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Compulsive Behavior


I am the teacher of a 13-year-old girl who appears to need permission to do everything. If I tell her to pick up a fork and take a bite, she looks at me. I then repeat it and she moves the fork toward her mouth and must be told a couple more times in order for her to eat the food. It appears that she looks for permission with every comment. The same is true when she is told to sit down. It's about 10-20 times of saying it over and over. I have been her teacher for two years and the problem seems to be getting more pronounced. Her mother has the same difficulty at home. What do you suggest?

Answer of our experts

On hearing this story it is not easy for me to tell what is going on. The options are: Volitional, she enjoys the prompting and seeks it, as "attention;" There is a cognitive component and she needs to be guided; She is anxious and needs reassurance; Medication is "slowing her down." A good first approach is to do a functional analysis of the behavior and see what reinforces the seeking of prompting, if it seems behavioral, rewards for completing tasks without too many prompts may shape her behavior differently.

If it is 2) it will be difficult to manage.

If it is 3) or 4) more medication manipulation may help (she is not on any anti-anxiety agent), but she is already on several meds.

So, hoping it is 1) could you use behavior management or 4) could you simplify meds? Would suggest seeking help from a child psychiatrist and/or behavioral psychologist.

MG/ TK 7-13-10

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Interventions targeting problematic repetitive behaviour in individuals with CdLS should be sensitive to anxiety, sensory problems and social demands. These interventions should also consider environmental factors.
Atypical presentation of anxiety and mood disorder should be considered when behaviour changes occur.
As anxiety is common in individuals with CdLS during periods of environmental change/transitions, a planned program should be implemented.
Treatment of anxiety and mood disorders in individuals with CdLS should be considered using psychosocial interventions (therapies) and pharmacotherapy (medication).

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