Movements are most often midline hand wringing or hand washing, and persist while the girl is awake but disappear during sleep. Other hand movements include hand clapping or tapping. Hands are sometimes clasped behind the back or held at the sides in a specific pose, with random touching, grasping and releasing. Breathing irregularities may be noticed, and may include episodes of breath holding and hyperventilation associated with vacant spells. However, breathing is usually normal during sleep.
Some girls appear autistic-like with loss of social interaction and communication.
General irritability and sleep irregularity may be seen. Periods of tremulousness may be obvious, especially when excited. Gait patterns are unsteady, and initiating motor movements can be difficult. This stage, from 2-10 years, follows the rapid destructive period. Apraxia, motor problems and seizures are more prominent.