We all have fears, but phobias tend to be viewed as unreasonable or excessive compared to standard fears.
The distress and anxiety caused by a germ phobia are out of proportion to the damage that germs are likely to cause. Someone who has germaphobia might go to extreme lengths to avoid contamination.
The symptoms of germaphobia are the same as the symptoms of other specific phobias. In this case, they apply to thoughts and situations that involve germs.
The emotional and psychological symptoms of germaphobia include:
intense terror or fear of germs
anxiety, worries, or nervousness related to exposure to germs
thoughts of germ exposure resulting in an illnesses or other negative consequence
thoughts of being overcome with fear in situations when germs are present
trying to distract yourself from thoughts about germs or situations that involve germs
feeling powerless to control a fear of germs that you recognize as unreasonable or extreme
The behavioral symptoms of germaphobia include:
avoiding or leaving situations perceived to result in germ exposure
spending an excessive amount of time thinking about, preparing for, or putting off situations that might involve germs
seeking help to cope with the fear or situations that cause fear
difficulty functioning at home, work, or school because of fear of germs (for example, the need to excessively wash your hands may limit your productivity in places where you perceive there to be many germs)
The physical symptoms of germaphobia are similar to those of other anxiety disorders and can occur during both thoughts of germs and situations that involve germs. They include:
sweating or chills
shortness of breath
chest tightness or pain
shaking or tremors
nausea or vomiting
Children who have a fear of germs can also experience the symptoms listed above. Depending on their age, they may experience additional symptoms, such as:
tantrums, crying, or screaming
clinging to or refusing to leave parents
Sometimes a fear of germs can lead to obsessive-compulsive disorder.
With germaphobia, the fear of germs is persistent enough to impact your day-to-day life. People with this fear might go to great lengths to avoid actions that could result in contamination, such as eating out at a restaurant or having sex.
They might also avoid places where germs are plentiful, such as public bathrooms, restaurants, or buses. Some places are harder to avoid, such as school or work. In these places, actions like touching a doorknob or shaking hands with someone can lead to significant anxiety.
Sometimes, this anxiety leads to compulsive behaviors. Someone with germaphobia might frequently wash their hands, shower, or wipe surfaces clean.
While these repeated actions might actually reduce the risk of contamination, they can be all-consuming, making it difficult to focus on anything else.
Passing concern about germs or illnesses isn’t necessarily a sign of obsessive-compulsive disorder (OCD).
With OCD, recurring and persistent obsessions result in significant anxiety and distress. These feelings result in compulsive and repetitive behaviors that provide some relief. Cleaning is a common compulsion among people who have OCD.
It’s possible to have germaphobia without OCD, and vice versa. Some people have both germaphobia and OCD.
The key difference is that people with germaphobia clean in an effort to reduce germs, while people with OCD clean (aka engage in the ritual behavior) to reduce their anxiety.
Germaphobia falls under the category of specific phobias in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
To diagnose a phobia, a clinician will conduct an interview. The interview might include questions about your current symptoms, as well as your medical, psychiatric, and family history.
The DSM-5 includes a list of criteria used to diagnose phobias. In addition to experiencing certain symptoms, a phobia typically causes significant distress, impacts your ability to function, and lasts for a period of six months or more.
During the diagnosis process, your clinician may also ask questions to identify whether your fear of germs is caused by OCD.
Most people take precautions to avoid common illnesses, such as colds and the flu. We should all be somewhat concerned about germs during flu season, for example.
In fact, it’s a good idea to take certain steps to lower your risk of contracting a contagious illness and potentially passing it on to others. It’s important to get a seasonal flu shot and wash your hands on a regular basis to avoid getting sick with the flu.
Concern for germs becomes unhealthy when the amount of distress it causes outweighs the distress it prevents. There is only so much you can do to avoid germs.
There may be signs that your fear of germs is harmful to you. For instance:
If your worries about germs put significant limitations on what you do, where you go, and who you see, there may be reason for concern.
If you’re aware that your fear of germs is irrational, but feel powerless to stop it, you may need help.
If the routines and rituals you feel compelled to carry out to avoid contamination leave you feeling ashamed or mentally unwell, your fears may have crossed the line into a more serious phobia.
Seek help from a doctor or therapist. There is treatment available for germaphobia.
The goal of germaphobia treatment is to help you become more comfortable with germs, thereby improving your quality of life. Germaphobia is treated with therapy, medication, and self-help measures.
Therapy, also known as psychotherapy or counselling, can help you face your fear of germs. The most successful treatments for phobias are exposure therapy and cognitive behavioral therapy (CBT).
Exposure therapy or desensitization involves gradual exposure to germaphobia triggers. The goal is to reduce anxiety and fear caused by germs. Over time, you regain control of your thoughts about germs.
CBT is usually used in combination with exposure therapy. It includes a series of coping skills that you can apply in situations when your fear of germs becomes overwhelming.
Certain lifestyle changes and home remedies might help relieve your fear of germs. These include:
practicing mindfulness or meditation to target anxiety
applying other relaxation techniques, such as deep breathing or yoga
Social anxiety disorder is a common type of anxiety disorder. A person with social anxiety disorder feels symptoms of anxiety or fear in certain or all social situations, such as meeting new people, dating, being on a job interview, answering a question in class, or having to talk to a cashier in a store. Doing everyday things in front of people—such as eating or drinking in front of others or using a public restroom—also causes anxiety or fear. The person is afraid that he or she will be humiliated, judged, and rejected.
The fear that people with social anxiety disorder have in social situations is so strong that they feel it is beyond their ability to control. As a result, it gets in the way of going to work, attending school, or doing everyday things. People with social anxiety disorder may worry about these and other things for weeks before they happen. Sometimes, they end up staying away from places or events where they think they might have to do something that will embarrass them.
Some people with the disorder do not have anxiety in social situations but have performance anxiety instead. They feel physical symptoms of anxiety in situations such as giving a speech, playing a sports game, or dancing or playing a musical instrument on stage.
Social anxiety disorder usually starts during youth in people who are extremely shy. Without treatment, social anxiety disorder can last for many years or a lifetime and prevent a person from reaching his or her full potential.
What are the signs and symptoms of social anxiety disorder?
When having to perform in front of or be around others, people with social anxiety disorder tend to:
Blush, sweat, tremble, feel a rapid heart rate, or feel their “mind going blank”
Feel nauseous or sick to their stomach
Show a rigid body posture, make little eye contact, or speak with an overly soft voice
Find it scary and difficult to be with other people, especially those they don’t already know, and have a hard time talking to them even though they wish they could
Be very self-conscious in front of other people and feel embarrassed and awkward
Be very afraid that other people will judge them
Stay away from places where there are other people
What causes social anxiety disorder?
Social anxiety disorder sometimes runs in families, but no one knows for sure why some family members have it while others don’t. Researchers have found that several parts of the brain are involved in fear and anxiety. Some researchers think that misreading of others’ behavior may play a role in causing or worsening social anxiety. For example, you may think that people are staring or frowning at you when they truly are not. Underdeveloped social skills are another possible contributor to social anxiety. For example, if you have underdeveloped social skills, you may feel discouraged after talking with people and may worry about doing it in the future. By learning more about fear and anxiety in the brain, scientists may be able to create better treatments. Researchers are also looking for ways in which stress and environmental factors may play a role.
How is social anxiety disorder treated?
First, talk to your doctor or health care professional about your symptoms. Your doctor should do an exam and ask you about your health history to make sure that an unrelated physical problem is not causing your symptoms. Your doctor may refer you to a mental health specialist, such as a psychiatrist, psychologist, clinical social worker, or counselor. The first step to effective treatment is to have a diagnosis made, usually by a mental health specialist.
Social anxiety disorder is generally treated with psychotherapy (sometimes called “talk” therapy), medication, or both. Speak with your doctor or health care provider about the best treatment for you. I
A type of psychotherapy called cognitive behavioral therapy (CBT) is especially useful for treating social anxiety disorder. CBT teaches you different ways of thinking, behaving, and reacting to situations that help you feel less anxious and fearful. It can also help you learn and practice social skills. CBT delivered in a group format can be especially helpful. For more information on psychotherapy, please
Many people with social anxiety also find support groups helpful. In a group of people who all have social anxiety disorder, you can receive unbiased, honest feedback about how others in the group see you. This way, you can learn that your thoughts about judgment and rejection are not true or are distorted. You can also learn how others with social anxiety disorder approach and overcome the fear of social situations.
Autism is a complex neurobehavioral condition that includes impairments in social interaction and developmental language and communication skills combined with rigid, repetitive behaviors. Because of the range of symptoms, this condition is now called autism spectrum disorder (ASD). It covers a large spectrum of symptoms, skills, and levels of impairment. ASD ranges in severity from a handicap that somewhat limits an otherwise normal life to a devastating disability that may require institutional care.
Children with autism have trouble communicating. They have trouble understanding what other people think and feel. This makes it very hard for them to express themselves either with words or through gestures, facial expressions, and touch.CONTINUE READING BELOW
A child with ASD who is very sensitive may be greatly troubled — sometimes even pained — by sounds, touches, smells, or sights that seem normal to others.
Children who are autistic may have repetitive, stereotyped body movements such as rocking, pacing, or hand flapping. They may have unusual responses to people, attachments to objects, resistance to change in their routines, or aggressive or self-injurious behavior. At times they may seem not to notice people, objects, or activities in their surroundings. Some children with autism may also develop seizures. And in some cases, those seizures may not occur until adolescence.
Some people with autism are cognitively impaired to a degree. In contrast to more typical cognitive impairment, which is characterized by relatively even delays in all areas of development, people with autism show uneven skill development. They may have problems in certain areas, especially the ability to communicate and relate to others. But they may have unusually developed skills in other areas, such as drawing, creating music, solving math problems, or memorizing facts. For this reason, they may test higher — perhaps even in the average or above-average range — on nonverbal intelligence tests.
Symptoms of autism typically appears during the first three years of life. Some children show signs from birth. Others seem to develop normally at first, only to slip suddenly into symptoms when they are 18 to 36 months old. However, it is now recognized that some individuals may not show symptoms of a communication disorder until demands of the environment exceed their capabilities. Autism is four times more common in boys than in girls. It knows no racial, ethnic, or social boundaries. Family income, lifestyle, or educational levels do not affect a child’s chance of being autistic.
Autism is said to be increasing; however, it is not entirely clear whether the increase is related to changes in how it is diagnosed or whether it is a true increase in the incidence of the disease.
Autism is just one syndrome that now falls under the heading of autism spectrum disorders. Previous disorders that are now classified under the umbrella diagnosis of ASD or a social communication disorder include:
Autistic disorder. This is what most people think of when they hear the word “autism.” It refers to problems with social interactions, communication, and imaginative play in children younger than 3 years.
Asperger’ssyndrome. These children don’t have a problem with language — in fact, they tend to score in the average or above-average range on intelligence tests. But they have the same social problems and limited scope of interests as children with autistic disorder.
Pervasive developmental disorder or PDD — also known as atypical autism. This is a kind of catch-all category for children who have some autistic behaviors but who don’t fit into other categories.
Childhood disintegrative disorder. These children develop normally for at least two years and then lose some or most of their communication and social skills. This is an extremely rare disorder and its existence as a separate condition is a matter of debate among many mental health professionals.
Rett syndrome previously fell under ASD spectrum but it is now confirmed that Rett’s cause is genetic. It no longer falls under ASD guidelines. Children with Rett syndrome, primarily girls, start developing normally but then begin losing their communication and social skills. Beginning at the age of 1 to 4 years, repetitive hand movements replace purposeful use of the hands. Children with Rett syndrome are usually severely cognitively impaired.
What Causes Autism?
Because autism runs in families, most researchers think that certain combinations of genes may predispose a child to autism. But there are risk factors that increase the chance of having a child with autism.
Advanced age of the mother or the father increases the chance of an autistic child.
When a pregnant woman is exposed to certain drugs or chemicals, her child is more likely to be autistic. These risk factors include the use of alcohol, maternal metabolic conditions such as diabetes and obesity, and the use of antiseizure drugs during pregnancy. In some cases, autism has been linked to untreated phenylketonuria (called PKU, an inborn metabolic disorder caused by the absence of an enzyme) and rubella (German measles).
Although sometimes cited as a cause of autism, there is no evidence that vaccinations cause autism.
Exactly why autism happens isn’t clear. Research suggests that it may arise from abnormalities in parts of the brain that interpret sensory input and process language.
Researchers have no evidence that a child’s psychological environment — such as how caregivers treat the child — causes autism.
The exact cause of ASD is unknown. The most current research demonstrates that there’s no single cause.
Some of the suspected risk factors for autism include:
having an immediate family member with autism
fragile X syndrome and other genetic disorders
being born to older parents
low birth weight
exposure to heavy metals and environmental toxins
a history of viral infections
fetal exposure to the medications valproic acid (Depakene) or thalidomide (Thalomid)
According to the National Institute of Neurological Disorders and Stroke (NINDS), both genetics and environment may determine whether a person develops autism.
Multiple sources, old and new, have concluded that the disorder isn’t caused by vaccines, however.
A controversial 1998 study proposed a link between autism and the measles, mumps, and rubella (MMR) vaccine. However, that study has been debunked by other research and was eventually retracted in 2010.
An ASD diagnosis involves several different screenings, genetic tests, and evaluations.
The American Academy of Pediatrics (AAP) recommends that all children undergo screening for ASD at the ages of 18 and 24 months.
Screening can help with early identification of children who could have ASD. These children may benefit from early diagnosis and intervention.
The Modified Checklist for Autism in Toddlers (M-CHAT) is a common screening tool used by many pediatric offices. This 23-question survey is filled out by parents. Pediatricians can then use the responses provided to identify children that may be at risk of having ASD.
It’s important to note that screening isn’t a diagnosis. Children who screen positively for ASD don’t necessarily have the disorder. Additionally, screenings sometimes don’t detect every child that has ASD.
Other screenings and tests
Your child’s physician may recommend a combination of tests for autism, including:
DNA testing for genetic diseases
visual and audio tests to rule out any issues with vision and hearing that aren’t related to autism
occupational therapy screening
developmental questionnaires, such as the Autism Diagnostic Observation Schedule (ADOS)
Diagnoses are typically made by a team of specialists. This team may include child psychologists, occupational therapists, or speech and language pathologists.
Not every child is the same. The signs and symptoms of psychological retardation deffer with different children. Here are a few:
Difficulty in articulating a point
Learning speech at a slower rate
Having trouble remembering things
Poor academic performance
Overall Low Intelligence
Poor performance in IQ tests
Particular attention required to learn simple skills
Have trouble putting on clothes
The tendency to inflict injury on self
Poor interpersonal relationships
Excessive dependency on parents
Unable to respond to situations in a measured manner
Low attention span
Characteristics of Mentally Disabled Kids
Mentally disabled, also known as differently abled kids portray the following characteristics.
Bad Memory: These kids have a short-term memory recall. However, when doing a task repeatedly, they can recall information without displaying any symptoms of mental retardation.
Slow Learning Curve: Their ability to process new information is relatively low when compared to other kids. That does not mean they are incapable of learning. Some educationists are of the view that a slowing down of the instructions can help in better reception of the information.
Attention Deficiency: They are unable to sustain their attention for too long on a single task. A good way of tackling this deficiency is by making them aware of the most crucial aspect of the work and then building their attention from there on.
Disinterest: Due to repeated failures, some children don’t trust their skills, even if they are correct. Over time they lose faith in their abilities and become disinterested in learning.
Independent Living: One of the brighter side children with special needs can be trained in repetitive tasks which they can master over time. This can help them stay independent for a short duration of time and also prepare them for adulthood.
Inability to Restrain Emotions: As children grow older, they can give measured responses when faced with unknown situations. Children with mental disabilities are unable to do this and may respond unpredictably, usually displaying aggression. Once the episode is over, they can sense that they have misbehaved and are capable of feeling like they are a burden.
Social Development: Due to bizarre outbursts and poor language skills, they may be unable to have healthy social interactions.
Application of New Ideas: They are unable to incorporate any newly acquired skills innovatively.
There a few ways to diagnose mental retardation in kids.
Stanford-Binet Intelligence Scale: This test gauges quantitative reasoning, knowledge, fluid reasoning, visual-spatial processing and memory. It is one of the primary tests that identify learning disorders in children.
Kaufman Assessment Battery for Children: This test is used to assess the cognitive development of a child. The types of tests administered are wide-ranging and vary based on the age of the child. This test is not a stand-alone test, meaning that the results of this analysis must be seen in conjunction with other tests.
Bayley Scale of Infant Development: This is a standardised test for infants between 1-42 months of age. Motor, language and cognitive skills are tested. This, in turn, helps to screen out children who are prone to having development problems in the future.
There is no medical “cure” for mental retardation. However, there are ways in which you can enrich their lives and help them have a pleasant childhood.
Stem Cell Therapy: This can be beneficial for children who have Down Syndrome. While it cannot eliminate Down Syndrome, it can help repair any damaged cells which help in improving their cognitive abilities.
Acupuncture: Studies have shown that children who given this form of treatment saw a marked increase in IQ tests as well as social skills.
Home Schooling: As the pace of learning is slow, homeschooling is a good option where the child can thrive in a protected environment. If the child is auditory rather than visual, the entire learning experience can be changed based on the child’s needs. This flexibility would not be available in schools.
Special Needs Schools: These schools have other children with disabilities studying under the same roof. The classes are conducted at a slower pace, and hence the children can grasp the concepts quickly.
Common challenges faced by developmentally disabled children are as follows:
Social Isolation: Perceived as slow, these kids are often ostracised by their peers. All it takes is one rumour, and most kids would start avoiding a mentally disabled child. Not just them, even the ones who try to befriend them are ridiculed.
Bullying: People fear what they can’t understand and hate what they can’t conquer. The inability of children or even adults to understand the needs of a mentally disabled child can breed hatred, fear and contempt. Many kids with disabilities must face ridicule from their peers and are often called unflattering names.
Low Self Esteem: Consistently poor academic performance can have a negative impact on their psyche. Complex topics might be difficult to grasp for any child. However, poor academic performance in natural subjects where their peers outclass them may make them have a low opinion of themselves.
Loneliness: Due to social isolation and bullying, many children with mental disabilities suffer from loneliness.
Medical Problems: Children that suffer from profound mental retardation are likely to have other health complications as well. These could include reduced vision, hearing issues, poor motor function, etc.
Parenting Tips to Help in Raising a Child with an Intellectual Disability
Parents can play a significant role in treating and raising a child with an intellectual disability. Here are a few tips to help build a differently-abled child:
Encourage Independence: Children with mental disabilities have a slow learning curve. A parent telling their child that he cannot do anything will make him even more dependent and foster low self-esteem. One method to make kids independent is by breaking down complex tasks/ideas into simple ones.
Follow Up On Academic Progress: Be active at parent-teacher meetings to find out what are the strengths and weaknesses of your child. Parent-teacher conferences can be an excellent forum where you can keep track of your child’s development. It can also be a place where a healthy exchange of ideas can take place.
Socialise: Many parents limit their child’s interactions with others in a bid to protect them. Then there are others who wish to avoid unpleasant situations. While these are legitimate reasons, making a child socially active would foster a sense of normalcy.
Network: Taking care of a child with disabilities is difficult for parents. Often there are instances when parents go into depression or bickering takes place between the couple. It can be helpful to know that there are other parents out there who are going through the same ordeal. Networking helps parents a lot, as it not just acts as a support group but also becomes a place where parents can share their experiences and ideas to come up with new ways of raising kids with disabilities.
Educate Themselves: Raising a mentally challenged child may be difficult, and counselling sessions with experts can help in overcoming these difficulties. Even if you are unable to meet an expert, buy books such as:
When your Child has Disabilities by M.L. Batshaw
A Parent’s and Teacher’s Guide to the Special Needs Child by Darrell M. Parker
Routine: Develop a habit that can be followed by your kid as it can help them feel secure. School can be stressful, and a safe environment at home with a predictable routine can help them feel secure.
Praise and Reward: Due to the challenges they face every day, low self-esteem issues are typical, and they need constant appreciation and affection to overcome those. Encouragement through a reward system can help boost their self-confidence. However, avoid any negative punishments as it is likely to demotivate them.
Behaviour Management: Children with mental disabilities may find it difficult to cope with certain situations. In such cases, it is essential that they don’t dwell on their inability to comprehend those things. Diverting their mind would be a good idea in such situations. Something as simple as giving them headphones and making them listen to music would help in diverting their mind.
Many children who have intellectual challenges have in time, learned to overcome their disability and live healthy lives. Even the most difficult cases, children have responded well to proper treatment with many showing a semblance of normalcy.
This classification is given to children with poor IQ, typically in the range of 70-75 or less. They also have low adaptive skills meaning social skills and a sharp learning curve is virtually non-existent. Mentally disabled children are slower than their peers in acquiring life skills such as speech development or logic.
Types of Mental Retardation in Kids
Mental retardation has been stereotyped by movies and television shows. These have made people believe that a mentally disabled person is someone who is slow and dim-witted, often ridiculed as the village idiot. In reality, this disability is nuanced with different scales of limitation, and there is room for improvement for those afflicted.
Mild Intellectual Disability: More than 85% of kids with the disability fall in this category and have no trouble until shortly before high school. With an IQ of around 55-70, they are sometimes unable to grasp abstract concepts but can by and large function independently.
Moderate Intellectual Disability: Falling under the IQ range of 35-54, they constitute about 10% of the children that are afflicted with mental retardation. These children can be integrated into society as they can pick up speech and essential life skills. However, their academic performance is likely to be dismal and would fare poorly in school. These children can have some amount of autonomy but cannot remain independent for a long duration.
Severe Intellectual Disability: With an IQ of 20-34, these kids are in a minority of 3-4% of the mentally challenged child population. Through extensive training, these kids may be able to learn necessary life skills but would need to live in a sheltered home to avoid stressful situations.
Profound Intellectual Disability: This is the most severe form of disability and is also the rarest, with only 1-2% of mentally challenged children constituting this group. They are severely handicapped and require extensive supervision due to poor life skills. With regular training and setting a routine, they may be able to pick up essential life functions.
Causes of Mental Retardation in Children
Some of the reasons include:
Genetic: Over 30% of mental retardation is attributed to genetics. These children are likely to suffer from problems such as Down Syndrome and fragile X syndrome.
Head Trauma: A severe head injury can cause inflammation in the brain. This can change the mental state of the child and lead to difficulties in memory, attention and reasoning.
Pregnancy-Related Issues: Pregnant women who do recreational drugs, smoke and drink alcohol can severely affect the brain development of the foetus.
Illness: Children suffering from measles can develop encephalitis which causes mental retardation. Infants suffering from congenital hyperthyroidism are also at the risk of poor brain development.
Exposure To Toxic Materials: Elements such as mercury, lead and cadmium are known to be linked with a reduction in intellectual growth.
Pregnant women should avoid doing drugs, smoking or drinking as it can lead to neural defects in the child.
Children should be immunised against diseases that cause mental disorders such as measles.
Women suffering from hyperthyroidism need to get treated as it can lead to a foetus with neural defects.
Tourette syndrome is a disorder that involves repetitive movements or unwanted sounds (tics) that can’t be easily controlled. For instance, you might repeatedly blink your eyes, shrug your shoulders or blurt out unusual sounds or offensive words.
Tics typically show up between ages 2 and 15, with the average being around 6 years of age. Males are about three to four times more likely than females to develop Tourette syndrome.
Although there’s no cure for Tourette syndrome, treatments are available. Many people with Tourette syndrome don’t need treatment when symptoms aren’t troublesome. Tics often lessen or become controlled after the teen years.
Tics — sudden, brief, intermittent movements or sounds — are the hallmark sign of Tourette syndrome. They can range from mild to severe. Severe symptoms might significantly interfere with communication, daily functioning and quality of life.
Tics are classified as:
Simple tics. These sudden, brief and repetitive tics involve a limited number of muscle groups.
Complex tics. These distinct, coordinated patterns of movements involve several muscle groups.
Tics can also involve movement (motor tics) or sounds (vocal tics). Motor tics usually begin before vocal tics do. But the spectrum of tics that people experience is diverse.
In addition, tics can:
Vary in type, frequency and severity
Worsen if you’re ill, stressed, anxious, tired or excited
Occur during sleep
Change over time
Worsen in the early teenage years and improve during the transition into adulthood
Before the onset of motor or vocal tics, you’ll likely experience an uncomfortable bodily sensation (premonitory urge) such as an itch, a tingle or tension. Expression of the tic brings relief. With great effort, some people with Tourette syndrome can temporarily stop or hold back a tic.
When to see a doctor
See your child’s pediatrician if you notice your child displaying involuntary movements or sounds.
Not all tics indicate Tourette syndrome. Many children develop tics that go away on their own after a few weeks or months. But whenever a child shows unusual behavior, it’s important to identify the cause and rule out serious health problems.
The exact cause of Tourette syndrome isn’t known. It’s a complex disorder likely caused by a combination of inherited (genetic) and environmental factors. Chemicals in the brain that transmit nerve impulses (neurotransmitters), including dopamine and serotonin, might play a role.
Risk factors for Tourette syndrome include:
Family history. Having a family history of Tourette syndrome or other tic disorders might increase the risk of developing Tourette syndrome.
Sex. Males are about three to four times more likely than females to develop Tourette syndrome.
People with Tourette syndrome often lead healthy, active lives. However, Tourette syndrome frequently involves behavioral and social challenges that can harm your self-image.
Conditions often associated with Tourette syndrome include:
Urinary incontinence (enuresis) is the loss of bladder control. In children younger than age 3, it’s normal to not have full bladder control. As children get older, they become more able to control their bladder. Wetting is called enuresis when it happens in a child who is old enough to control his or her bladder. Enuresis can happen during the day or at night. It can be a frustrating condition. But it’s important to be patient and remember that it’s not your child’s fault. A child does not have control over enuresis. And there are many ways to treat it and help your child.
There are 4 types of enuresis. A child may have 1 or more of these types:
Nighttime (nocturnal) enuresis. This means wetting during the night. It’s often called bedwetting. It’s the most common type of enuresis.
Daytime (diurnal) enuresis. This is wetting during the day.
Primary enuresis. This happens when a child has not fully mastered toilet training.
Secondary enuresis. This is when a child has a period of dryness, but then returns to having periods of wetting.
What causes enuresis in a child?
Enuresis has many possible causes. The cause of nighttime enuresis often is not known. But possible causes and risk factors may include 1 or more of these:
Attention deficit/hyperactivity disorder (ADHD)
Constipation that puts pressure on the bladder
Delayed bladder development
Not enough antidiuretic hormone (ADH) in the body during sleep
Obstructive sleep apnea
Slower physical development
Structural problems in the urinary tract
Trouble feeling that the bladder is full while asleep
Urinary tract infection
Very deep sleep
Daytime enuresis may be caused by:
Constipation that puts pressure on the bladder
Stopping urine stream before finishing (dysfunctional voiding)
Not going to the bathroom often enough
Not urinating enough when going
Structural problems in the urinary tract
Urinary tract infection
Keeping legs too close together traps urine in the vagina and urine leaks out (vaginal voiding)
Which children are at risk for enuresis?
A child is more at risk for enuresis if he or she:
Doesn’t have regular bathroom habits
Has physical development problems
What are the symptoms of enuresis in a child?
Symptoms can be a bit different for each child. The main symptom is when a child age 5 or older wets their bed or their clothes 2 times a week or more, for at least 3 months. But 1 in 10 children age 7, 1 in 20 children age 10, and 1 in 100 children older than 15 still have at least one episode of nighttime enuresis.
The symptoms of enuresis can seem like other health conditions. Have your child see his or her healthcare provider for a diagnosis.
How is enuresis diagnosed in a child?
Many children may have enuresis from time to time. It can take some children longer than others to learn to control their bladder. Girls often have bladder control before boys. Because of this, enuresis is diagnosed in girls earlier than in boys. Girls may be diagnosed as young as age 5. Boys are not diagnosed until at least age 6.
Your child’s healthcare provider will ask about your child’s health history. Tell the healthcare provider:
If other family members have had enuresis
How often your child urinates during the day
How much your child drinks in the evening
If your child has symptoms such as pain or burning when urinating
If the urine is dark or cloudy or has blood in it
If your child is constipated
If your child has had recent stress in his or her life
The healthcare provider may give your child a physical exam. Your child may also need tests, such as urine tests or blood tests. These are done to look for a health problem, such as an infection or diabetes.
How is enuresis treated in a child?
In most cases, enuresis goes away over time and does not need to be treated. If treatment is needed, many methods can help. These include:
Changes in fluid intake. You may be told to give your child less fluids to drink at certain times of day, or in the evening.
Keeping caffeine out of your child’s diet. Caffeine can be found in cola and many sodas. It is also found in black teas, coffee drinks, and chocolate.
Night waking on a schedule. This means waking your child in the night to go urinate.
Bladder training. This includes exercises and urinating on a schedule.
Using a moisture alarm. This uses a sensor that detects wetness and sounds an alarm. Your child then gets up to use the bathroom.
Medicines. Medicines can boost ADH levels or calm bladder muscles.
Therapy (counseling). Working with a therapist can help your child cope with life changes or other stress.
Work with your child’s healthcare provider to find out the best choices that may help your child.
What are possible complications of enuresis in children?
Possible problems from enuresis can include:
Emotional stress and embarrassment
Skin rash from wet underwear
How can I help my child live with enuresis?
Remember that your child can’t control the problem without help. Don’t scold or blame them.
Make sure your child is not teased by family or friends.
Keep in mind that many children outgrow enuresis.
Protect your child’s mattress bed with a fitted plastic sheet.
Have a change of clothes on hand while out and about.
When should I call my child’s healthcare provider?
Call the healthcare provider if your child has:
Symptoms that don’t get better, or get worse
Key points about enuresis in children
Urinary incontinence (enuresis) is the loss of bladder control. In children under age 3, it’s normal to not have full bladder control. As children get older, they become more able to control their bladder.
It can happen during the day or at night.
It has many possible causes. These include anxiety, constipation, genes, and caffeine.
In many cases, it goes away over time and does not need to be treated.
If treatment is needed, many methods can help. These include changes in fluid intake, reducing caffeine, and urinating on a schedule.
Tips to help you get the most from a visit to your child’s healthcare provider:
Know the reason for the visit and what you want to happen.
Before your visit, write down questions you want answered.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
Ask if your child’s condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if your child does not take the medicine or have the test or procedure.
If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
Tics are irregular, uncontrollable, unwanted, and repetitive movements of muscles that can occur in any part of the body.
Movements of the limbs and other body parts are known as motor tics. Involuntary repetitive sounds, such as grunting, sniffing, or throat clearing, are called vocal tics.
Tic disorders usually start in childhood, first presenting at approximately 5 years of age. In general, they are more common among males compared with females.
Many cases of tics are temporary and resolve within a year. However, some people who experience tics develop a chronic disorder. Chronic tics affects about 1 out of 100.
Types of tics disorders
Tic disorders can usually be classified as motor, vocal, or Tourette’s syndrome, which is a combination of both.
Motor and vocal tics can be short-lived (transient) or chronic. Tourette’s is considered to be a chronic tic disorder.
Transient tic disorder
Transient tic disorder occurs for less than 1 year, and are more commonly motor tics.
According to the American Academy of Child and Adolescent Psychiatry, transient tic disorder or provisional tic disorder affects up to 10 percent of children during their early school years.
Children with transient tic disorder will present with one or more tics for at least 1 month, but for less than 12 consecutive months. The onset of the tics must have been before the individual turned 18 years of age.
Motor tics are more commonly seen in cases of transient tic disorder than vocal tics. Tics may vary in type and severity over time.
Some research suggests that tics are more common among children with learning disabilities and are seen more in special education classrooms. Children within the autism spectrum are also more likely to have tics.
Chronic motor or vocal tic disorder
Tics that appear before the age of 18 and last for 1 year or more may be classified as a chronic tic disorder. These tics can be either motor or vocal, but not both.
Chronic tic disorder is less common than transient tic disorder, with less than 1 percent of children affected.
If the child is younger at the onset of a chronic motor or vocal tic disorder, they have a greater chance of recovery, with tics usually disappearing within 6 years. People who continue to experience symptoms beyond age 18 are less likely to see their symptoms resolved.
The defining symptom of tic disorders is the presence of one or more tics. These tics can be classified as:
Motor tics: These include tics, such as head and shoulder movements, blinking, jerking, banging, clicking fingers, or touching things or other people. Motor tics tend to appear before vocal tics, although this is not always the case.
Vocal tics: These are sounds, such as coughing, throat clearing or grunting, or repeating words or phrases.
Tics can also be divided into the following categories:
Simple tics: These are sudden and fleeting tics using few muscle groups. Examples include nose twitching, eye darting, or throat clearing.
Complex tics: These involve coordinated movements using several muscle groups. Examples include hopping or stepping in a certain way, gesturing, or repeating words or phrases.
Tics are usually preceded by an uncomfortable urge, such as an itch or tingle. While it is possible to hold back from carrying out the tic, this requires a great deal of effort and often causes tension and stress. Relief from these sensations is experienced upon carrying out the tic.
Anxiety, anger, and fatigue may make the symptoms of a tic disorder worse.
The symptoms of tic disorders may:
worsen with emotions, such as anxiety, excitement, anger, and fatigue
worsen during periods of illness
worsen with extreme temperatures
occur during sleep
vary over time
vary in type and severity
improve over time
Causes and risk factors
The exact cause of tic disorders is unknown. Within Tourette’s research, recent studies have identified some specific gene mutations that may have a role. Brain chemistry also seems to be important, especially the brain chemicals glutamate, serotonin, and dopamine.
Tics that have a direct cause fit into a different category of diagnosis. These include tics due to:
Risk factors for tic disorders include:
Genetics: Tics tend to run in families, so there may be a genetic basis to these disorders.
Sex: Men are more likely to be affected by tic disorders than women.
Conditions associated with tic disorders, especially in children with TS, include:
autism spectrum disorder
speech and language difficulties
Other complications associated with tic disorders are related to the effect of the tics on self-esteem and self-image.
Some research has found that children with TS or any chronic tic disorder experience a lower quality of life and lower self-esteem than those without one of these conditions.
In addition, the Tourette Association of America say that people with TS often experience difficulties with social functioning due to their tics and associated conditions, such as ADHD or anxiety.
Tic disorders are diagnosed based on signs and symptoms. The child must be under 18 at the onset of symptoms for a tic disorder to be diagnosed. Also, the symptoms must not be caused by other medical conditions or drugs.
The criteria used to diagnose transient tic disorder include the presence of one or more tics, occurring for less than 12 months in a row.
Chronic motor or vocal tic disorders are diagnosed if one or more tics have occurred almost daily for 12 months or more. People with a chronic tic disorder that is not TS, will experience either motor tics or vocal tics, but not both.
TS is based on the presence of both motor and vocal tics, occurring almost daily for 12 months or more. Most children are under the age of 11 when they are diagnosed. Other behavioral concerns are often present, as well.
To rule out other causes of tics, a doctor may suggest:
MRI scans or other imaging
Treatment and coping
Treatment depends on the type of tic disorder and its severity. In many cases, tics resolve on their own without treatment.
Severe tics that interfere with daily life may be treated with therapies, medications, or deep brain stimulation.
Therapies for tic disorders
Some types of cognitive behavioral therapy can help people manage the discomfort of a tic disorder.
Some therapies are available to help people control tics and reduce their occurrence, including:
Exposure and response prevention (ERP): A type of cognitive behavioral therapy that helps people become accustomed to the uncomfortable urges preceding a tic, with the aim of preventing the tic.
Habit reversal therapy: A treatment that teaches people with tic disorders to use movements to compete with tics, so the tic cannot happen.
Deep brain stimulation
Deep brain stimulation (DBS) is an option for people with TS whose tics do not respond to other treatments and impact someone’s quality of life.
DBS involves the implantation of a battery-operated device in the brain. Certain areas of the brain that control movement are stimulated with electrical impulses with the aim of reducing tics.
Coping and self-help tips
Some lifestyle changes can help reduce the frequency of tics. They include:
avoiding stress and anxiety
getting enough sleep
It can be helpful to:
join a support group for people with TS and other tic disorders
reach out to friends and others for help and support
remember that tics tend to improve or disappear with age
Parents of children with tics may wish to:
inform teachers, caregivers, and others who know the child, about the condition
help boost the child’s self-esteem by encouraging interests and friendships
ignore times when a tic occurs, and avoid pointing it out to the child