|Year : 2016 | Volume
| Issue : 1 | Page : 48-50
Gratification behavior in a young child: Course and management
Aditya Anand Pandurangi1, Swapna Aditya Pandurangi1, Sameer Belvi Mangalwedhe2, Mahesh Mahadevaiah1
1 Department of Psychiatry, Dharwad Institute of Mental Health and Neurosciences, Dharwad, India
2 Department of Psychiatry, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
|Date of Web Publication||2-Feb-2016|
Aditya Anand Pandurangi
Department of Psychiatry, Dharwad Institute of Mental Health and Neurosciences, PB Road, Dharwad - 580 008, Karnataka
Source of Support: None, Conflict of Interest: None
Masturbation (gratification behavior) is rarely seen in young children. It occurs in children between the age of 3 months and 3 years with a second peak incidence at about the adolescent age. A 26-month-old child presented to us with gratification behavior. On evaluation, she did not have any physical illness mimicking gratification behavior. The parents were counseled, and 6 sessions of behavior therapy were carried out. Gratification behavior in young children is not pathological. Waxing and waning of the symptoms may be present.
Keywords: Behavioral, gratification behavior, gratification disorder, infantile masturbation, techniques
|How to cite this article:|
Pandurangi AA, Pandurangi SA, Mangalwedhe SB, Mahadevaiah M. Gratification behavior in a young child: Course and management. J Sci Soc 2016;43:48-50
|How to cite this URL:|
Pandurangi AA, Pandurangi SA, Mangalwedhe SB, Mahadevaiah M. Gratification behavior in a young child: Course and management. J Sci Soc [serial online] 2016 [cited 2017 Mar 25];43:48-50. Available from: http://www.jscisociety.com/text.asp?2016/43/1/48/175464
| Introduction|| |
Masturbation (gratification behavior) is a common and normal behavior. It occurs in 90-94% of males and 50-60% of females at some point in their lives. Gratification behavior in excess leading to discomfort and disability (gratification disorder) is rarely seen in young children. Gratification disorder occurs in children between the age of 3 months and 3 years with a second peak incidence at about the adolescent age.  Gratification disorder also known as "benign idiopathic infantile dyskinesia" or "infantile masturbation" is a form of masturbatory behavior that is often mistaken for epilepsy, abdominal pain, paroxysmal dystonia, or dyskinesia. 
Though the concept of childhood masturbation was recognized as early as 1909,  there is limited literature regarding the treatment methods and long-term follow-up of children with masturbatory behavior. We present this case of gratification disorder treated with behavioral therapy over a period of 18 months.
| Case report|| |
A girl child aged 26 months presented with a history of odd movements of the body since six months which occurred in episodes lasting 5-10 min. The episodes were characterized by lying in the prone position, placing the hands on the genitals with to and fro rubbing over them. All the episodes were similar in nature and had an abrupt onset.
Frequency of episodes increased from 1/day to 3-4 episodes/day.
There was no diurnal variation. She would also produce a typical sound during the entire episode. At the peak of the episodes, she would have flushing of the face and sweating followed by termination of the episode. It was possible to terminate the episode by distracting her by making a loud sound or by physically holding her during the episode. All the episodes occurred in clear consciousness during the day time, never in the sleep and irrespective of the presence of others. After each episode, she appeared tired for about 5 or 10 min. In between the episodes, during normal play, family members observed her fondle with her genitalia more often than that was observed earlier to the start of this problem. Before index visit to the psychiatrist, the child was evaluated by a pediatrician and dermatologist who opined no other morbidity. There was no history of similar complaints in the past or in the family. Physical examination revealed no excoriation marks on the genitalia. Personal history was unremarkable other than that she was born of a precious pregnancy to her parents 10 years after their marriage. She was a full-term child and the birth, and early developmental history were uneventful. She was brought to us in view of social stigma associated with this behavior. General physical examination and systemic examination were noncontributory. She was conscious, alert and had age appropriate play. Two electroencephalograms (EEG) were recorded at different times did not reveal any epileptiform discharges.
The parents were counseled regarding the benign nature of child's behavior. Six sessions of behavior therapy was carried out during which they were taught positive and negative reinforcement techniques and later followed up regularly for next 1½ years. Gradually the episodes reduced and completely stopped at the end of 4 months. The parents stopped following the behavioral technics after the episodes stopped completely. There was a relapse of episodes after a year without any apparent precipitating cause. Again two booster sessions of behavior therapy were done, and significant improvement in the behavior was noticed.
| Discussion|| |
Similar physiological changes that occur during masturbation in adults are also noticed in children. In infants and toddlers, this behavior can be difficult to recognize because of the absence of genital manipulation and atypical manifestations of this behavior.  In a study of normal sexual behavior in children, sexual behavior that appeared most frequently included self-stimulating behavior and peaked at 5 years of age for both boys and girls, dropping off over the next 7 years. 
This behavior is commonly misdiagnosed as seizures, paroxysmal nonepileptic movement disorder or abdominal colic requiring detailed physical and neurological evaluation such as magnetic resonance imaging, EEG, intravenous pyelography, small bowel biopsy, and gastrointestinal barium swallow. ,
The distinction between masturbatory behavior and seizures can be difficult. Children with masturbatory behavior can appear to have altered consciousness with a glassy-eyed, fixed gaze. However, a key feature of masturbatory behavior is that it is volitional and can cease with distraction. Children will often appear annoyed if they are interrupted. In addition, torsional postures and rocking are uncommon in seizures. 
The exact mechanism of infantile masturbation is poorly understood, but has been associated with self-tension, boredom, excitement, genital infection, and lack of stimulation. 
Treatment usually involves counseling and educating the parents that though it is called "disorder" it is normal behavior in children and that they will often outgrow it. Scolding or punishment could lead to low self-esteem, and that children may benefit when talked gently to them regarding the need to avoid such behavior especially in public places and then subsequently even in privacy. Attempts should also be made to engage the child in other play activities that could redirect their attention from masturbatory activities. 
In our case study, reassuring the parents and behavior therapy helped in stopping the masturbatory behavior completely. But the re-emergence of such episodes suggests that such children need regular follow-up and continuation of behavioral management.
| Conclusion|| |
Gratification behavior can be seen in young children, and it is not pathological. Reassuring the parents and following regular behavior techniques by parents help in reducing the masturbatory behavior. Waxing and waning of the symptoms may be present.
We sincerely thank the child and her parents for their cooperation during the study and their consent for publication of this article without whom this study could not be possible.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Leung AK, Robson WL. Childhood masturbation. Clin Pediatr (Phila) 1993;32:238-41.
Nechay A, Ross LM, Stephenson JB, O′Regan M. Gratification disorder ("infantile masturbation"): A review. Arch Dis Child 2004;89:225-6.
Masters WH, Johnson VE. Human Sexual Response. 1 st
ed. Boston, MA: Little, Brown and Company; 1966.
Friedrich WN, Fisher J, Broughton D, Houston M, Shafran CR. Normative sexual behavior in children: A contemporary sample. Pediatrics 1998;101:E9.
Bower B. Fits and other frightening or funny turns in young children. Practitioner 1981;225:297-304.
Livingston S, Berman W, Pauli LL. Masturbation simulating epilepsy. Clin Pediatr (Phila) 1975;14:232-4.
Ibrahim A, Raymond B. Gratification disorder mimicking childhood epilepsy in an 18-month-old Nigerian girl: A case report and review of the literature. Indian J Psychol Med 2013;35:417-9.