Five values for COVID-19 vaccine acceptance described by racial and ethnic minoritized caregivers.

Complex motor stereotypies (CMS) are non-goal directed (purposeless and non-pathological), recurrent (continuously repeated), rhythmic (moving in a particular rhythm), predictable (having a similar form), and distractible (stopping with distraction). Commonly observed examples of these complex movements include bilateral flapping, waving, or rotating movements of the arms and hands, fluttering fingers in front of the face, opening and closing of the hands, and finger wiggling. Movements typically begin before age 3 years, diminish in intensity in the teenage-years (), last for seconds to minutes, and occur multiple times per day often in association with periods of excitement, stress, fatigue, or visual imagery (–). CMS is classified into two groups: primary, indicating an otherwise developmentally typical child; and secondary, for those with developmental disorders (e.g., autism, Rett syndrome, Lesch-Nyhan syndrome), sensory conditions such as deafness and blindness, and other metabolic or genetic disorders (, ). The precise etiology and anatomical brain region involved in the pathophysiology of primary CMS (pCMS) remains unknown. Being an abnormality of motor control, stereotypies have often been broadly localized to the cortical-basal ganglia-thalamo-cortical (CBGTC) circuitry (), a complex network of pathways originating from neuronal networks within in the cerebral cortex (principally frontal cortex), with projections to the basal ganglia and cerebellum, and ultimately back to the cerebral cortex via the thalamus (). Although the CBGTC circuit offers an intuitively appealing framework, it oversimplifies complex neurobiology by neglecting the regional functional specialization within these circuits and their extensive integration with other brain systems, including regions of the ventral striatum (motivation and reward), cerebellum (motor coordination), hippocampus (motor memory), amygdala (emotional and motivational modulation of movement), and dopaminergic nuclei such as the substantia nigra and ventral tegmental area, which regulate reward and learning (). Recognizing the continued scientific need to identify specific neuroanatomical alterations in children with pCMS, this study utilized expanded methodologies to re-investigate volumetric abnormalities previously reported in several small magnetic resonance neuroimaging studies, with a focus on proposed alterations within frontal-cortical, basal ganglia, and cerebellar regions. Interactions between cerebellum and CBGTC circuitry. Adapted from Singer and Augustine ().