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Excessive fidgeting with hands
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Excessive fidgeting with hands

For the last 4 months, my 8 yr old boy has been fidgeting and playing with his hands excessively at all times.  During football and basketball games, it appeared like he was spelling words in the are during games and practices... now during practices and games he makes a fist and then spreads his hand out every few minutes until he needs his hands to grab a ball.  He holds his hands and arms very stiffly at other times.  When he talks to you, we continues to play with his hands and if your bring it up to him he says he doesn't notice that he is doing it.  He used to do it occasionally and now he is constantly doing it regardless of the activity he is doing at the time.  Is this a sign of stress, hyperactivity or something worse?  What steps can we take to stop him from doing this? We have received a few notes from school that he is not completing his classwork and not working up to his potential.  I don't know if this issues go hand in hand.  
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521840_tn?1348844371
Hello,
    This is a broad one, and only someone who sees your son can get a sense of the type of movement issue present here. If its something that has always sort of been there, it may be what we call a stereotopy. The movements you are describing sound like fairly typical stereotypic movements. If you go to google video or youtube, you can see what these look like. This is a harmless repetitive movement that gets repeated in times of excitement or even joy. These movements are part of what we call 'nervous system overflow', and they have that 'overflow' quality to them--where when you look at the kid it seems as if they are feeling so much that they are moving their body in response. Don't freak out if you google the term and find its something that lots of children with autism have, because it lots of kids without disabilities can have them too.

If the movements come in bursts -- and have an almost explosive, staccato 'burst' to them, that would be more like tic. Though tics are the most obvious feature of Tourette's Syndrome, many kids develop transient tics in times of stress. Tics can come and go, and if its just one or two tics then it may be something harmless that waxes and wanes across his life. Hand movements, grimaces, blinks and throat clearing are common tics. Again, there is video online to show you what these look like. Kids with tics may report feeling an 'urge' to do the movement and find it difficult to suppress it for very long. If a child tries to suppress tics, they sometimes can do so for a bit and then tic hard and fast for a while.

Some children develop motor compulsions in times of stress. Kids with anxiety disorders may feel compelled to repeat the same motion again and again, and can become very stressed if told not to do so. Compulsions are often, but not always, associated with the sense of needing to do the movement, and relief afterward. Adults find compulsions unwanted, and wish they could stop. In a child as young as your son, it not bother him. He may not be conscious of feeling the need to do it, and so it becomes a habit. Kids sometimes tap their hands, touch things, count/recite things, wash hands repeatedly or pick at their skin/hair. Kids can suppress compulsions but often feel lots of stress when they try to resist the urge.

This does not particularly sound like hyperactivity, though not having seen your son I could not say for sure. Hyperactive kids do move a lot, but the movements are not repetitive.

It may be that your son has always done some form of this movement and you never really noticed how frequent it was until he became older. We get so used to our children that we often don't notice their quirks until they get to an age where these differences can interfere with life (or we worry what the other kids will say). However, you seem to have an instinct that this is stress related. I see a lot of eight year old boys in my office because this can be a very stressful time for them if subtle learning problems are starting to 'bite' them.

The curriculum in the second half of second grade (though more so in 3rd grade) changes from quick tasks to tasks that require sustained attention to task and application of skills. If a child has trouble sitting still, tolerating boredom and frustration, and concentrating, then this time in elementary school can be pretty miserable. This does not necessarily mean your son has a learning problem or ADHD, but it is something to consider given the timing of the symptom onset.

So first, go see your pediatrician. But be aware that not all pediatricians know much about movement disorders or anxiety, so you will want primarily to ask for referrals. If it is bothering you, do not let your pediatrician tell you that its not a big deal. Better to trust your instincts, because the physician only has 15 minutes to listen and complete an exam. He/she may not even see the movements during such a brief visit, and compared to the serious things he/she sees everyday, this may not seem serious in comparison.

I would ask for a referral to a developmental pediatrician or pediatric neuropsychologist. If you live near a pediatric hospital, these folks won't be hard to find. Your physician may recommend a neurologist, and thats a good first step too. A general psychologist with the proper training in identifying movement disorders may be a helpful, but not all psychologists have this background. Its ok to ask before making the appointment, because the psychologist should be able to refer you to the right professional if he/she can't help you.

Once you know the nature of the movement, you will have decisions to make about treatment, or doing nothing. For example, though a stereotopy is technically a movement disorder, there is not much you can do besides try to teach some alternative behaviors (if you chose to go this route). However, if it is related to anxiety, you may be pursuing a psychological assessment to rule out learning problems, then medication and cognitive behavioral therapy. The good news is that research shows very clearly that anxiety disorders respond well to a 'one-two punch' of medication and cognitive behavioral therapy.

Good luck!
Rebecca Resnik

Disclaimer: This post was written for informational purposes only. It is not intended to replace face to face medical or psychological care. This post was not intended to create a patient-psychologist relationship, nor to give or rule-out a diagnosis.
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Avatar_m_tn
Thank you so much for such a through response.  I will schedule an appoinment with his pediatrician and follow through with a request to a referral if I still have questions.
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1639856_tn?1395189207
Oh wow, that is my 8 year old! Picture perfect image!! My son a comb of both ADD and ADHD. If there is a Children's Hospital near you they often have studies for children with symptoms like this. I had to get something done when it effected his schooling. That is when it is a cause for concern. This is a good age also. Talk his teachers and mention the ADD/ADHD disorder. There is paperwork that your child's doctor will give you to take to them. Have them fill them out and get that taken care of as soon as possible! If this is the problem, trust me you do not want to wait. Keep us up to date please! I would almost lay money on it, that this is what's going on. Your story sounds all WAY to familiar!!!!
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