Addressing Behavioral Disorders in Childhood and Adolescence

When a child wets the bed past age five, walks around the house in the middle of the night, or repeatedly blinks or shrugs without any apparent reason, parents often feel confused – and sometimes worried. These behaviors are more common than many realize, and they fall under a group of behavioral disorders that can affect children and adolescents during key stages of their development. Understanding what these conditions are, why they occur, and how they are treated can make a significant difference for both children and the families supporting them.

Sleepwalking (somnambulism): more than just walking in sleep
What triggers sleepwalking?
Managing and treating sleepwalking
Tic disorders: involuntary movements and sounds
Who is affected and when?
Treating tic disorders
Enuresis and encopresis: elimination disorders in childhood
Enuresis: understanding bedwetting
Encopresis: a less discussed but equally important condition
Treatment approaches for elimination disorders
The role of parents and consistent routines

Sleepwalking (somnambulism): more than just walking in sleep

Sleepwalking, formally known as somnambulism, is a sleep disorder in which a child gets up and performs complex behaviors while remaining mostly asleep. It is classified as a parasomnia – a category of sleep disorders involving undesirable physical events during sleep or while transitioning between sleep stages. Beyond simply walking, a sleepwalking child may sit up in bed, rummage through drawers, eat, or even attempt to go outside, all without any awareness or memory of these actions.

Approximately 15% of children between 4 and 12 years of age will experience sleepwalking at some point. It occurs more commonly in boys and tends to run in families. Sleepwalking typically happens during the first or second sleep cycle of the night, during deep non-REM (NREM) sleep. Because the episodes occur in this early stage, children almost never remember them the next morning.

What triggers sleepwalking?

For most children, sleepwalking is not linked to any serious psychological or medical condition. Common triggers include sleep deprivation, stress, fever, and intense emotional problems. When these factors are addressed, episodes often resolve on their own. However, research indicates that in some children, sleepwalking does not simply disappear by adolescence as was once widely assumed – and as children grow older, the physical risks associated with sleepwalking episodes increase.

Managing and treating sleepwalking

In most cases, sleepwalking does not require medical treatment. The primary concern is safety. Parents are advised to secure windows and doors, install stair gates, and avoid placing children in bunk beds. If a child is found sleepwalking, the recommended approach is to gently guide them back to bed without shaking or startling them.

For children who sleepwalk frequently, a behavioral technique called scheduled awakening has proven effective. This involves monitoring the child’s sleepwalking pattern over several nights and then waking them approximately 15 minutes before an episode is expected, helping to reset the sleep cycle. Maintaining a consistent, positive bedtime routine has also been shown to reduce episodes by improving overall sleep quality. When sleepwalking poses a genuine safety risk or is linked to an underlying condition like obstructive sleep apnea, medication such as low-dose benzodiazepines may be considered, but this is reserved for more severe cases.

Tic disorders: involuntary movements and sounds

Tics are another common behavioral concern in childhood. Tics are sudden, quick, repetitive, and involuntary movements or sounds that a child cannot control. They can be motor tics (involving physical movement) or vocal tics (involving sounds). Both types are further divided into simple and complex forms.

Simple motor tics involve a single muscle group – such as eye blinking, nose wrinkling, head jerking, or shoulder shrugging. Complex motor tics involve coordinated patterns across multiple muscle groups, such as hopping, touching objects, or mimicking others’ movements. Simple vocal tics include repetitive sounds like throat clearing, sniffing, grunting, or coughing. Complex vocal tics involve words or phrases, and in rare cases, the uncontrolled use of inappropriate language (coprolalia).

Who is affected and when?

Tics typically first appear between ages 3 and 9, affect up to 1 in 5 school-aged children, and are more common in boys than girls. Tic severity tends to peak around ages 10 to 12, and most tics diminish during adolescence. When both motor and vocal tics persist for more than a year, the condition meets the criteria for Tourette syndrome, the most recognized tic disorder. Tics frequently co-occur with other conditions, including ADHD, OCD, and anxiety disorders.

It is important to note that tics often become more noticeable during periods of stress, fatigue, excitement, or when attention is drawn to them. A child who is anxious about school or experiencing a difficult transition may show a significant increase in tic frequency. This connection between emotional state and tic expression is an important consideration in both counseling and classroom support.

Treating tic disorders

For mild tics that are not interfering with daily life, no treatment is typically needed. When intervention becomes necessary, the first-line non-pharmacological approach is Comprehensive Behavioral Intervention for Tics (CBIT). CBIT was developed in collaboration with the Tourette Association of America and, in its first large-scale trial with children published in 2010, demonstrated it could help people with tic disorders manage tics more effectively without medication.

The core of CBIT involves awareness training – helping the child recognize when a tic is about to happen – followed by competing response (CR) training, where the child practices an alternative behavior that physically conflicts with the tic. For example, a child with a shoulder-raising tic might be taught to press their shoulders firmly downward when they feel the urge to shrug. More than 50% of children who complete a course of CBIT go on to see long-term improvement in tic control. When medication is required, options include alpha-adrenergic agonists and, in more severe cases, antipsychotics – though these are associated with side effects and are reserved for situations where behavioral therapy alone is insufficient.

Enuresis and encopresis: elimination disorders in childhood

Among the most emotionally sensitive behavioral disorders of childhood are the elimination disorders – enuresis and encopresis. These conditions involve the involuntary (or occasionally intentional) release of urine or feces in inappropriate contexts, beyond the age when bladder and bowel control is normally expected.

Enuresis: understanding bedwetting

Enuresis refers to urinating in bed or into clothing in children aged 5 or older – the age at which bladder control is typically established. It is estimated to affect 5 to 10% of 5-year-olds, 3 to 5% of 10-year-olds, and about 1% of 15-year-olds, according to the DSM-5. The condition is classified as primary enuresis when the child has never maintained consistent dryness, and secondary enuresis when wetting resumes after at least one year of continence – often triggered by significant stress such as divorce, bereavement, or trauma.

The causes of enuresis are typically multifactorial, involving an imbalance between bladder capacity and nighttime urine production, combined with difficulty waking when the bladder is full. There is also a strong genetic component – a positive family history is frequently noted. Emotionally, the condition can be deeply distressing: children with enuresis commonly experience shame, embarrassment, and social withdrawal, and may be reluctant to attend sleepovers or camps. The International Children’s Continence Society reports that 20 to 30% of children with enuresis have at least one co-occurring mental health condition – roughly twice the rate found in non-wetting peers.

Encopresis: a less discussed but equally important condition

Encopresis refers to repeated, involuntary defecation in places not designated for that purpose in children aged 4 or older. It affects approximately 1.5 to 3% of 7- to 8-year-old schoolchildren, with boys twice as commonly affected as girls. In the majority of cases (around 80%), encopresis is linked to chronic constipation and stool withholding, which eventually leads to overflow incontinence. A thorough assessment is essential to rule out physical causes before any psychological intervention is initiated.

Treatment approaches for elimination disorders

Both enuresis and encopresis respond well to structured, behavioral interventions. For enuresis, the most evidence-backed first-line treatment is the bedwetting alarm. Multiple studies have demonstrated the superiority of moisture-detecting alarms over medication in terms of cure rates, low relapse, and absence of side effects. The alarm trains the child to wake when urination begins, gradually conditioning the bladder. When non-pharmacological options are unsuccessful, medications such as desmopressin or imipramine may be prescribed, typically for children aged 7 or older.

For encopresis, treatment usually begins by addressing the physical component: if constipation is present, it is treated first with fecal disimpaction, stool softeners, and dietary changes, followed by behavioral training using operant conditioning such as rewarded, scheduled toilet visits.

The role of parents and consistent routines

Across all three of these conditions – sleepwalking, tics, and elimination disorders – a consistent theme emerges: parental involvement and routine are central to effective management. Children thrive when their environment feels predictable and safe. A regular sleep schedule reduces the likelihood of sleepwalking episodes. A calm, non-punitive response to bedwetting prevents children from developing shame or anxiety around the condition. Clear expectations, gentle reinforcement, and close communication with teachers and healthcare providers all contribute to better outcomes.

It is equally important that parents avoid reacting with frustration or embarrassment, as this can significantly worsen a child’s distress. Maintaining a warm and supportive attitude is considered a foundational part of the management of bedwetting. The same applies to tics – drawing repeated attention to a child’s tic or asking them to stop can make episodes more frequent. Educating family members, caregivers, and school staff about the involuntary nature of tics helps create a supportive environment where the child is less likely to feel singled out.

Many of these disorders improve naturally with time and maturation. However, when they persist, cause distress, or impair functioning at school or home, a structured behavioral intervention – delivered by a trained counselor or psychologist, with active family participation – offers the most reliable path to improvement.

What do you think? If a child you knew was dealing with one of these behavioral disorders, how would you approach the conversation with them about it – and how much do you think the attitudes of adults around them influence their recovery? Is there enough awareness among parents and educators about how common and treatable these conditions are?

References

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Table of Contents

Sleepwalking (somnambulism): more than just walking in sleep 🔗

What triggers sleepwalking? 🔗

Managing and treating sleepwalking 🔗

Tic disorders: involuntary movements and sounds 🔗

Who is affected and when? 🔗

Treating tic disorders 🔗

Enuresis and encopresis: elimination disorders in childhood 🔗

Enuresis: understanding bedwetting 🔗

Encopresis: a less discussed but equally important condition 🔗

Treatment approaches for elimination disorders 🔗

The role of parents and consistent routines 🔗