Parenting expert, David Coleman has advice on how to tackle a behavioural/vocal tic in a teenager and on whether children sharing a bedroom is a good idea.
Question: Our 13-year-old daughter has a habit of snorting and sniffing every 10 seconds! Everything we read tells us to ignore it but it is driving us daft. She is what you could call a 'worry wart'. Up until a year ago she constantly coughed. We brought her to see several consultants who ruled out any medical cause for the cough. They put it down as habitual. She stopped coughing but started sniffing and snorting. Our understanding is that it is a form of stress relief? We don't want her to feel odd, but should we be going the route of behaviour therapy?
David replies: It certainly sounds like the sniffing and snorting has become a kind of behavioural/vocal tic. Tics are largely unconscious and involuntary movements or sounds.
I think there are a lot of similarities between behaviours like skin-picking, hair-pulling and tics. They all seem to have some neurological component, as if the brain is giving a reflex message to the body.
In my understanding, stopping a behavioural or vocal tic, for the person affected, is akin to you or I trying to stop a sneeze that is tickling the back of our noses. It is so automatic, and like I mentioned, involuntary, that the child cannot seem to prevent it.
You are quite correct that the typical advice, in relation to childhood tics is to ignore them unless they are causing the child some kind of physical harm.
It is interesting that your daughter had a previous habit of coughing, which is another form of vocalisation, and that in managing to stop it (perhaps because of the focus on it due to the trips to see all the doctors) she has simply developed an alternative tic.
That suggests to me that ignoring the sniffing and snorting is unlikely to encourage your daughter to stop, or even to lead to a reduction in the frequency or intensity of this habit.
I wonder if the sniffing or snorting affects any of her friendships? Are other people, outside of your family, as aware or as 'driven daft' by it? Does she even notice herself? Is she ever frustrated or embarrassed by it?
If so, then it is probably worth pursuing some kind of intervention for her. Indeed, more so, if she herself is aware and unhappy about the sniffing or snorting.
As you seem aware of, Habit Reversal Therapy (HRT) is the most effective behavioural approach to reducing tics.
Essentially, HRT requires your daughter to learn to recognise that the tic is about to occur, then to use some competing behaviour or response to block or replace the tic behaviour.
So, for example, with your daughter's sniffing, she might be encouraged to replace it with a long slow breath in through her nose, or a swallow motion (which will disrupt the inward 'sniff' breath).
To achieve this she needs to be fully aware of the actual tic movement. So she needs to see herself doing the sniffing or snorting, in slow motion, in the mirror, so she knows exactly what muscles are involved and then she and the therapist can work out the best, alternative, muscle action to disrupt or replace it.
Once she has her competing response, it is all about practice, practice, practice, to encourage her body to adopt the new muscle action (which should be less noticeable or bothersome) as her new habit.
If your daughter is bothered by her tics then it is well worth seeking some behaviour therapy for her. She may already consider her sniffing to be 'odd', and so getting help for it shouldn't stigmatise her any further.
Finally, you might want to explore more about a relatively new intervention that is being researched in Yale University, looking at the effects of a food supplement, N-acetyl cysteine (NAC), which acts as an antioxidant.
I don't fully understand the physiological rationale for NAC, but is has already been shown to help reduce trichotillomania (hair pulling) and so researchers think it might also help with Tourette's Syndrome and tics.
Naturally, you need to discuss NAC, and its appropriateness, with your GP as it is always important to get qualified medical advice before considering new food supplements.
Question: We have two children, a boy of two and a girl of six months. At this stage our daughter is ready to move out of our room. Should we move her in with her brother or should she have her own room? My instinct is that it would be a good thing to have them to share. My concern, though, is that they will be giddy and keep each other awake, or wake each other up if one is sick etc. Our daughter will soon start crèche and so change is imminent. Would you suggest that I bite the bullet and put them together or keep them separate for the moment?
David replies: Lots of families have no choice about co-sleeping. Necessity and space demand that children share with each other or with their parents. So having a choice about room sharing is a bonus.
Of course given that choice, many parents do choose to settle their child, from day one, in their own room, while other parents celebrate the communality of sharing space during the night.
Indeed the variety of sleeping options that families choose suggests that there can be no absolute right or wrong about where we have our children sleep.
Sleeping alone might allow some children an uninterrupted night, and for others may lead to anxiety in that separation. Sleeping together gives great comfort to some children and leads to disruption and giddiness at settling time for others.
Co-sleeping is not the same as bed-sharing. Co-sleeping is the more general term used to describe when we choose to either sleep in the same room as our children or have them share with each other.
As I explained recently on the radio, I am a fan of co-sleeping. I think we are social beings and family communality breeds security and confidence in children when they are small. As they get older, they tend to look for their own space in any event.
Also, in my experience, children tend not to wake each other during the night, even if one of them is sick or has a nightmare.
The key thing for you to hold onto in coming to your own decision, about your children co-sleeping, is your instinct. You mention that your instinct tells you to have them share a room. I think it is fine to follow that instinct.
It is of course possible that they could, as they get older, chat, giggle and wind each other up at bed-time. However, if your ground-rules and boundaries are clear from the start, by the time they both are at a talking age they should be clear that such messing won't be tolerated.
The key to establishing room sharing, in the early stages, is to stagger the bedtimes.
Depending on the rhythm and routine that your daughter has come to, she may have a regular bedtime.
Even if she doesn't yet, your son probably does, and so you can engineer it that he goes to bed either before his sister or after she is asleep.
Of course if your instinct proves wrong and it is unsettling for either or both of them, you can just change to separate rooms, if space in your house allows.
The issue of the timing of any move for your daughter out of your room, irrespective of whether she goes to her own room or to share with her brother, requires a bit of thought.
It sounds like you are already close to the deadline for returning to work and if it's likely that this bedroom transition will merge with the move into the crèche, it may all end up being too much change for your daughter to get used to easily. Too much change can lead to anxiety.
Anxiety, in turn, can often lead to a disruption in sleep. If her move to sharing a room coincides with starting in the crèche and she ends up with disturbed sleep it may be harder to tell what is the cause of that disruption.
So, on balance, I would suggest leaving her in your room for a few more months until she is well settled in the crèche.
Then you can move her, probably to share with her brother. Stagger the bedtimes to let them settle without disturbing each other and with a bit of luck you may get to enjoy having your bedroom back to yourself!
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