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April 24, 2013
Jewish World Review
Medical Edge from Mayo Clinic: When and how to address repetitive behaviors in children
Michael Mellon, Ph.D.
DEAR MAYO CLINIC: I have a healthy 6-year-old daughter. She's doing well in school. However, she has a habit of putting her hands in front of her mouth and moving her fingers back and forth while tensing her facial muscles. She's been doing this since she was 1, primarily when engaged in pretend play. Our pediatrician said this behavior is classified as stereotypy, and we should ignore it. Why does she do this, and will she ever stop?
ANSWER: Human beings are creatures of habit. Often, these habits have useful functions. For example, when you're nervous, you may tap your foot to calm yourself or clear your throat before you speak. But, when a repetitive behavior happens so often that it interferes with other responsibilities, or it triggers negative social feedback, it's considered a problem. The repetitive motor movements (stereotypy) you describe may fall into the second category.
Stereotypies are common in young children. They can take the form of hand flapping, stiffening, shaking, posturing, clenching, body rocking, spinning or more complex rituals. A 2004 study of 40 normally developing children who also met the criteria for stereotypy indicated that 75 percent of the participants showed some sort of repetitive motor movement before age 2. Of those, 90 percent had stereotypies that occurred at least once a day. Stereotypies are most often triggered by excitement, anxiety, stress, fatigue or being engrossed in an activity. In some cases, children aren't aware that they are making these movements. Parents can usually interrupt the stereotypy by calling their child's name. As you have found, stereotypies can last for years. These movements persisted for more than five years in 53 percent of the children involved in the study and completely resolved in only 5 percent.
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Even though these behaviors are common, stereotypies can be a source of concern for several reasons. In the 2004 study, 23 percent of the children age 6 and older reported being teased because of the stereotypy. The behavioral disorder can interfere with education, as it may take time away from learning activities. And in some cases, stereotypy can be associated with a developmental disorder such as autism.
Your daughter sounds like a girl who is developing normally. If she is engaging in the stereotypy during imaginative play, however, she may not be actively playing with other children and thus missing opportunities to develop socially. I would also suspect that at age 6, her peers might find this behavior odd. When made aware of a stereotypy, some children can voluntarily stop it. So, it would be appropriate to provide gentle feedback that encourages her to limit the stereotypy behavior to private settings, away from other children, to avoid teasing. Finding ways for your daughter to share her imaginative play with other children, without the stereotypy, may also help.
If the stereotypy doesn't decrease after you take these steps, I suggest you seek the assistance of a clinical child psychologist with training in applied behavior analysis. He or she may be able to help you and your daughter better understand why she is engaging in this behavior and find ways to reduce its frequency. -- Michael Mellon, Ph.D., Pediatric Psychology, Mayo Clinic, Rochester, Minnesota
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