James Greenblatt, MD
James Greenblatt, MD, founder and medical director, Comprehensive Psychiatric Resources, Inc., Waltham, Massachusetts, and author of Finally Focused. JamesGreenblattMD.com
Whenever my granddaughter visits, I notice that she tends to continuously tap each of her fingers, in order, over and over. She’s eight years old. Is this just a sign of nervousness, or is something else going on?
Constant, compulsive movements in children, such as finger-tapping or jiggling a foot, can be just habits…or a sign that something else is going on, such as attention-deficit/hyperactivity disorder (ADHD) or an anxiety issue. Whether the finger-tapping happens fairly regularly or only under stressful conditions can offer clues as to what is going on. Constant physical movement is a form of hyperactivity and is one of the hallmark symptoms of ADHD, a common childhood neuropsychiatric disorder. Genetics as well as chemical and structural factors in the brain contribute to the condition, which is characterized by problems with executive functioning skills—such as attention, concentration, memory, motivation, effort, organization—as well as hyperactivity and poor social skills and impulse control. Typically, children with ADHD have some combination of these symptoms in varying levels of severity. And while ADHD can be very trying to deal with and can stretch parental patience to the breaking point, it is not willful bad behavior. Behavioral management therapy to teach skills for how to stay organized and avoid distractions can help with ADHD. Some studies have found that nutritional supplements, including magnesium, vitamin B-6 and fish oil, are effective at reducing some symptoms. (Children should not take supplements without proper medical supervision, however.) And treatment of ADHD often includes drugs that increase the brain chemical dopamine. ADHD can be hard to distinguish from obsessive-compulsive disorder (OCD), another common neuropsychiatric condition that affects children. Both ADHD and OCD share some of the same symptoms. A professional evaluation is necessary to determine whether someone is suffering from one disorder or the other—or both. If, on the other hand, you notice that your granddaughter’s repetitive finger-tapping happens only at certain times, it’s more likely to be a sign of anxiety. In that case, you might want to suggest to her parents that they explore this possibility with a mental health professional. Especially effective for dealing with anxiety disorders is cognitive behavioral therapy, which doesn't require drugs and can give children effective tools for taming distressing feelings. Bottom line: In and of itself, compulsive finger-tapping is more bothersome for others than for the person doing it. But if there also are other issues—performing poorly at school, social isolation or signs of chronic emotional distress, for instance—it’s a good idea to seek further help.
