Causes of obsessive movement syndrome in children. Doctor Komarovsky about obsessive movement syndrome in children. Common OCD Symptoms

Obsessive-compulsive disorder is approximately half as common in children as in adults. According to statistics, 1-2 children out of 300-500 suffer from it, and the symptoms of this neurosis are not always pronounced.

Often, parents consider the obsessive movements characteristic of this disorder to be simply bad habits. For example, a constant desire to bite nails or the cap of a pen, pull one's hair, pick one's nose - all this sometimes irritates parents, although it should have alerted them, because such symptoms indicate increased anxiety in the child.

Currently, obsessive-compulsive disorder is called another term - obsessive-compulsive disorder and has code F42 in ICD-10. However, when working with children, psychologists most often use the “outdated” name, since it somewhat more accurately reflects what is happening to the child.

Obsessions are obsessive thoughts, usually negative, that the patient cannot stop by force of will. Compulsions are obsessive behaviors that are repeated over and over again.

People with high intelligence, emotional, and sensitive feelings are most susceptible to this disorder. They are also characterized by a feeling of insecurity in the world around them, various fears and phobias.

For the first time, obsessive-compulsive neurosis usually manifests itself against a background of severe stress and anxiety. But for the onset of the disease to occur, psychological trauma alone is not enough - it will only become a trigger that starts the process, but not its cause.

Sometimes the appearance of obsessions may not be associated with a specific event - this is precisely why this neurosis in children differs from the same disorder in adults. Anxiety seems to “accumulate” gradually, and symptoms appear rarely at first, and then become more frequent.

As for the causes of OCD, there are several theories:

• Neurotransmitter – explains the onset of the disease by a deficiency of the hormone serotonin in the body;
• The PANDAS syndrome theory suggests that OCD may be caused by a previous streptococcal infection;
• The genetic theory states that the cause of this neurosis is genetic mutations that are inherited.

And although scientists have not yet come to a consensus on the causes of obsessive-compulsive neurosis, there are observations from practicing doctors who prove that OCD is more likely to manifest itself in children whose relatives already have patients with this disorder.

Manifestations of OCD in children

OCD in children most often manifests itself in the form of obsessive movements and tics, as well as fears, phobias and “strange”, negative ideas and thoughts.

Symptoms of obsessive-compulsive disorder may include the following:

• Thumb sucking;
• Lip smacking;
• Twisting hair around the finger or pulling hair out (some children eat the hair they pull out, which sometimes leads to intestinal obstruction);
• Intrusive coughing;
• Picking the skin or picking at pimples;
• Biting nails or other objects - pen caps, pencils, etc.;
• Cracking of knuckles;
• Frequent blinking;
• Grimaces, wrinkling of the forehead;
• Stomping, clapping.

This is not a complete list of possible manifestations, since the manifestations of neurosis may differ in each individual child. In addition, tics are often added to the actual movements - involuntary contractions of individual muscles, similar to twitching or mild convulsions.

The number of such movements increases sharply if the child is excited or overexcited. In fact, compulsions (and that’s exactly what they are) “serve” the nervous system as a kind of “safety valve” that allows you to release excess tension. The level of anxiety is reduced to an easily tolerable level. If you force the child to restrain these movements, then the psychological tension will grow, eventually breaking through into uncontrollable hysteria or panic.

Most children suffering from OCD experience not only compulsions, but also obsessions—obsessive thoughts. They usually relate to pollution, disaster or symmetry. For example, a child may constantly wash his hands, be afraid of contracting some dangerous disease, or for the same reason not eat certain foods.

It is worth mentioning separately about children from religious families, where parents devote a lot of time to rites and rituals associated with faith in God. They are usually not alarmed when a child begins to frantically say prayers many times a day, but oddly enough, this behavior can also indicate OCD. Another mistake of believers (or parents close to the church) may be attempts to take the child to the “grandmother”, who “with God’s help will cast out the demon from him.” Such situations are quite rare, but they still happen, so we decided to mention them separately. Moreover, mental disorders cannot be treated either with prayers, or with “reprimands,” or with herbal decoctions.

Psychologist Pavel Zhavnerov talks about the causes of various neuroses in children and adults.

Older children and teenagers, as a rule, try to hide their behavioral characteristics from the people around them, because they are afraid of judgment, that they will be considered “abnormal”. Such thoughts further increase discomfort and provoke a new round of symptoms. Therefore, it is important to help the child in time by turning to specialists, otherwise in adolescence he will receive many unnecessary complexes and fears that will greatly complicate his life in the future.

Treatment of OCD in children and adolescents

To cure obsessive-compulsive neurosis, it is imperative to consult a specialist - a psychiatrist or qualified psychotherapist. Neuroses in children do not always require drug therapy, since the psyche at this age is much more “flexible”, and an experienced doctor will help cope with many manifestations of OCD even without the use of drugs. But this depends on many factors that parents cannot determine on their own.

By the way, when it comes to neurosis in a child, doctors usually carefully collect family history and are interested in the conditions in which the little patient grows up. For example, if someone in the family suffers from alcoholism, then it is natural that the child will exhibit a variety of neurotic symptoms. The same can be said about families where parents constantly quarrel and make scandals, treat each other poorly and live together “for the sake of the children.” Overprotection, excessive parental demands and other unhealthy manifestations of relationships in the parental home put a lot of pressure on the young psyche. In such situations, before asking the question “how to cure?”, you need to carefully analyze the possible factors that constantly make the child worry and worry.

By definition, a mentally healthy child cannot grow up in a destructive family, and parents should remember that both the prognosis of the disease and the timing of recovery depend on their attitude.

Therefore, the first thing that should be done if a child is diagnosed with obsessive-compulsive disorder is to change the situation in the house and reduce the pressure on the child’s psyche. Otherwise, treatment may be ineffective.

How to treat obsessive-compulsive disorder? The main method of treating OCD is working with a psychotherapist. Methods of art therapy, fairytale therapy, play therapy, and so on are used to treat young children. For teenagers, the exposure method will be more effective, that is, facing your fear face to face to make sure that nothing terrible happens in the end.

But the main idea that the therapist must convey to the child when treating obsessive disorders is the belief in the safety of the world, in the reliability of parents and their support. The little patient must eventually come to the conclusion that “everyone loves me, I will succeed.” Confidence in oneself, one’s surroundings and the world is the path that ultimately leads a young patient to remission, or even complete recovery.

As for drug treatment, they are usually prescribed for a short period of time in situations where obsessions and compulsions greatly complicate life. Sometimes the symptoms appear so often that they eventually lead to neurasthenia and nervous exhaustion. In such cases, the use of medications (antidepressants and tranquilizers) helps to quickly and effectively remove most of the signs of neurosis so that the patient can rest and begin working with a psychotherapist.

To summarize: a reminder for parents

Unfortunately, even in our time they do not know what obsessive-compulsive neurosis is and how it can manifest itself in children. At the same time, the number of children suffering from this disease is increasing every year. In order to promptly recognize the signs of this disorder in their child, fathers and mothers need to carefully monitor the child’s behavior and not ignore possible oddities and repetitive movements. Remember that it is easier to overcome any neurosis if you start treatment on time, without prolonging the situation, and the absence of such symptoms in the future will help the child to adapt normally in society and grow up to be a self-confident and happy person.

Diseases of the central nervous system are not uncommon. Unfortunately, children are also susceptible to similar disorders. Obsessive movement neurosis in children is a functional psychogenic disorder that has a reversible effect. May develop over a long period of time. The disorders are both chronic and episodic in nature.

Children of any age may experience obsessive movements, actions (obsessions) or tics. Most often these are kids who are characterized by fearfulness and indecisiveness. Such children experience difficulties in independently overcoming everyday troubles, fears and negative emotions. A baby susceptible to the development of neurosis can be capricious, have a poor appetite and look tired.

Provoking factors

Modern life is such that almost every day people experience stress of varying degrees of severity. Few people think about the consequences of the unrest they experienced. Each person’s body reacts individually, and a negative result may appear even after several months. Obsessive movement syndrome in children occurs because the baby’s psyche is not yet strong and immediately perceives any influences, especially those that have a negative effect. In childhood, the psyche reacts sensitively to changes occurring in the world around us. The reasons why a diagnosis of “neurosis” can be made are often:

• fright;
• situations that traumatize the psyche;
• unfavorable family environment.

Changes in the child’s usual way of life that are insignificant in the parent’s opinion can lead to the development of neurosis and the appearance of obsessive movements. When sending children on vacation to a summer camp or to visit relatives, we must not forget that the child may not be mentally ready for change, and such actions will cause a deterioration in well-being.

Symptoms and differences between obsessive movements and tics

It happens that parents simply do not notice the changes occurring in the child. Knowing the symptoms of neurosis, it is easy to recognize nervous tics or obsessive movements.

Nervous tics are rapid muscle contractions that cannot be controlled by willpower. These are twitches that are not caused by psychological disorders. They arise due to an erroneous command from the brain to move. An example of this phenomenon is involuntary blinking.

Obsessive movements are annoying repetitions of an action. Unlike tics, compulsive movements can be controlled by willpower. Their appearance is almost always associated with an emotional disorder experienced by the child. They can also arise due to psychological discomfort in which the baby remains for a long time.

Obsessive movements in children can be manifested by the following symptoms:

• biting nails;
• smacking;
• snapping fingers;
• involuntary sharp turns of the head;
• coughing and sniffling;
• lip biting;
• twisting strands of hair around your fingers;
• uncontrollable hand waves.

Of course, there are many more types of obsessive actions, and they are individual in nature. Parents should note that such movements in most cases occur every minute.

In a state of neurosis, a baby may constantly fiddle with his clothes or twist the buttons on them. It's time to worry about your child's condition if he begins to walk around objects on one side or constantly blows on his palms.

Such obsessive manifestations cannot be ignored. It is better to start treating the disease as early as possible, because ultimately the baby can injure himself by accidentally biting his lip or chewing his nails until they bleed.

Is medication therapy required?

Before you seek help from a doctor, you need to try to understand what led your baby to the onset of the syndrome. Parents must adequately assess the situation in the family and try to make the life of their child as comfortable as possible. If noisy quarrels regularly arise between family members, you should not be surprised at unwanted changes in the baby’s psyche.

To bring the child’s emotional background back to normal, parents should try to resolve intra-family conflicts without using drug treatment. It would be a good idea to spend a lot of time outdoors with your baby, playing sports games. Drawing is a great way to get your little one interested in creativity and distract him from situations that worry him every day.

Often, parents are unable to determine what was the trigger for the development of the disease. A child may hide reasons that negatively affected him. In such a situation, the only correct solution may be to seek professional help from a specialist.

Treatment with drugs

After examining the baby, the psychotherapist may prescribe pharmacological therapy. Obsessive movement syndrome in children is treated with sedatives or antidepressants. This treatment regimen is usually selected in advanced cases. The doctor must choose safe drugs that will not cause drowsiness and apathy. A properly prescribed medication will not interfere with the normal development of a child of any age. Among the drugs that give the best effect are:

• "Persen";
• "Glycine";
• "Sonapax";
• "Milgamma";
• "Cinnarizine";
• "Pantogam";
• "Asparkam."

You can prevent the progression of the disease if the diagnosis is made at the initial stage. This will require several sessions with a psychologist, but no medication.

Nail biting is a sign of obsessive movement disorder

Traditional methods of treatment

Neurosis is a reversible disorder of a person’s neuropsychic state. If symptoms are noticed in a timely manner, you can try to cure them with homeopathy. You should consult your doctor about the use of homeopathic remedies. It is recommended to independently stabilize the emotional state of your child in the following ways:

• You can give your baby baths with sea salt. It is possible to add soothing herbs to the water: lavender, mint.
• Read positive children's books at night.
• Help the baby express emotions through dancing or creativity. You need to give crayons, pencils, and paints more often.
• Spend as much time as possible with your baby and do things together. For example, cook your favorite dish.
• You can give honey water before going to bed. Its preparation does not require much time: you need to stir a teaspoon of natural honey in a glass of water.
• You can relieve your baby of anxiety through soothing herbs: lemon balm, mint, valerian root, motherwort. It is recommended to discuss the dosage suitable for the child’s body with your doctor.

Many parents are faced with autism in their children, and here we told you what symptoms of autism in children may be and how to identify them.

Prevention

Even if the child is absolutely healthy and young, it is necessary to take care of his emotional state. To prevent neurosis from affecting the baby in the future, sufficient attention should be paid to his mental development and upbringing. The baby should know the rules of personal hygiene and regularly play sports games.

It is good if parents instill in their child such qualities as hard work and perseverance. Children need to be taught to cope with negative situations. The baby cannot be constantly scolded, criticized and demanded the impossible. This can cause the child to become withdrawn. The child must trust his parents in everything. Mom and dad should avoid scandals and try to make the atmosphere in the house as calm as possible. It is necessary to avoid regular stressful situations and try to smooth out sudden changes in the usual way of life.

Summary

No matter how old a child is, parents and teachers are obliged to take part in correcting his behavior. Symptoms of neurosis are protective manifestations of a child suffering from psychological discomfort.

Caregivers and teachers must be notified of the child’s illness. This measure is necessary to avoid the baby’s remarks and jerks. It is extremely undesirable to scold a baby for uncontrolled movements. You cannot mock or make fun of the baby. This provokes even greater psychological discomfort and, together with other reasons, can lead to the appearance of new symptoms of neurosis.

These repetitive thoughts (obsessions) and actions (compulsive urges) are uncontrollable and can interfere with normal functioning and ultimately disrupt family life. In approximately one third or even half of all children affected by the disease, obsessive-compulsive disorders begin to appear during childhood and adolescence.

Children with obsessive-compulsive behavior may wash their hands or brush their teeth too hard. They can get themselves into a state of constantly double-checking their actions to make sure they put homework or lunch in their bag in the morning. They may perform a certain ritual several times, perhaps entering and leaving a room a certain number of times. They may meticulously organize their desks and then rearrange everything again, or experience worries about germs, dirt, crime, violence, illness, or death in an overly dramatic way.

One doctor treated a child with obsessive-compulsive disorder who was tormented by thoughts of a destructive tornado. Since age 6, this child had been checking weather maps on television and constantly asking his mother if she had heard any warnings about an impending tornado.

An eight-year-old boy's obsessive-compulsive behavior began with frequent hand washing and soon escalated to a constant feeling of fear of the possibility of a fire or accident. He spent 6-8 hours a day checking electrical outlets and light switches in the house, constantly washing his hands with a brush, and exhibiting other signs of compulsive behavior.

Even at an early age, these children often recognize that their behavior seems strange, but if they begin to try to control it, they usually become very anxious and return to their old habits in order to feel relief. Realizing that their behavior is different from others, such children usually try to hide it from family members and friends. For many children, this strange behavior continues for many months before anyone notices their strange behavior.

Why do these children keep doing the same things over and over again? Most children answer this question that they simply don’t know why they are doing it. Experts who study the causes of obsessive-compulsive disorder describe it as a neurobiological disorder that often occurs among members of the same family.

Symptoms and signs of obsessive-compulsive disorder

• compulsive actions: compulsive hand washing, controlled actions, repetition of certain movements;
• thoughts: obsessive fears, rumination (mental chewing), repetitive thinking.

It is possible that manifestations may intensify, even to the point of obsessive rituals.

Significant negative impact on the patient's daily life.

The patient perceives clinical manifestations as absurd, but in some cases the patient is unable to suppress obsessive actions or thoughts.

Treatment method for obsessive-compulsive disorder

If your child exhibits compulsive behavior, talk to your pediatrician, who may refer you to a child psychiatrist or psychologist. Behavior therapy works effectively for many children, often reducing their receptivity to traditional behaviors. For example, a child who is overly bothered or averse to dirt and who washes their hands many times a day may have dirt on their hands and not be given the opportunity to wash them immediately. At first the child will be very frightened and it will be difficult for him to cope with it. But eventually he realizes that his worst fears are not as destructive as he thought, and that he can get by with irregular hand-washing. Desensitization is a specialized technique that should only be performed by a qualified mental health professional.

The therapist can also help put your child's fears into perspective (“Tornados don't happen here more often than every 30 years or so, and they've never been too bad; your worry isn't worth what might actually happen.”)

Experts have concluded that a class of drugs such as selective serotonin reuptake inhibitors help reduce symptoms of the disease. These and other drugs are an important part of the modern treatment approach. Like other psychotropic medications, these medications should be prescribed only to treat appropriate symptoms and require close supervision by a child psychiatrist or pediatrician who is familiar with these medications and their potentially serious side effects.

Behavioral therapy: learning avoidance techniques, negative exercises, thought control, systematic desensitization, confrontation and avoidance of certain reactions.

Therapeutic conversations: provide access to one's own sensory world, identify aggressive components of obsessions, teach coping strategies, show the value of obsessions as actions that reduce fear.

Drug treatment: antidepressants, in particular fluvoxamine (fevarin), sulpiride.

The medical definition states that unobtrusive movement syndrome is a disorder manifested in the form of repeated unmotivated (and even unconscious) actions that are formed in response to experienced emotional shock. If treatment is not started in time, the pathology may persist for a long time.

An unfavorable course often leads to the fact that some of the child’s actions are replaced or supplemented by others, more complex. In some cases, the condition is one of the symptoms of a nervous tic, a pervasive developmental disorder, or obsessive-compulsive disorder.

The main symptoms of the syndrome in childhood

Pathological obsessive movements in children can be very diverse and unexpected. Most often, experts note the following actions:

• Finger sucking or nail biting.
• Sniffing your nose in the absence of a runny nose, wiping it frequently.
• Teeth grinding, and not only at night.
• Nodding head.
• Monotonous rocking of the whole body or flapping of the limbs.
• Boys often experience twitching of the genitals.
• Prolonged hand washing, even when they are not dirty or are already completely clean.
• Twisting hair around a finger or monotonously pulling it out.

Apart from this, there are usually no other negative manifestations. Children often behave absolutely calmly and in other areas are no different from their peers. Often, if the child’s behavior does not go beyond the bounds of decency, specialized treatment is not even carried out. In this case, experts characterize the symptom as an attempt to adapt to changed environmental conditions. Over time, repeated specific actions go away on their own.

Reasons for the development of the disease

While tics are a consequence of neurotic disorders, unobtrusive movement syndrome is based on a psychological nature. Most often it is caused by the following factors:

• Acute psychological trauma in which the stimulus affected the child for a short period.

Advice: Contrary to popular belief, this result can be achieved not only by negative emotions, but also by intense, unexpected joy. For this reason, it is better to refuse to prepare pleasant surprises for an overly excitable or emotionally unstable baby.

• The child's prolonged stay in a situation that affects his emotional state in a negative way.
• Lack of a number of microelements.
• Hereditary predisposition.
• An attempt to copy the behavior of familiar children or adults.

Most often, experts diagnose unobtrusive movement syndrome in children living in unfavorable or large families, constantly experiencing stress, and suffering from lack of attention. Excessive guardianship can also play a cruel joke in this case. Often, treatment is required for spoiled children who went to kindergarten or school, which led to a sharp change in their usual way of life. Doctors note that the risk of such a disease is higher in children who have suffered a traumatic brain injury. In addition, children with a history of infectious diseases, organ pathologies and neuroinfections are at risk.

Methods for diagnosing the condition

If unobtrusive movements in the child’s behavior are obvious, then it is necessary to consult a neurologist. Using simple tests and examination, he will help determine whether the problem is a symptom of internal problems. Timely assessment of the condition and timely treatment will prevent the development of actions that could threaten the health or life of the child. For example, it happens that children not only pull out hairs, but also eat them, which leads to intestinal obstruction.

Particular attention should be paid to children with established slowing of intellectual development. Statistically, the problem is more common in boys. The first symptoms can appear at any age, the speed of their development and replacement by new manifestations is purely individual. The severity of the condition may increase with exacerbation or repetition of the provoking factor. Such manifestations usually do not bother the child at all and do not cause any complaints on his part.

Effective methods of treating the syndrome

If the diagnosis of the condition and treatment were carried out in a timely manner, then the chances of complete relief from obsessive movements are very high. The maximum effect is achieved by combining drug therapy prescribed by a neurologist with visits to a psychologist. It is important to understand that getting rid of the external manifestations of the disease is not a reason to refuse further therapy. Some neurotic symptoms and psychogenic manifestations may subside for a while and return in full. The duration of successful therapy is about six months; in more serious cases, the time period is calculated in years.

A lot in this case depends on the parents. They should not be nervous, focus on the child’s characteristics, and constantly correct his behavior. Their responsibilities include creating a calm, favorable and conducive atmosphere for communication with the baby. A small patient needs to be given sufficient, but not excessive, attention. If the problem is self-esteem, you should think about the sports section, which usually only has a positive effect on the condition of the kids.

With the permission of a doctor, the use of natural sedatives is allowed. This could be a course of glycine, aromatherapy, relaxation baths with sea salt or herbal decoctions. Such areas as art therapy, audio therapy, and breathing exercises aimed at relieving tension have a good effect. At the same time, you should pay attention to the child’s nutrition; if necessary, we give him a vitamin and mineral complex. In addition to all of the above, you need to properly build communication with your child, based on trust, and not just education and creating restrictions.

In order to protect the little man from traumatic factors that cause obsessive-compulsive neurosis, parents need to pay special attention to his behavior in the period between 2–3 and 5–7 years. It is at this crisis age, when there is a confrontation between growing children and their parents, as well as the outside world, that a nervous disorder most often begins to develop.

CAUSES OF NEUROSIS IN CHILDREN

Neurosis is a complex disease that can develop due to many reasons and prerequisites.

At its core, childhood obsessive neurosis is a child’s painful reaction to difficult life situations. Fortunately, neurotic disorder can be completely cured. The main thing is to pay attention to suspicious symptoms as early as possible and prevent the disease from moving into the chronic stage, which requires more serious and lengthy treatment.

The main prerequisites for the development of neuroses are psychological trauma, frequent and prolonged stress, and severe fear. However, psychotraumatic situations (quarrel between parents, etc.) occur in the life of every child, why do some children develop neurosis and others not? Psychologists advise paying attention to the temperamental characteristics of a small person. Obsessive neurosis is more common in children:

• timid, anxious and suspicious;
• with increased suggestibility;
• pedantic;
• overly touchy;
• deeply experiencing their own failures.

If you notice the following behavior patterns in your child, consult a psychologist. Timely psychological correction is the best prevention of obsessive-compulsive neurosis. To prevent neurotic disorders, experts recommend developing perseverance, endurance, and hard work in a child from an early age.

SIGNS AND SYMPTOMS OF NEUROSIS OF OBSESSIVE CONDITIONS IN CHILDREN

The presence of obsessive-compulsive neurosis in a child is evidenced by repeated thoughts, actions, or entire “rituals” performed against one’s will.

Obsessive thoughts can be associated with various. Some children are afraid to stay at home on their own, others are afraid of the dark, heights, being called to the blackboard, etc.

No less varied are obsessive actions - repeatedly repeated movements, for example, grunting, licking or biting lips, smacking, frequently adjusting clothes or washing hands, twitching various parts of the body (head, shoulders, arms), etc.

In some cases, obsessive actions take the form of quite complex rituals, which are also a child’s defensive reaction to a frightening factor. Thus, in medical practice, there are cases when children walk in a circle and walk around various objects only on the right or only on the left. In other situations, before going to bed, children perform strange rituals with jumping, of which there must be a certain number, for example, 10, in this way they “protect” themselves from the fear of the dark. There are many other examples of unexplained compulsions that children cannot stop on their own.

Parents should not hope that such strange behavior will go away “on its own” over time. Moreover, in addition to obsessive, constantly repeating movements, neuroses are usually accompanied by tearfulness, insomnia, and deterioration in the child’s performance and appetite. In addition, such children are constantly teased by peers, which causes additional psychological trauma and aggravates the problem.

TREATMENT OF NEUROSIS OF OBSESSIVE MOVEMENTS IN CHILDREN

Having noticed the first signs and symptoms of obsessive-compulsive neuroses in children, parents should immediately seek advice from a psychologist or neuropsychiatrist. The specialist will prescribe individual treatment after examining the little patient and finding out the causes of the manifestation of neurosis. Therapy should also take into account the child’s personal characteristics and temperament.

The duration and method of treatment depend on the severity of the disorder (therapy can last from several weeks to several years). In mild cases, restorative and psychotherapeutic methods are used (including play psychotherapy, behavioral therapy, which involves confronting the child with a frightening factor, autogenic training, etc.).

With neuroses, vegetative, motor and behavioral reactions are disturbed to one degree or another. To restore all these functions, complex treatment is used, including taking medications, including sedatives.

In cases where correction and prevention of obsessive-compulsive neuroses in children is required, the drug Tenoten for children, which can eliminate states of anxiety and fear, has proven itself well. Its advantages are a mild effect without side effects. Tenoten for children is not addictive or addictive.

In order for the treatment of obsessive movement neuroses in children to be effective, parents will have to show patience and tact. If you notice a repetition of obsessive movements and rituals, you should not yell at your child; you need to spend time with him and talk about what is bothering him.