Familial congenital mirror movements is a rare genetic condition in which one hand makes involuntary movements that mirror the other, so everyday tasks like writing or buttoning clothes can be harder. It usually begins in infancy or early childhood and is often lifelong. Not everyone will have the same experience, but many people with familial congenital mirror movements have otherwise typical strength, feeling, and thinking. Familial congenital mirror movements is not usually linked to a shorter life span. There is no cure, but treatment often focuses on occupational therapy, practical coping strategies, and support for activities that need fine hand control.
How many people live with Familial congenital mirror movements?
Because Orphanet lists familial congenital mirror movements as affecting fewer than 1 in 1 million people (Orphanet, 2024), this suggests fewer than about 8,100 people worldwide (estimated from Orphanet, 2024, using United Nations, 2024 population figures). In the United States, that works out to fewer than about 340 people (estimated from Orphanet, 2024, using U.S. Census Bureau, 2024 population figures), although this is a rough estimate rather than a direct count.
Overview
Familial congenital mirror movementsSymptoms
Familial congenital mirror movements causes involuntary matching movements on one side of the body when the other side moves on purpose, most often in the hands. These signs are usually noticed in early childhood and can make tasks like writing or buttoning clothes harder.
Outlook and prognosis
People with familial congenital mirror movements usually have a normal life span and normal thinking. The extra hand movements often stay lifelong, but many learn practical ways to manage writing, typing, sports, and other two-handed tasks.
Causes and risk factors
Familial congenital mirror movements usually results from a gene change present before birth, most often passed down from a parent, though it can also begin as a new genetic change. Family history is the main risk factor.
Genetic influences
Genetics are central to familial congenital mirror movements, which is usually inherited. Changes in genes such as DCC, and less often RAD51, can disrupt how movement pathways develop, though not every family has an identifiable genetic change.
Diagnosis
Diagnosis of familial congenital mirror movements is usually based on clinical features and a neurologic exam. Doctors often confirm it with genetic tests. Imaging may be used to rule out other causes.
Treatment and drugs
Familial congenital mirror movements are usually managed with occupational or physical therapy to improve hand control and make daily tasks easier. Some people benefit from task-specific exercises, school or workplace adjustments, and, occasionally, medicines or botulinum toxin for troublesome extra movements.
Symptoms
Familial congenital mirror movements usually become noticeable in childhood, often during tasks that ask the hands to do different things. In daily routines, this might show up as small but noticeable changes. A child may try to write with one hand, tie a shoe, or play a simple two-handed game, and the other hand moves in a similar way without meaning to. These are the early features of Familial congenital mirror movements, and they are often present for life, although how much they interfere can vary.
The main sign is that when one hand or fingers move on purpose, the other side makes a similar movement automatically. This is often easiest to spot during fine motor tasks like writing, using utensils, or pressing buttons.
Many people with Familial congenital mirror movements find it hard to make each hand do something different at the same time. Everyday tasks such as typing, tying laces, cutting food, or playing a musical instrument can take more effort.
These movements are usually noticed in infancy or childhood rather than starting later in life. Loved ones often notice the changes first, especially when a child begins drawing, dressing, or using school tools.
Repeated hand tasks can feel tiring, awkward, or slower because the unwanted mirrored movement gets in the way. Some may grip objects differently or avoid activities that need precise finger control.
How people usually first notice Familial congenital mirror movements?
Familial congenital mirror movements are usually first noticed in early childhood, often when a child tries to use one hand for a simple task and the other hand makes a very similar movement without meaning to. The first signs of familial congenital mirror movements often show up during activities that are supposed to use one hand at a time, such as writing, buttoning clothes, or picking up small objects, and families or doctors may notice that both hands seem to move together like linked controls. For many people with this condition, these movements are present from the start of life rather than appearing later, although they may become most obvious once fine motor tasks are expected at home or school.
Types of Familial congenital mirror movements
No distinct types of familial congenital mirror movements are widely recognized.
Can I slow down the onset of symptoms?
No. Familial congenital mirror movements usually begin very early in life, often when a child first starts using their hands, and there is no good evidence that lifestyle changes or medical treatment can meaningfully delay the start of symptoms. At this time, things like exercise, diet, sleep, or supplements have not been shown to reduce the risk of symptoms starting or prevent the condition, and early assessment or hand therapy may help with daily activities but does not stop symptoms from appearing; even so, getting support early can still make day-to-day life easier.
What genetics can tell you about symptoms
In familial congenital mirror movements, genetics can help confirm why involuntary matching movements happen on the opposite side of the body, especially in the hands, and changes in certain genes are known to be linked to this condition. These genetic differences can influence whether symptoms are more noticeable or milder and may help explain why some family members are more affected than others, even within the same family. Symptoms usually begin in early childhood, and while genetic testing may support the diagnosis, it often cannot predict exactly how severe the movements will be for one individual.
Causes and risk factors
Familial congenital mirror movements usually happen because of a change in a gene such as DCC, which helps movement signals cross correctly during early development. These gene changes are often inherited from a parent, but they can also happen for the first time in a child. Family history is the main risk factor for familial congenital mirror movements, and genetic testing for familial congenital mirror movements can sometimes confirm the cause. There are no well-known lifestyle choices or environmental exposures that cause this condition. Not everyone with the same risk develops the condition, and stress or fatigue may make the mirrored movements easier to notice.
What are the most common causes or risk factors?
Familial congenital mirror movements are most often caused by an inherited change in a gene that helps the brain’s movement pathways form and separate properly before birth, so having a parent or close relative with the condition is the main risk factor. In some families, changes in genes such as DCC are found, but not every family has an identifiable gene change. For this familial form, there are no well-known lifestyle, diet, or injury-related risk factors.
Environmental and biological risk factors
For familial congenital mirror movements, doctors have not identified clear environmental or non-genetic biological risk factors. If you are looking for risk factors for familial congenital mirror movements, it helps to know that this area is still very limited. Current evidence does not show that routine pregnancy exposures, common maternal illnesses, or birth events are established causes of this condition.
No environmental exposure or non-genetic biological factor has been consistently shown to increase the chance of familial congenital mirror movements. This means doctors do not currently point to proven outside or body-based triggers for the condition.
Genetic risk factors
In many families, familial congenital mirror movements happen because of a change in a gene that helps movement pathways form and cross correctly as the brain develops. The genes most often involved are DCC and RAD51, with NTN1 reported in a smaller number of families. Carrying a genetic change doesn’t guarantee the condition will appear, because these changes can affect relatives differently. In some people, genetic testing can help confirm the genetic causes of familial congenital mirror movements.
DCC changes: DCC is the gene most often linked to familial congenital mirror movements. It helps nerve pathways for voluntary movement cross properly during early development, so a change can cause both sides of the body to be activated at once.
RAD51 changes: Changes in RAD51 are a rarer but well-established genetic cause. They can disrupt how movement pathways are laid out before birth, which may make one intended hand movement trigger a matching movement in the other hand.
NTN1 changes: In a small number of families, changes in NTN1 have also been linked to familial congenital mirror movements. This gene works in the same guidance system as DCC, helping growing nerve fibers find the right path.
Family history: Having a parent or close relative with the same lifelong mirror movements raises the chance of an inherited genetic cause. In many families, the pattern is autosomal dominant, which means one changed copy of the gene can be enough to run in the family.
Reduced penetrance: Some relatives carry the same gene change but have very mild mirror movements or none that they notice. This can make the condition seem to skip generations even when the genetic change is still being passed on.
New gene change: Sometimes the gene change begins for the first time in the affected family member instead of being inherited from a parent. When this happens, there may be no known family history even though the cause is still genetic.
Unknown gene: Not every family with familial congenital mirror movements has a change found in DCC, RAD51, or NTN1. This suggests that other genes are likely involved, even though they have not all been clearly identified yet.
Lifestyle risk factors
Familial congenital mirror movements are not caused by lifestyle habits, but daily routines can influence how noticeable the involuntary movements are and how much they interfere with school, work, and self-care. When people ask about lifestyle risk factors for Familial congenital mirror movements, the main issue is not causing the condition but identifying habits that can worsen hand overflow, fatigue, or injury risk. Practical lifestyle choices can also support better motor control, safer task performance, and less frustration in day-to-day life.
Tiredness often makes mirror movements more obvious and harder to suppress during fine hand tasks. Poor or irregular sleep can reduce concentration and motor control, which may make daily activities more difficult.
Stress and performance pressure can increase muscle tension and make unintended matching movements more noticeable. Learning stress-management strategies may help some people perform hand tasks with better control.
Long periods of handwriting, typing, gaming, or tool use can bring out stronger mirror movements and hand fatigue. Taking breaks, pacing tasks, and alternating activities may reduce loss of precision and frustration.
Awkward workstations or poorly adapted utensils can increase the effort needed for two-handed activities and worsen functional interference. Supportive grips, stable positioning, and one-handed adaptations can make dressing, writing, and food preparation easier.
Risk prevention
Familial congenital mirror movements are present from early life, so there is no proven way to prevent the condition itself from happening. Prevention here means lowering the chance of strain, injury, and day-to-day difficulties that can come from involuntary matching movements of the hands, especially during writing, dressing, typing, or sports. Different people need different prevention strategies—there’s no single formula. For many living with familial congenital mirror movements, early support can make school, work, and daily tasks easier and safer.
Early assessment by a doctor or therapist can help spot which activities trigger the most unwanted hand movements. This can guide practical changes before pain, frustration, or overuse become bigger problems.
Occupational or physical therapy can teach hand positioning, pacing, and task-specific strategies that reduce strain during daily activities. For many people with familial congenital mirror movements, this is one of the most useful ways to prevent secondary problems rather than the condition itself.
Adapted pens, keyboards, grips, scissors, or two-handed techniques may make school and work tasks easier to control. Small changes in setup can help prevent cramping, fatigue, and repetitive stress injuries.
Regular breaks and alternating hand-heavy tasks can lower muscle fatigue when both hands tend to move together. This can be especially helpful if early symptoms of familial congenital mirror movements interfere with handwriting, gaming, music practice, or tool use.
Can you prevent Familial congenital mirror movements?
No, familial congenital mirror movements usually cannot be prevented, because it is an inherited condition caused by a gene change and it begins early in development before birth. If this condition runs in your family, genetic counseling before pregnancy may help you understand the chance of passing it on, but it cannot guarantee prevention.
Transmission
Familial congenital mirror movements is not an infection, so it does not spread through touch, coughing, blood, food, or sexual contact. Instead, how Familial congenital mirror movements is inherited usually involves a gene change passed from a parent to a child.
In many families, the pattern is autosomal dominant, which means a parent with the gene change has a 1 in 2, or 50%, chance of passing it on in each pregnancy. Sometimes the change starts new in one family member rather than being inherited, and symptoms can vary even among relatives who carry the same change.
When to test your genes
Consider genetic testing when mirror movements have been present since early childhood, especially if they affect daily tasks or run in your family. Testing can help confirm familial congenital mirror movements, distinguish it from other neurologic conditions, and guide family planning and supportive care, even though it usually does not change day-to-day treatment.
Diagnosis
People with familial congenital mirror movements are often diagnosed after repeated everyday patterns become hard to ignore, such as one hand copying what the other hand is doing when writing, buttoning a shirt, or using utensils. The diagnosis of familial congenital mirror movements usually starts with a careful review of when these movements began, because they are typically present from early childhood and tend to stay fairly stable over time. Getting a diagnosis is often a turning point toward answers and support. Doctors then use the exam, family history, and sometimes genetic testing to confirm the cause and rule out other neurologic conditions.
Doctors ask when the mirror movements started, how much they affect daily tasks, and whether they have changed over time. In familial congenital mirror movements, symptoms usually begin in early life and are most noticeable during voluntary hand movements.
A clinician watches for involuntary matching movements on one side while the other side performs a task. The rest of the neurologic exam is often normal, which helps separate this condition from broader brain or nerve disorders.
A detailed family and health history can help show whether similar movements are present in close relatives. This matters because some conditions have a genetic link, meaning they can run in families.
Genetic tests may be offered to look for changes in genes linked to familial congenital mirror movements, especially DCC and less often RAD51. A positive result can support the genetic diagnosis of familial congenital mirror movements, although not everyone with the condition will have an identifiable gene change.
How is Familial congenital mirror movements diagnosed?
Familial congenital mirror movements is usually diagnosed from the story of the symptoms and a nerve and movement exam, where the doctor asks a person to move one hand and watches whether the other hand copies the movement without meaning to. The diagnosis is stronger when these movements have been present since early childhood and run in the family, and a brain scan or other tests may be used to rule out other causes. Genetic testing can sometimes confirm the diagnosis by finding a change in a gene linked to the condition, but the diagnosis is often made from the pattern of symptoms and family history.
Stages of Familial congenital mirror movements
Familial congenital mirror movements does not have defined progression stages. This is because the movements usually begin in early childhood and tend to stay fairly stable over time rather than gradually worsening through set stages. Doctors usually start with a conversation about when the mirrored movements were first noticed, such as one hand copying the other during writing, buttoning clothes, or using utensils. Diagnosis is usually based on the pattern of symptoms, a neurologic exam, family history, and sometimes genetic testing to clarify how familial congenital mirror movements is diagnosed and whether it runs in the family.
Outlook and prognosis
The outlook for people with familial congenital mirror movements is generally good, as the abnormal involuntary movements are usually stable over time rather than progressively worsening. Symptoms often begin in early childhood and may become less noticeable with age for some individuals, although many continue to have persistent hand-mirroring throughout life. Life expectancy is typically normal, and the condition itself is not known to increase mortality. Prognosis depends mainly on how much the mirror movements interfere with daily activities such as writing, playing instruments, or tasks requiring independent hand movements. In families with isolated familial congenital mirror movements, cognitive development and overall neurologic health are usually otherwise normal, though rare cases can occur with additional features depending on the underlying genetic cause.
Long-term effects
Familial congenital mirror movements often continue through life, although the degree can vary from one person to another. The main long-term effect is ongoing involuntary movement on one side of the body when the other side is trying to do a task, which can make some everyday activities slower or more tiring. Long-term effects vary widely, and many living with familial congenital mirror movements have stable features rather than a condition that steadily worsens. Early symptoms of familial congenital mirror movements usually begin in childhood, and the movement pattern often remains present into adult life.
The most lasting effect is extra movement in the opposite hand during intentional tasks such as writing, buttoning clothes, or using utensils. For many, this can make fine motor work less precise and more time-consuming.
Activities that need the hands to do different things at the same time can stay difficult over the years. This may affect tasks like typing, tying shoelaces, playing musical instruments, or opening packaging.
In childhood, mirror movements may interfere with handwriting and classroom tasks, and in adulthood they can affect jobs that rely on fast or highly independent hand movements. The overall impact often depends on how strong the movements are and what kinds of tasks someone does each day.
Repeated effort to control unwanted matching movements can lead to hand tiredness during long tasks. Some people also develop muscle strain or discomfort from using awkward positions to compensate.
How is it to live with Familial congenital mirror movements?
Living with familial congenital mirror movements usually means that when one hand is asked to do something, the other hand makes a similar movement without meaning to, most often from early childhood onward. For many people with this condition, daily life is less about pain or illness and more about extra effort: tasks that need the hands to work separately, like writing while holding paper still, typing, buttoning clothes, tying shoelaces, or playing certain instruments, can be slow, tiring, or frustrating. Around them, family members, teachers, and coworkers may need to understand that these movements are neurologic, not careless or intentional, and small adjustments, patience, and practical workarounds can make a real difference.
Treatment and drugs
Familial congenital mirror movements is usually managed by focusing on day-to-day function, since there is no treatment that reliably stops the extra involuntary movements in both hands. For many people, treatment begins with small daily steps, such as hand therapy or occupational therapy to practice tasks like writing, buttoning clothes, typing, or using tools with less strain and better control. Some may find that changing how they do activities, using adaptive devices, or pacing hand-heavy tasks makes school, work, and self-care easier. Medicines are not a standard treatment for familial congenital mirror movements, and surgery is rarely used, because the condition comes from how movement pathways formed early in life rather than from a problem that pills can usually correct. If early symptoms of familial congenital mirror movements are interfering with daily life, a neurologist or rehabilitation specialist can help build a plan that fits your needs.
Can you cure Familial congenital mirror movements?
No, there is no cure for familial congenital mirror movements at this time. Treatment is aimed at making everyday tasks easier, often with occupational or physical therapy and practical ways to adapt when both hands tend to move together. For many people, this can improve day-to-day function, but the extra movements usually do not fully go away.
Non-drug treatment
Familial congenital mirror movements can make everyday tasks harder, especially when one hand unintentionally copies what the other is doing. For many, this can mean trouble with writing, buttoning clothes, using utensils, or playing instruments, even though muscle strength is often otherwise normal. Non-drug treatments often lay the foundation for care by helping people improve control, protect independence, and adapt daily activities. Not every approach works the same way, so support is usually tailored to age, goals, and how much the movements interfere with school, work, or self-care.
Occupational therapy helps people with familial congenital mirror movements practice daily tasks in safer, simpler ways. A therapist may work on handwriting, dressing, eating, keyboard use, and other activities that need one hand to stay still while the other works.
Physical therapy can improve posture, shoulder and arm control, and overall coordination during movement. This may be especially helpful when mirror movements lead to awkward body mechanics, fatigue, or strain during repeated tasks.
Repeated practice of one-handed and two-handed activities can help many living with familial congenital mirror movements find more efficient movement patterns. Structured programs, like guided hand exercises and graded motor practice, can help with common challenges such as the early symptoms of familial congenital mirror movements becoming more noticeable during schoolwork or fine motor tasks.
Built-up grips, non-slip mats, special keyboards, writing aids, and other assistive devices can make tasks easier to manage. Some strategies can slip naturally into your routine—like stabilizing an object on the table instead of holding it with the other hand.
Your genes may have an impact on how drugs work for you
For people living with familial congenital mirror movements, treatment is usually not centered on medication, so there is no well-established evidence that the gene change causing the condition also changes how common medicines work for it. In day-to-day life, this means care often focuses more on occupational therapy, physical therapy, and practical ways to make hand use easier than on finding the “right” drug. If medicine is used for another health issue, doctors may still consider your overall medical and family history, but genetic testing to guide drug choice is not a routine part of care for this condition.
Pharmacological treatments
For people living with familial congenital mirror movements, medicines usually do not play a central role because there is no standard drug that reliably stops the extra involuntary movements. Medication can feel like a big step, but current treatment for familial congenital mirror movements is mainly focused on hand therapy, practical adjustments, and, in selected cases, specialist procedures rather than tablets. In severe cases, a neurologist may occasionally consider symptom-focused treatment, but this is individualized and the benefit can be limited.
There is no approved medicine that specifically treats familial congenital mirror movements. Most people with this condition are not prescribed a routine daily drug because medicines have not shown consistent benefit for the core movement problem.
Botulinum toxin injections may sometimes be considered when mirror movements are severe, very disruptive, and linked to overactivity in a small group of muscles. The effect is temporary, so treatment would need repeat injections, and it is not a standard first-line option for most people with familial congenital mirror movements.
Medicines may still be used if someone with familial congenital mirror movements also has another treatable problem such as pain, muscle tightness, or anxiety around hand use. These drugs treat the associated symptom, not the underlying mirror movements themselves.
Genetic influences
When one hand seems to copy the other from early childhood, the reason is often inherited. In familial congenital mirror movements, changes in genes such as DCC, and less often RAD51 or NTN1, affect how movement pathways in the developing brain and spinal cord are wired. These pathways normally help each side of the brain control the opposite side of the body, but the gene change can leave extra crossed signals, so both hands may move together. Familial congenital mirror movements is usually passed down in an autosomal dominant pattern, which means a parent with the gene change can pass it to a child. Having a gene change doesn’t always mean you will develop the condition, and symptoms can be milder in some relatives than in others. Because of this, genetic testing and genetic counseling can help families understand the genetic causes of familial congenital mirror movements and what they may mean for other relatives.
Is Familial congenital mirror movements genetic?
Genetics are central to familial congenital mirror movements, which is usually inherited. Changes in genes such as DCC, and less often RAD51, can disrupt how movement pathways develop, though not every family has an identifiable genetic change.
Having a genetic risk is not necessarily a diagnosis
Genetic variants, or changes in genes, are a normal part of human biology and are common throughout the general population. Most of these variants do not have a direct effect on health and are simply part of natural human variation. For many genes, carrying a variant associated with a condition points to a possible link rather than a clear diagnosis, especially when more than one gene and environmental factors are involved. In some cases, though, a single well-studied variant in a particular gene can be enough to confirm a diagnosis.
Pharmacogenetics—how genetics influence drug effects
When one hand copies the other, everyday tasks like buttoning a shirt, typing, or writing can take extra effort for people with familial congenital mirror movements. In this condition, genetic changes can affect how movement pathways between the brain and spinal cord formed before birth, and that information can help confirm the diagnosis and guide supportive care. Not every difference in response is genetic, but for familial congenital mirror movements there is currently no well-established medicine chosen by a specific gene result, and no drug has been shown to reliably stop the mirror movements themselves. Instead, treatment for familial congenital mirror movements usually centers on occupational therapy, hand-use strategies, and changes at school or work to reduce strain and improve function. Genetic testing can still be helpful because it explains why the condition happened, may clarify the chance of it running in a family, and helps set realistic expectations about what treatment can and cannot do.
Interactions with other conditions
For many living with familial congenital mirror movements, the main overlap with other health problems shows up in everyday tasks: using one hand can trigger unwanted movement in the other, and that can feel even more limiting if another nerve, muscle, or coordination problem is also present. Doctors call it a comorbidity when two conditions occur together. Familial congenital mirror movements are often isolated, but similar mirror movements can also be seen with certain brain or spinal cord conditions, developmental differences, or rare genetic syndromes, so the wider health picture matters. If someone with familial congenital mirror movements also has weakness, stiffness, trouble with balance, delayed development, changes in smell, or neck and spine differences, clinicians usually look more closely for another condition rather than assuming everything comes from the mirror movements alone. This is part of why the early symptoms of familial congenital mirror movements are usually assessed in context, especially in children, since treatment and follow-up may change if another disorder is involved. The condition itself does not usually lead to diseases in other organs, but when it appears alongside another neurologic condition, day-to-day function and rehabilitation needs can be more complex.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
What other conditions can cause similar symptoms to Familial congenital mirror movements?
Familial congenital mirror movements can look similar to the normal “copying” movements many young children have before brain control fully matures, and they can also be mistaken for movement problems caused by cerebral palsy or an early brain injury. In older children or adults, similar unwanted matching movements may also be seen after a stroke or other brain injury, and sometimes with Parkinson’s disease or rare conditions that affect how the brain and spinal cord are connected.
History
For some people, using one hand sets off an unwanted matching movement in the other. A child may try to write with the right hand while the left hand makes the same shape, or buttoning a shirt with one hand may make the other hand tighten or curl. This pattern, known as familial congenital mirror movements, has likely been noticed for a very long time, even before medicine had clear language for it.
Early doctors described these movements by watching how they appeared in everyday tasks, especially hand use. At first, reports were based almost entirely on what families and physicians could see: the movements were present from early life, tended to stay fairly stable over time, and could show up in more than one relative. Because the condition is uncommon and often mild enough that people adapt, it was probably underrecognized for many years, especially in those who were otherwise healthy.
In recent decades, awareness has grown, and that has helped doctors separate familial congenital mirror movements from other causes of unusual movements, such as conditions that begin after a brain injury or disorders that include weakness, stiffness, or developmental problems. As brain imaging and movement studies improved, researchers learned that the issue is tied to how movement signals are organized and controlled, rather than to a problem with muscles or motivation. Later research also showed that in some families there is a genetic cause, which helped confirm that this is a distinct medical condition rather than simply a variation in coordination.
The history of familial congenital mirror movements is a good example of how medicine often moves from careful observation to clearer understanding. Not every early description was complete, but over time doctors built a more accurate picture of who is affected, what the early symptoms of familial congenital mirror movements can look like, and how the condition differs from other movement disorders. That growing understanding has made diagnosis more reliable and has helped many living with the condition put a name to something they may have experienced since childhood.