For many children, inattention or the tendency to fidget can happen from time to time. How can you tell if your child's behavior is within the normal range or if something more might be going on? For parents, this can be a very concerning question.
Joining the show to discuss tic disorders and nervous habits that might be affecting a childs daily life, is Patrick Mabray, MD, PhD. He is a Pediatric Neurologist specializing in movement disorders, ADHD, epilepsy, and headache at Boston Medical Center.
Patrick Mabray, MD, PhD
Patrick Mabray, MD, PhD is a Pediatric Neurologist specializing in movement disorders, ADHD, epilepsy, and headache. Dr. Mabray completed a combined MD, PhD at Boston University. Prior to joining the team at Boston Medical Center he trained at Children’s National Medical Center in Washington, DC where he earned several research and training awards.
Melanie Cole (Host): For many children, inattention or the tendency to fidget can happen from time to time, but as a parent, how can you tell if your child’s behavior is within the normal range or if something more might be going on? For parents, this can be a very concerning question. My guest today is Dr. Patrick Mabray. He’s a pediatric neurologist and the head of pediatric movement disorders at Boston Medical Center. Welcome to the show. Tell us a little bit about the prominence of these kinds of fidgety behaviors in children and are they mostly considered normal.
Dr. Patrick Mabray, MD, Ph.D. (Guest): Thanks so much for having me. That’s a great question. There are lots of children that will have lots of fidgety movements and it really depends on the age that you're having them and what they look like, and then also what they're stopping you from being able to do. For example, there was a study done back around the 70's and 80's where the pediatricians just sat in a kindergarten class and nearly one out of four kids during the time that they were sitting there in the class watching them had some kind of fidgety movement or kick movements where it looked like an uncontrolled movement of their body. They're very common, especially in different age ranges and you'll see movements that seem a little different than or less controlled than you'd see in older children.
Melanie: If this is reasonably normal, especially in kindergarteners and toddlers and those kinds of kids, and you see it, when is it that a parent should be concerned because we all have this thing pop into our head worrying about if this is an OCD or ADD – these questions pop into our head. When should we actually be concerned and what if the school comes to us and tells us about some of these things?
Dr. Mabray: The primary thing when I'm talking to families and looking at patients and talking with patients that try to find out is, are these movements affecting your ability to function? There's a number of ways it might affect your ability to function in the grade school age. One is, is it causing impairments or problems with your peers? Are other kids noticing them? Is it abnormal enough that kids are picking on you or making fun of you? Is it a movement that is making a noise or that is so disruptive that it’s affecting other kids in class and they're not able to learn, the teachers are putting you outside for a period of time or sending you to the principal’s office, or are the movements causing some kind of pain? Is your head turning to the side repetitively to the point where you start getting neck pain from that? Those are things that are concerning and those are reasons why you'd want to come and ask to be evaluated.
Melanie: What's an evaluation like?
Dr. Mabray: An evaluation begins with just talking about what the movements are. As everyone always says, a picture is worth 1000 words and a video is worth 10,000 words. We all walk around with video recorders in our hip, so pulling out that phone, taking a recording of the different movements if you can and bringing that in so that I can see them, or whichever pediatric neurologist that you're going to be evaluated by, can see it, really look at it and then we start asking questions. When did they happen? What makes them happen? Are there any other things going on with your child? How are doing in school? How've their developments been? Going through a lot of different questions to understand what these movements are and just the general health of the child, in particular, and then we do a thorough neurological evaluation. At that point, we sit down and discuss what we think is going on, what are the issues here, what's being required, treatment whether or not it’s medicine or different therapies, including behavioral therapies, reversal therapies, or whether or not these are things that can just continue to monitor and have you come back in a couple of months and make sure things aren’t changing.
Melanie: Are these types of neurological conditions or tick disorders, or whatever the movement disorder is, something that you can actually see if you do some kinds of tests or is it just you're taking the family history and you're determining that this is what's going on? Is there anything that you can actually see and point to directly?
Dr. Mabray: The movements themselves. The witnessing the movements, which is why I was saying bringing in a video is incredibly helpful. When you actually see these movements, they're very specific, and ticks have a very specific quality to them as well as a very specific story around them. There's not a blood test that I can recommend. There are research grade imaging tests that some people have used but aren’t diagnostic or 100% accurate and they aren’t currently in the clinical realm. There's really no test other than the general knowledge and the evaluation.
Melanie: You mentioned that sometimes you might watch and wait or see if it's stress related to the child and there are medicational interventions that you can try. When you tell a parent some of these options, a lot of parents are afraid when they hear the word “meds” because they think the ADHD meds and if their child is going to be on these for a very long time. What do you tell them about some of the treatment options available that can help their child?
Dr. Mabray: The first thing I tell parents is that we want to make sure that we’re treating the child for the correct reasons. I'm bringing this up because tick disorders tend to travel with some other companions, and so during evaluation, we try to figure out which of these comorbidities or other illnesses you have, and then we target our management to treat the problem. If the ticks are the problem, then we’ll talk about medicines. Sometimes you'll only need to take medicines for a short period of time, for a few months, and sometimes people will be on medicine for longer periods of time. Ticks also have such an interesting time course with the way they present. Often ticks will flare up around different times such as times of illness or times of stress – August and September is a huge time for ticks to pop up – the carefree summer days are over and you're back to school with all of the stresses that it brings with it, and so ticks might flare up during that time. As you become more comfortable with your new teacher and classmates, then ticks start to go away on their own and you get the illness around winter. If we start a medicine, we might start them at a time when there is less stress, or in a lot of cases, we might decide not to use them.
Melanie: What about the psychosocial aspects? As a child might have these movements disorders and maybe they come and go, if they are noticeable by other children, whether it's blinking or head movements or hand movements, they could cause some psychosocial effects. How do you help parents to deal with that with their children so that the kid doesn't feel left out or different or anything of those things?
Dr. Mabray: That's another great question. That's one of the things we really try to delve into when we're in the appointments and we're talking with the families and the children. Determining from the children's perspective, are they feeling any of those symptoms? If they are, then that would be a reason to start a treatment. That would be a medicine. There are also other treatments. For examples, there's habit reversal therapy or comprehensive behavioral intervention for tick disorders, which we happen to have a specialty trained psychologist in our movement disorders clinic who has the training to work with a child to help identify what the movements are, the specific movements that are causing the distress, that are being witnessed by other children or that are potentially stressful to the child, and then sublimating or changing them to a different movement that is less noticeable. For example, if you have a movement where your whole arm from your shoulder down is flying upward and that's what kids are noticing, then we'll work with the children to potentially change the movement to moving your first finger up and down, and that's enough to relieve the urge of the tick and help you feel better and it's not as noticeable to your peers or the children around you, and therefore reduce the stigma that can be associated with it.
Melanie: It certainly is very tough on children to have these kinds of things and that feeling that you're somehow different. Tell us about the pediatric movement disorders clinic at Boston Medical Center and some of what you're treating there and how you're helping children.
Dr. Mabray: We’re actually very excited about it. We’ve set up a day, Friday morning, where we actually have our neuropsychologists there with us in the clinic able to see patients are necessary. They're coming in so they can get multidisciplinary evaluations during that time for ticks and Tourette’s syndrome. At that point, we’ll give them a diagnosis that tells them we’ll start treatment if necessary from that very first appointment, and then we’ll follow up. We also have additional openings throughout the week for other movement disorders.
Melanie: Wrap it up for us with your best advice and information to help parents that might be afraid their child has an OCD or ADHD or a movement disorder or ticks and something that you can tell them that will give them hope and about the pediatric movement disorders clinic at BMC.
Dr. Mabray: The best advice that I can give parents regarding tick disorders and all the comorbidities and the other illnesses that come along with them is that these are immensely treatable illnesses and what's important is to figure out what are the challenges that your child is having, what are the specific illnesses that they have and look and say how can we improve your child’s life? In many cases, these disorders will be either self-limited or able to be treated to where they are not causing any impact on their life whatsoever. I'm very proud and happy to be honored to take care of these children in order to help make their lives and the lives of their families better, make sure they can focus in school, that they're able to achieve their maximum potential, even with having some of these altered movements or conditions.
Melanie: Thank you so much for being with us. This is Boston MedTalks with Boston Medical Center. For more information on the pediatric movement disorders clinic at Boston Medical Center, you can go to bmc.org. That’s bmc.org. This is Melanie Cole. Thanks so much for listening.