Nail biting, clothing picking, ice chewing, knuckle cracking, oh my!

Frustrating! So very frustrating when your ADHD child has these “bad habits.” But are they really just bad habits? Or are they something else that they can’t help, something that they are compelled to do?

I had a few compulsive behaviors when I was younger. Most of them seemed to resolve on their own. One stayed put, well into my thirties. Nail biting. My parents tried everything: shaming, yelling, putting nasty tasting stuff on my fingers. Nothing worked. I just couldn’t help myself. Not until I finally found out that if I had acrylic nails, the biting would stop. There are other behaviors that I was compelled to do, and some of them were very embarrassing. So I shouldn’t have been surprised, when Ryan started to show some of these very same behaviors.

Ryan has had a grouping of behaviors since he was small that are definitely compulsive. We’ve tried lots of different things to get him to stop, to no avail. Thankfully for him and us, these habits are just annoying to others and not completely physically destructive. But bringing them quietly to his attention on a regular basis without the notice of others in the vicinity has been difficult. Afterall, some of these behaviors could be seen as socially unacceptable. Many things have worked for him over the years, including fiddle toys to keep his hands busy and awareness training.

There is an official diagnosis of these physical behaviors – Body Focused Repetitive Behaviors, or BFRB. The diagnosis can be found in the DSM-5 under Obsessive Compulsive Disorder. Some of the behaviors that fall under this heading are nail biting, knuckle and joint cracking, nose picking, skin picking, hair pulling, twirling, and visual inspection of hair. There are actual technical words for these things but I’m not going to add them here. You can just do a quick and easy internet search of BFRB and find all kinds of information on it with a more complete listing of behaviors and official medical terms.

My purpose here in writing about BFRB is to bring awareness to it and how it can affect people with ADHD. Children (and adults) like Ryan who have ADHD are predisposed to having BFRB. Many people with ADHD can have sensory seeking behavior. These behaviors give the ADHD brain this extra sensory input they so badly need. They can increase dopamine, and give a sense of release and pleasure and sometimes even pain that the brain craves. They can relieve stress and give a sense of comfort. The person can show hyperfocus on a particular behavior, which can truly baffle a neurotypical parent, especially when they can’t get their child to even focus for a few minutes on doing their homework. And it’s even harder for the child when their parent yells at him, “for all that is holy, stop chewing that ice!”

There can be a lot of shame in bringing your child’s compulsions to light. For the child, these compulsions can cause embarrassment and socially awkward situations. We want to push them under the rug, hoping and praying that no one else will notice or that “Johnny will just grow out of it.” Well honestly, you just can’t count on that. You or your child may really want to stop these behaviors, but will power alone won’t be enough.

What can we do? Talk to your child’s therapist or psychiatrist if you have one. Presently there are no medications that will help, but psychotherapy can, and there’s different kinds of treatment modalities that can help: Habit reversal training, awareness training, cognitive behavior therapy to name a few. Trust me, you won’t be able to change the behavior on your own. And you’ll just be setting up a home battlefield. Please, just don’t. If you don’t have a therapist, you can talk to your or your child’s doctor about your concerns, and hopefully they can steer you to an appropriate therapist. You can also visit bfrb.org to learn more about the disorder and find clinicians in your area.

Be kind and patient with yourself or your loved one who exhibits these behaviors. Ask what you can do to help them. Try not to be disgusted with them ( I know – that’s really really hard!) and encourage them. Remember that they just can’t stop doing something because you tell them to.