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Habit disorders in children

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Most youngsters will probably exhibit some form of behavioural problems throughout their childhood, but how do you know when it’s more than just a ‘phase’. It can be especially difficult to know when to be worried about behaviours such as thumb-sucking, nail biting, teeth grinding, repetitive vocalisations, hair pulling, body rocking and head banging. Activities such as these are usually referred to as ‘habit disorders’ – which come under the general umbrella of common behaviour disorders in children.

Is it a habit disorder?

Other habits which fall under this category include breath holding, air swallowing, tics, manipulating parts of the body and children hitting and biting themselves. It is quite likely that all children will at some stage display repetitive behaviours, but whether they can actually be considered ‘disorders’ will depend on their frequency and persistence and whether they are doing any physical damage or having an impact on day to day functioning.

Some habit behaviours can come from intentional acts which get repeated and incorporated into normal behaviour. Others, such as hair pulling or head banging, develop as a way of providing a form of sensory input and comfort when a child is alone. Many childhood habits, such as thumb-sucking, are considered a normal part of development and go away by themselves, but they can sometimes cross over into habit disorder territory. This is when repetitive, seemingly driven, behaviours begin to interfere with normal activities or result in bodily injury. When functional impairment is significant, a diagnosis of stereotypic movement disorder may be considered.

For example, teeth grinding can result in tooth damage; thumb sucking can lead to crooked teeth and hair pulling can lead to hair loss or evolve into the more serious disorder of trichotillomania. Habit disorders can usually be defined as either those occurring in children who are otherwise developing normally and will often remain stable or disappear, and those which occur in conjunction with neurological conditions such as autism or tourettes.

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Few habit disorders occurring in children who are otherwise developing normally are expected to result in permanent physical damage, but in some cases it may be advisable to treat a childhood habit before it becomes a clear-cut dysfunction. Therapeutic interventions may be recommended if the habit is causing the child or family members substantial distress, social isolation or physical injuries like the ones mentioned above. At this point a GP may refer you to a specialist. There are no specific tests to diagnose habit disorders, but paediatricians may look to rule out other conditions such as obsessive compulsive disorders, trichotillomania and vocal and tic disorders such as Tourettes. Tourette syndrome causes a person to have repetitive involuntary jerky movements, or tics, make facial grimaces and repeat certain sounds out loud. Trichotillomania involves the habit of pulling out your own hair, eyebrows or eyelashes. It is more than just a habit and is said to arise from powerful urges produced in the brain.

Obsessive-compulsive disorder causes people to become trapped in a pattern of unwanted and upsetting thoughts and repeated behaviours or rituals.

What treatment is available for habit disorders?

Prognosis of habit disorders which do not arise as a result of these more serious conditions, will depend on the severity of the disorder. Recognising symptoms early can help reduce the risk of self-injury. Some of the treatments will focus on the injuries being caused, such as dental splints for teeth grinding and helmets for head banging. Behavioural therapies may be recommended, such as habit reversal, where the child is made aware of the habit and taught to make a competing response, such as folding their arms instead of sucking their thumb. Other treatments include relaxation training, self-monitoring and reinforcement. Interventions may be different where the behaviour is a secondary symptom of another predominant neurological condition or disability. Behavioural therapies are most effective when children are co-operative and motivated to reverse the habit. Most of the common habits can be improved with therapeutic interventions without the need for medication. Drugs may be suggested in more severe cases, in addition to behavioural therapy, to get the best possible outcome.

In any case, living with these habits and managing them can be isolating and difficult for others to understand. There are a number of support groups which can provide help and advice. These include organisations such as The Challenging Behaviour Foundation, Includem, Young Foundations and What About the Children.

 

 

 

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