Bad Habits

0 Comments | Insight on the News, Dec 27, 1999 | by Anne Veigle

A child's nail biting or other compulsions make parents wonder when to seek help.

Nail biting, hair twisting, knuckle chewing -- these anxious habits in children can bedevil a parent who has to fight the impulse to grab fingers out of a youngster's mouth. Many parents are dismayed when they see such behaviors erupt, typically during nursery or elementary school. The behaviors reach their peak in adolescence and the teen years, and for some will continue into adulthood.

"It is estimated that one-third of all children between the age of 7 and 10 bite their nails" says Robert Steele, a pediatrician at St. John's Regional Health Center in Springfield, Mo. "Boys lead the pack of nail biters after the age of 10."

Stress is believed to be the culprit in common anxiety outlets. But some researchers believe there's a genetic component involved, while others claim the habits are learned. Nail biting and hair pulling may trigger calming sensors in the nervous system, says Barbara Hanft, an occupational therapist who specializes in working with children. Such activities may look painful to an outsider, but children can feel a sense of relief in response to internal nervous-system turmoil.

As annoying as it might be to watch a child bite nails, parents should not assume that the problem is going to require therapy. Devoted nail biters can achieve top grades, have satisfying friendships and happily continue their habit into adulthood with no serious consequences other than cosmetic appearance. Parents should consider professional help when a repetitive, self-destructive behavior begins to interfere with normal functioning.

"You have to look at everything in the context of the child" says Nora Galil, medical director of the child psychiatry unit at Children's Hospital in Washington. "Yes, knuckle cracking is annoying, but the questions to ask are `Is it a new symptom, is it getting worse or is it disabling?'"

Behavioral therapy is the treatment of choice. Children are taught substitute behaviors or given chew cords or worry beads that allow a safer way to channel nervous energy.

"We see a variety of problems -- one that is common but doesn't get much attention is skin picking" says Charles Mansueto, director of the Behavior Therapy Center of Greater Washington in Silver Spring, Md. "We try to divert them away into some nondestructive direction. We sometimes allow them to get rewards like Pokemon cards if they can stop the behavior for a certain period of time. But for any therapy to work, the child has to be willing to consider changing."

Some repetitive behaviors could be signs of more serious disorders. Tics, such as a jerking of the head or repeated sound in the throat, may be a symptom of Tourette's syndrome, a complex malfunctioning of the nervous system. And insistence upon a certain routine that does not make logical sense could be a sign of obsessive-compulsive disorder, which some researchers think has a biological basis.

Detecting obsessive-compulsive disorder in young children is tricky, however. "A lot of younger children want things to be the same and that should not be viewed as obsessive but simply an appropriate stage of development," says Galil. "It's when the behavior starts to take over or is disabling in some way that it becomes a problem"

RELATED ARTICLE: Nagging Can Make Matters Worse

Don't nag. This is the first step in dealing with children who display anxious habits such as hair twirling, nail biting or knuckle cracking.

While it is understandable that parents want to stop their children from engaging in habits that are self-destructive, drawing attention to the problem in a negative way increases a child's stress. A better choice is to offer incentives for stopping or to teach the child an alternative behavior.

Short-lived anxieties, such as fear of the dark, are a normal part of development -- unless those fears begin to interfere with daily activities. The American Academy of Child and Adolescent Psychiatry has developed some guidelines to help parents determine when it is time to seek help. For elementary-school children, parents should consider consulting a physician if the following symptoms develop:

* A sudden and dramatic decline in school performance;

* Failure to achieve good grades in school despite considerable effort spent on homework and class work;

* Refusal to attend school or participate in activities with other children or family;

* Hyperactivity, fidgeting and constant movement such as pacing beyond the normal play associated with children of the same age;

* Persistent disobedience -- for a period longer than six months -- accompanied by a combative stance in relation to any authority figures; and

* Frequent, unexplainable temper tantrums.

For preadolescent and adolescent children, the academy recommends parents get help if any of these problems occur:

* Marked change in school performance;

* Abuse of alcohol or drugs;

* Inability to cope with daily activities;

* A sudden increase of physical complaints that do not seem to be related to an obvious illness;