eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics

Childhood Habit Behaviors and Stereotypic Movement Disorder: Follow-up

Author: Cynthia R Ellis, MD, Director of Developmental Medicine, Associate Professor, Department of Pediatrics and Psychiatry, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center
Coauthor(s): Connie J Schnoes, MA, PhD, Psychologist, Director of Training, Supervising Practitioner, Father Flanagan's Boys' Home, Boys Town; Holly Jean Roberts, PhD, Assistant Professor, Pediatrics, Munroe-Meyer Institute, University of Nebraska Medical Center
Contributor Information and Disclosures

Updated: Jan 26, 2010

Follow-up

Further Outpatient Care

  • Consult a developmental-behavioral pediatrician, child psychologist, and/or child psychiatrist for further assessment and possible treatment modalities as indicated.

Prognosis

  • Most childhood habits that do not involve self-injury are benign and remit without intervention.
    • When a habit persists and interferes with daily functioning, intervention is warranted.
    • The prognosis for reducing and eliminating habit disorders is typically good.
    • Treatment research shows that behavioral intervention can reduce the habit behavior by 90%.
  • A child with breath-holding spells does not have an increased risk of seizures but does have an increased risk of syncopal episodes as an adult.
  • Data about habit behaviors as markers for increased emotional stress, anxiety, or behavior problems are inconsistent.

Patient Education

Miscellaneous

Special Concerns

  • Although habit disorders can affect any child, stereotypic movements and stereotypies are most common among children with mental retardation and other developmental delays. For example, one should be cognizant of a child who has mental retardation or developmental delay and who engages in head banging and other repetitive behaviors.
  • Some habitlike behavior is normal for a developing child.
    • For example, approximately one half of all 2-year-old children engage in thumb sucking. However, if this behavior persists through childhood, the likelihood of it becoming a substantial problem may increase with age.
    • Careful observation of normal developmental behaviors should be considered before a child is evaluated for a severe problem.
 


More on Childhood Habit Behaviors and Stereotypic Movement Disorder

Overview: Childhood Habit Behaviors and Stereotypic Movement Disorder
Differential Diagnoses & Workup: Childhood Habit Behaviors and Stereotypic Movement Disorder
Treatment & Medication: Childhood Habit Behaviors and Stereotypic Movement Disorder
Follow-up: Childhood Habit Behaviors and Stereotypic Movement Disorder
References
Further Reading
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References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

  2. Allen KW. Chronic nailbiting: a controlled comparison of competing response and mild aversion treatments. Behav Res Ther. Mar 1996;34(3):269-72. [Medline].

  3. American Academy of Pediatrics. Atypical behaviors. In: Wolraich ML, Felice ME, Drotar D, eds. The Classification of Child and Adolescent Mental Diagnoses in Primary Care: Diagnostic and Statistical Manual for Primary Care (DSM-PC) Child and Adolescent Version. Elk Grove Village, IL: American Academy of Pediatrics; 1996:267-75.

  4. Blum NJ. Repetitive Behaviors. In: Levine MD, Carey WB, Crocker AC, eds. Developmental-Behavioral Pediatrics. 3rd ed. Philadelphia, PA: WB Saunders; 1999:430-42.

  5. Ellingson SA, Miltenberger RG, Stricker JM, et al. Analysis and treatment of finger sucking. J Appl Behav Anal. Spring 2000;33(1):41-52. [Medline].

  6. Glaros AG, Epkins CC. Habit disorders: bruxism, trichotillomania, and tics. In: Roberts MC, ed. Handbook of Pediatric Psychology. 2nd ed. New York, NY: Guilford; 1995:558-74.

  7. Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J. An overview of behavioral strategies for reducing hand-related stereotypies of persons with severe to profound intellectual and multiple disabilities: 1995-2007. Res Dev Disabil. Jan-Feb 2009;30(1):20-43. [Medline].

  8. Long ES, Miltenberger RG. A review of behavioral and pharmacological treatments for habit disorders in individuals with mental retardation. J Behav Ther Exp Psychiatry. Jun 1998;29(2):143-56. [Medline].

  9. Matthews LH, Leibowitz JM, Matthews JR. Tics, habits, and mannerisms. In: Walker CE, Roberts MC, eds. Handbook of Clinical Child Psychology. 2nd ed. New York, NY: John Wiley & Sons; 1992:283-302.

  10. Meyer RG. Practical clinical hypnosis: techniques and applications. In: Scientific Foundations of Clinical Counseling Psychology. New York, NY: Lexington Books/Macmillan; 1992.

  11. Miller JM, Singer HS, Bridges DD, Waranch HR. Behavioral therapy for treatment of stereotypic movements in nonautistic children. J Child Neurol. Feb 2006;21(2):119-25. [Medline].

  12. Muthugovindan D, Singer H. Motor stereotypy disorders. Curr Opin Neurol. Apr 2009;22(2):131-6. [Medline].

  13. Peterson AL, Campise RL, Azrin NH. Behavioral and pharmacological treatments for tic and habit disorders: a review. J Dev Behav Pediatr. Dec 1994;15(6):430-41. [Medline].

  14. Shprecher D, Kurlan R. The management of tics. Mov Disord. Jan 15 2009;24(1):15-24. [Medline].

  15. Simon GE, Savarino J, Operskalski B, Wang PS. Suicide risk during antidepressant treatment. Am J Psychiatry. Jan 2006;163(1):41-7. [Medline].

  16. Singer HS. Motor stereotypies. Semin Pediatr Neurol. Jun 2009;16(2):77-81. [Medline].

  17. Stein DJ, Chamberlain SR, Fineberg N. An A-B-C model of habit disorders: hair-pulling, skin-picking, and other stereotypic conditions. CNS Spectr. Nov 2006;11(11):824-7. [Medline].

  18. Watson TS, Sterling HE. Habits and tics. In: Watson TS, Gresham FM, eds. Handbook of Child Behavior Therapy. New York, NY: Plenum; 1998:431-49.

  19. Wester WC II. Habits. In: Wester WC II, O'Grady DJ, eds. Clinical Hypnosis with Children. New York, NY: Routledge; 1991:85-96.

  20. Woods DW, Miltenberger RG. A review of habit reversal with childhood habit disorders. Educ Treat Child. 1996;19:197-214.

  21. Woods DW, Murray LK, Fuqua RW, et al. Comparing the effectiveness of similar and dissimilar competing responses in evaluating the habit reversal treatment for oral-digital habits in children. J Behav Ther Exp Psychiatry. Dec 1999;30(4):289-300. [Medline].

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Keywords

childhood habit behaviors, stereotypic movement disorder, habits, teeth grinding, bruxism, hair pulling, thumb sucking, breath holding, breath-holding spells, stereotypies, nose picking, rocking, nail biting, nailbiting, head banging, headbanging, habitlike behavior

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Contributor Information and Disclosures

Author

Cynthia R Ellis, MD, Director of Developmental Medicine, Associate Professor, Department of Pediatrics and Psychiatry, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center
Cynthia R Ellis, MD is a member of the following medical societies: Nebraska Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Connie J Schnoes, MA, PhD, Psychologist, Director of Training, Supervising Practitioner, Father Flanagan's Boys' Home, Boys Town
Disclosure: Nothing to disclose.

Holly Jean Roberts, PhD, Assistant Professor, Pediatrics, Munroe-Meyer Institute, University of Nebraska Medical Center
Holly Jean Roberts, PhD is a member of the following medical societies: Autism Society of America, National Association of School Psychologists, and Psi Chi
Disclosure: Nothing to disclose.

Medical Editor

Chet Johnson, MD, Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center
Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

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