Behavioral Problems

Behavior problems are seen in children and adults. The first step for adults and children is the completion of a thorough functional behavioral assessment (FBA). Cognitive, behavioral, contextual, social, medical, perceptual, and other relevant variables are taken into account. With an adult, most often a functional assessment of the behavior problem can be done together with the therapist, but with children it is very helpful to have parents and other important people such as the teacher provide information for the FBA. A treatment directly based on the FBA is then developed and implemented in collaboration with the patient, family, and school as needed. Assessment and treatment of the problems listed below usually involve a collaboration with medical professionals as well.

Trichotillomania: Trichotillomania or chronic and debilitating hair pulling and chronic skin picking are impulse control disorders where the person finds it very difficult to resist the temptation to pull their hair, pick their skin or bite their nails. The urges to engage in the behavior are often accompanied by a sense of mounting tension that is believed by the person to be only relieved by picking or pulling. Indeed, individuals, with this problem report a release of tension or even pleasure afterwards. People who exhibit this self injurious behavior often develop other difficulties related to the pulling or picking behavior such as hair loss, bleeding, scarring and a feeling of shame about their inability to control their impulses. They may also develop anxiety about others seeing the results of their behavior.

Tic Disorders:  Tics are involuntary movements of the body (motor) or involuntarily produced sounds (vocal). These movements are considered sudden, rapid, recurrent, and nonrhythmic. If they happen often or most of the time, they are considered chronic and can be diagnosed if they are specifically motor or vocal as: Chronic Motor or Vocal Tic Disorder. If they happen once in a while or in episodes, they are considered transient (Transient Tic Disorder). People with multiple motor and at least one vocal tic most of the time, with a beginning before age 18 that negatively impacts quality of life can be diagnosed with Tourette’s Disorder which can sometimes include the bizarre behavior of coprolalia (tics involving cursing or making other sounds that could be considered socially inappropriate).

Aggressive and Disruptive Behaviors:  Most often seen in children, sometimes at school, and sometimes at home with targets including parents, peers, siblings, pets, and others, aggressive behavior involves physical or even attempted or threatened physical attack. Common aggressive behaviors include hitting, kicking, scratching, slapping, and spitting. While often due to frustration in children, the source of the frustration or must be very carefully assessed and treated in the setting where and with the people with whom the behavior occurs. The same exact thing can be said about children with disruptive behaviors including tantrums, non-compliance, annoying others, leaving the seat, interrupting, and for a special class of behavior, Self Injurious Behavior, which is seen more frequently but not exclusively in individuals on the Autistic Spectrum. Such behaviors can be life threatening and/or debilitating.     

Elimination Disorders:  Usually diagnosed in children, Enuresis is uncontrolled urination. If it occurs during the day, it is called "Diurnal" and is usually associated with either social anxiety, reluctance to use an unfamiliar toilet, or over-focusing on an activity. If wetting occurs at night when the person is asleep it is referred to as "Nocturnal". Encopresis is the repeated passage of feces in inappropriate places. This can occur with or without a medical complication called "Constipation and Overflow Incontinence". When it involves this complication the treatment must be in collaboration with the child’s Pediatrician.

Eating Disorders:  Because of their life threatening nature, an eating disorder at LICCT is always treated in very close collaboration with the patients’ Primary Care Physician and relevant family members. Eating problems include overeating, obesity, anorexia nervosa, and bulimia nervosa. 

Cutting (Self Mutilation):  Seen in children and adults, self mutilation is apparently a maladaptive coping strategy involving deliberately inflicting harm upon oneself by cutting, burning, depriving oneself of air, or otherwise hurting oneself. Since such behaviors are physically dangerous, it is essential to employ the cooperation of the patient and other individuals that the patient trusts in order to assist with the management and treatment of this potentially debilitating behavior problem. 

Addictions:   Addictions, such as gambling, can be treated and the beginning is the development of a strong collaboration between the patient and the therapist with a focus on truth. Careful gauging of the patient’s readiness for and commitment to treatment occurs at the beginning and throughout treatment. Since addictions to medications, drugs, and alcohol involve damage to the body and internal systems, treatment of these types of addictive problems always involve frequent communication with a patient’s Primary Care Physician.

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