Elimination disorders occur in children who have problems going to the bathroom — both defecating and urinating. Although it is not uncommon for young children to have occasional “accidents,” there may be a problem if this behaviour occurs repeatedly for longer than three months, particularly in children older than 5 years.
There are two types of elimination disorders, encopresis and enuresis:
- Encopresis is the repeated passing of faeces into places other than the toilet, such as in underwear or on the floor. This behaviour may or may not be done on purpose.
- Enuresis is the repeated passing of urine in places other than the toilet. Enuresis that occurs at night, or bed-wetting, is the most common type of elimination disorder. As with encopresis, this behaviour may or may not be done on purpose.
Tic disorders are characterized by the persistent presence of tics, which are abrupt, repetitive involuntary movements and sounds that have been described as caricatures of normal physical acts. The best known of these disorders is Tourette’s disorder, or Tourette’s syndrome.
Tics are sudden, painless, non rhythmic behaviours that are either motor (related to movement) or vocal and that appear out of context — for example, knee bends in science class. They are fairly common in childhood; in the vast majority of cases, they are temporary conditions that resolve on their own. In some children, however, the tics persist over time, becoming more complex and severe.
Tics may be simple (using only a few muscles or simple sounds) or complex (using many muscle groups or full words and sentences). Simple motor tics are brief, meaningless movements like eye blinking, facial grimacing, head jerks or shoulder shrugs. They usually last less than one second. Complex motor tics involve slower, longer, and more purposeful movements like sustained looks, facial gestures, biting, banging, whirling or twisting around, or copropraxia (obscene gestures).
Simple phonic tics are meaningless sounds or noises like throat clearing, coughing, sniffling, barking, or hissing. Complex phonic tics include syllables, words, phrases, and such statements as “Shut up!” or “Now you’ve done it!” The child’s speech may be abnormal, with unusual rhythms, tones, accents or intensities. The echo phenomenon is a tic characterized by the immediate repetition of one’s own or another’s words. Coprolalia is a tic made up of obscene, inappropriate or aggressive words and statements. It occurs in fewer than 10% of people with tic disorders. Motor and vocal tics may be worsened by anxiety, stress, boredom, fatigue, or excitement. Some people have reported that tics are intensified by premenstrual syndrome, additives in food, and stimulants.