BEHAVIOR:
ASK THE EXPERTS

DOES INTERACTIVE METRONOME TRAINING HELP ADHD?

Q A teenager in my practice was recently given a diagnosis of attention deficit hyperactivity disorder (ADHD). In addition to the medications I prescribed, the child's optometrist has suggested using interactive metronome training—clapping or tapping the foot to the beat of a metronome—to help with behavioral modification. I would be interested in your opinion as to whether this type of therapy is useful for treating ADHD.

Nivedita More, MD
Rancho Santa Margarita, Calif.

A Parents often ask us about interactive metronome training. The pediatric ophthalmologists at our institution do not believe it is a useful practice, so we do not recommend it.

Although a few studies conducted with a small number of participants showed promising improvements in focus and attention span after using the technique, experts found the sampling in the studies too limited to be of much value. The research with which I am familiar indicates that there is no harm in using interactive metronome training for a youngster with ADHD but that there also is no proof that it is an effective treatment. More research remains to be done, but for now we don't recommend using interactive metronome training for ADHD—either with or without, prescribed medication.

Morris Green, MD

DR. GREEN is Perry W. Lesh Professor of Pediatrics, Indiana University School of Medicine, Indianapolis, and a member of the Contemporary Pediatrics Editorial Board.

NAIL BITING IN A TODDLER: CAN IT BE STRESS?

Q What advice can I give a parent concerned about her 2-year-old son's fingernail-biting habit? She reports that he bites his nails most often when he is watching videos or after being reprimanded. Other than having to adjust to the birth of a new baby sister, the boy is growing and developing well.

Kyung Murphy, MD
Gloucester, Va.

A Children cope with stressful situations in a variety of ways—as do adults. Habits such as biting fingernails, sucking the digits or the thumb, licking the lips, or repeatedly twirling a lock of hair are common behaviors in children. Nail biting typically begins after the fourth year, but its occurrence in a 2-year-old is not completely out of the normal range for the behavior.

Recommend that the parents review their son's daily routine and evaluate recent events in his life (including the birth of his sister) to see if there might be a specific reason for their son to feel unduly anxious. Also suggest the parents spend more one-on-one time with their son—playing, taking a walk, reading a story, for example, would add to his security, and be a pleasant diversion.

Many children who bite their nails, however, show no other signs of insecurity. Nail biting is simply an activity they fall into when they are bored or frustrated. Keeping the boy's nails well-trimmed and smooth is one practical measure that his parents can take to decrease the nail biting.

Habit interruption is another useful aid for changing a child's behavior. The idea is to add minor inconveniences to an established habit, which helps extinguish it. For example, when the parents see the boy start to bite his nails, they should tell him to wiggle his fingers for 30 seconds before he is allowed to begin nibbling. An interruption such as this helps the child become more aware of his habit and makes it more cumbersome—both of which discourage the behavior.

Marilyn Augustyn, MD

DR. AUGUSTYN is assistant professor and director of training, division of developmental and behavioral pediatrics, Boston Medical Center.

 

Behavior: Ask the experts. Contemporary Pediatrics August 2004;21:15.