What are typical ritualistic behaviors and repetitive movements?
Children often like routines—they are safe, predictable, and comforting all at the same time. At home, caregivers, children, or adolescents often establish morning routines, in-class routines, after-school routines, homework routines, and bedtime routines. When a young child needs to deviate from one of their routines, there may be some stress or resistance involved. Older children and teens are often more than happy to break a routine, such as when they want to stay up later than usual to watch a movie or play a game.
While routines involve actions that need to be done, like brushing the teeth and making the bed, rituals are usually internally motivated, have a sense of purpose, and are perceived as having a positive effect. In many children and adolescents, rituals are connected with fears and anxieties and help them accept and counterbalance stressful situations. Younger children’s ritualistic behaviors are related to fears, such as stranger and separation anxieties, whereas the ritualistic behaviors of older ones are related to more specific fears such as contamination and the risk of inflicting harm to self or others.
Some repetitive behaviors, routines, and rituals are expected. Young children may reenact their experiences during play, and adolescents may have a specific way of warming up before exercising. Some athletes are superstitious and engage in rituals before competing. All of these behaviors are typical, as long as they remain related to the specific activity at hand and do not intrude or interfere with other aspects of the individual’s life or the lives of others around them.
When should I be concerned about a child’s ritualistic behaviors or repetitive movements?
If a child or teen is engaging in ritualistic behaviors or repetitive movements compulsively or obsessively and there are difficulties in interrupting them, or if the behaviors are impacting other aspects of their lives or the lives of others around them, this may be cause for concern.
Some concerning repetitive behaviors include:
- Blinking.
- Clearing their throat.
- Body twitches.
- Touching.
- Shoulder shrugging.
- Facial grimacing.
- Sniffing.
- Making sounds.
Some concerning rituals include:
- Repeated or extensive washing or cleaning.
- Repeated checking behaviors (e.g., checking for mistakes over and over again).
- Repeated specific actions (e.g., going in and out of a doorway).
- Repeated object counting, or silently repeating words.
- Arranging or lining up objects.
- Strong refusal to throw things away.
- Unwillingness to “step on cracks”.
- Repeatedly insisting another person do or say something.
- Repeated praying.
What can I do to help a child with ritualistic behaviors or repetitive movements?
Caregivers know their children best. If you are a caregiver, there are a few things you may attempt:
- Talk to your child. Try to understand what your child is doing and what they are experiencing by asking simple questions. Listening to the reasons they do what they do helps caregivers to understand what kind of difficulty is behind repetitive behaviors.
- Be supportive, and let them know that you have noticed that something is wrong. Let your child know that their behavior has been noticed and that you are there to help anyway you can.
- Demonstrate problem solving. Without disregarding your child's point of view, you may try helping them to think about factual reasons why they could deal with their rituals in a different way.
- Whenever possible, guide your child on attempting not to engage in the rituals and repetitive movements. It may be really hard for your child not to engage in their rituals. So, you can guide them on attempting not to do what they feel the urge to do and sit with them. If they feel anxious about it, instruct your child to take deep breaths and talk to them in a calm, soothing and reassuring tone. Also, it is important to not engage or participate in your child's rituals, even when it seems like your child is asking for help.
If you have already tried some or most of these suggestions and the problems your child is facing persist, it may be time to seek out professional support.
Ritualistic behaviors and repetitive movements that are too frequent, intense, present in many different contexts, discrepant from those experienced by children the same age, and that negatively interfere with your child and family’s daily lives, may indicate the possibility of Obsessive Compulsive Disorder (OCD) or Tics.
What kind of professional support can I seek out for help?
It is not unusual that some caregivers feel embarrassed, inadequate, or guilty if their child is struggling with ritualistic behaviors and repetitive movements. But, if you are concerned about your child, support and guidance are available now. Communicate concerns during and between visits with your child's doctor.
Pediatricians or family physicians can help to address initial concerns and refer to specialized professionals. Also, whenever possible, a consultation with a mental health professional may be helpful. These professionals also work with caregivers so that they know how to support their children outside of therapy sessions.
The public system provides services through the Child and Adolescent Mental Health Services (CAMHS) and Centers of Multidisciplinary Assessment, Counseling, and Support (KEDASY).
Where to find more information
Specific, detailed, and clinical information on Obsessive Compulsive Disorder (OCD) or Tics can be found at [clinical short guide at the program website].
If you want to know more about the closest available services for educational and public health systems for children and adolescent assistance across the country, go to our Services Mapping webpage here.
You can also find more information by pointing your phone camera at the QR code below or by clicking here.
