Habit Disorders - Supporting Children in Schools

Dr Gwyn Williams 26 January 2023 3 min read

In this short article, GP Principal Dr Gwyndaf Williams presents an overview of habit disorders to assist school staff to gain an understanding of the condition to help with the implementation of planned support.

Habit disorders are characterised by repetitive, unwanted behaviours that are distressing and often result in significant functional impairment. The two primary classes of habit disorders are tic disorders and body-focused repetitive behaviours. Individuals with habit disorders report an uncomfortable urge that is satisfied by doing a particular behaviour. The relief from doing that behaviour reinforces them and they are more likely to do the behaviour again.

Tic disorders

Tics are sudden, rapid, repetitive movements and may involve:

Eye blinking;
Squinting;
Shoulder shrugging;
Coughing;
Sniffing;
Repeating a sound

Such behaviours are common in childhood. Any child displaying such behaviour should be seen by a medical professional to determine a diagnosis and exclude other medical reasons for the behaviour.

Tics are usually short lived, often change and may occur intermittently. A tic that changes e.g. when a pupil switches from weeks of shoulder shrugging to eye blinking, is known as a transient tic. Chronic tics differ from transient tics in their persistence and their unchanging nature. Both however, are heightened by stress, excitement or fatigue.

The most severe tic disorder is Tourette's Syndrome, a neurological disorder characterised by multiple, frequently changing motor and / or vocal tics that can be very debilitating. Those diagnosed with Tourette's Syndrome often have an urge to engage in compulsive behaviour, where they get 'stuck' on repeating a word, a phrase or in (rarer circumstances) cursing. The cause of Tourette's Syndrome is unknown however, there is some research which suggests an abnormality in brain function is involved.

Despite their tics, many children function well in school and with peers. In the absence of other difficulties, it is simply a case of waiting for the tic to stop. However, staff should remain vigilant to ensure there are no negative repercussions affecting the pupil, such as embarrassment, shame or bullying; and that symptoms do not negatively affect other pupils e.g. where tics, particularly vocal tics, intrude on their personal space or make it difficult for them to listen and concentrate. Professional help should be accessed if the tic persistently interferes with daily functioning to prevent the behaviour negatively impacting on the child's self-esteem and social development.

'Habit Reversal' is a type of behavioural intervention for the treatment of mild or transient tics. Such intervention increases the child's awareness of when the tic behaviour is happening and teaches them a competing response. The desired outcome of this intervention is that by engaging in this competing response, the tic behaviour will lessen.

Body-focused repetitive behaviours

Body-focused repetitive behaviours are complex disorders that cause those affected to repeatedly touch their hair and body in ways that result in physical damage. This includes:

Trichotillomania

A hair pulling disorder which causes a person to pull out the hair from their scalp, eyelashes, eyebrows and other parts of the body resulting in noticeable bald patches. Those with the disorder may also swallow the hair, which may lead to a gastrointestinal blockage and require surgery to remove the hairball.

Excoriation

A skin picking disorder which causes a person to repetitively touch, rub, scratch, pick at, or dig into their skin. This results in skin discoloration, scarring and can cause severe tissue damage and disfigurement.

Onychophagia

A nail biting disorder which causes a person to bite their nails past the nail bed and chew on their cuticles until they bleed. This leads to soreness and infection.

Cheek biting

A chronic compulsive behaviour that causes an individual to repeatedly bite the inside of the cheek. This results in redness, painful sores, and tears of the inner lining of the mouth. Repetitive biting causes the lining of the cheek to feel irregular which increases the urge to continue to bite to try and create a smooth surface.

Treatment for body-focused repetitive behaviours may include behaviour modification therapy, family therapy and medication. Therapies are designed to make those affected more aware of their triggers, stressors and emotions.

Support is a key factor to enabling treatment for tics and body-focussed repetitive behaviours to be successful, and measures taken by staff in educational settings should be guided by the bespoke plan for each individual child.

Want to know more about supporting mental health? Check out our Supporting Mental Health and Wellbeing training.

Dr Gwyn Williams

GP Principal