever - there can’t help but be a built-in-bias to assume or wonder or worry if a child is on the autism spectrum when you see them perform these unexplained rhythmic ways.

But now, in the last few years, research has caught up and recognized that an autism diagnosis (or any diagnosis) is not always linked with this class of behaviours.  For the people that have them, Primary Complex Motor Stereotypies are purely part of the repertoire of who they are.  Just as hair twirling, nail biting, and thumb sucking are common habits we accept, Primary Complex Motor Stereotypies are no different for these children and individuals.  It is immensely helpful to have a name and to have it medically accepted as such, and to be reassured that there’s nothing inherently wrong with PCMS movements, and nothing wrong with our children that perform them.   

Image Credit: Johnny McClung

Personally, knowing the existence of Primary Complex Motor Stereotypies and understanding that it is just another part of development and growth (for some), helped me change the conversation with others - strangers, friends, and teachers. Armed with this knowledge of PCMS (and CMS) and having a formal name for these endearing little movements, it helped me diffuse questioning looks and allowed me to share and educate, and helped me normalize stereotypic movements for my son.

Generally speaking, children’s Complex Motor Stereotypies aren’t openly discussed, as some parents are unsure of the behaviour, and the optics it presents to others.  For many reasons, they are afraid that it can be stigmatizing - the behaviours themselves, the assumption of ASD, and attention it can draw.  Many children are asked to suppress it or mask it, and some are shamed into hiding it or modifying it, so it’s less obvious to those around.  It remains unspoken and hidden - stuffed away - except amongst close and closed familiar circles (at best). Without parents of non-autistic children, and parents of neurotypical children discussing their little one’s stereotypic movements, Primary Complex Motor Stereotypies will continue to remain widely unknown, lost behind the doors of private parenting threads, and closed group forums.  The silence and silencing of the movements and behaviours mean that their children’s CMS activity quietly get sanctioned to the privacy and safety of their homes, and rooms (especially as they get older) - veiled from the rest of the world.  

Image Credit: Dakota Corbin

It would be incredible if we could blow open the discourse on Primary Complex Motor Stereotypies and change all of that.  If we as parents and individuals could openly start to talk, share, and educate others about PCMS, accept it, embrace it (so that our children can),  and allow it to happen freely and publicly, it would help move social acceptance forward.  With this, our children could unabashedly be themselves - all of who they are - flapping or not.  The beauty of these cornerstone measures would be confident children who are comfortable in their own skin and their motor stereotypies.  Free to physically express themselves and all their big feelings! Happy and unencumbered children and individuals will only mean greater self-expression and self-assurance that will hopefully open amazing avenues down the road.  The possibilities can be endlessly beautiful and exciting to explore – particularly if you have access to the world of IIM (See Intense Imagery Movements).

  • Thank you so much for taking the time to visit and read. I just wanted to share that I’m still new to the neurodivergent world and learning all the proper terms, and nuances that belong to it - so please forgive me if I make mistakes. I wanted to also include some subsequent thoughts to this written piece and my intentions behind it.

    Please let me be clear: I believe Autism is beautiful in many ways and there are so many special strengths and superpowers that those in the Autistic Community possess. In talking about Primary CMS, I only want to help uncover this other beautiful community of individuals that perform stereotypic behaviours who are NOT neurodivergent and who DON’T have subsequent secondary conditions. It’s also to share that there are children and adults that perform CMS that may be neurodivergent, but not necessarily on the Autism Spectrum.

    There is such a strong need for awareness of PCMS, and an importance to bring this hidden and little talked about world out into the open, out of the darkness, far away from the shame, and into the conversation. This is the only way that these little lovely, distinct, repetitive behaviours (that are part of our children, part of who they are, and what is darling about them), can be normalized and accepted. Just as finger nail biting, hair twisting, pencil tapping are considered everyday habitual characteristics, it would be wonderful to know that our children’s excited actions, their arm flapping, toe walking, finger wriggling and more, can just be part of who they are.

    1. Zsanett P., Oliphant, M.E., Fernandez, T.V. (2017). Motor Stereotypies: A Pathophysiological Review. Front. Neurosci. 11:171. doi.org/10.3389/fnins.2017.00171.

    2. McCarty, M.J. Brumback, A.C. (2021). Rethinking Stereotypies in Autism. Seminars in Pediatric Neurology,Volume 38. doi.org/10.1016/j.spen.2021.100897.

    3. John Hopkins Medicine. Motor Stereotypies. Accessed September, 2024

    4. Psychology Today. Stereotypic Movement Disorder. Updated - 8/25/2021. Accessed February 2024

    5. Child Neurology Foundation. Motor Stereotypies. Accessed Feburary 2024.

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