Are children with ADHD at higher risk of nose bleeds?
- Sara L
- Apr 26, 2024
- 4 min read
Looking over mom forums there were some questions regarding ADHD children being more at risk for nose bleeds. This was such an interesting question.
It seems that people with ADHD do get nose bleeds more often than their neurotypical friends.
There is surprisingly little research into the relationship between nose bleeds and ADHD, but I did manage to uncover a couple of reasons why children with ADHD might
have more nosebleeds than their neurotypical friends:
Bleeding disorders:
Hemophilia (a rare genetic bleeding disorder which stops blood from clotting properly and so leads to excess bleeding) is sometimes seen in children with ADHD. In fact, boys with hemophilia may be at higher risk for being diagnosed with ADHD¹.
The combination of ADHD and a bleeding disorder is concerning given that inattention, hyperactivity, and risk taking puts children with ADHD at greater risk of injury² ³. Then, if injured, any bleeding disorder makes the consequences worse.
If you're concerned about excess bleeding, it's important to have a discussion with your child’s healthcare provider so that they can fully assess them to rule out causes such as clotting issues or medication side effects. They can run tests to make sure that nothing else is going on that could be causing the bleeding (if your child is indeed not picking their nose.)
Nose picking behaviors:
This is the most likely reason that children with ADHD experience nose bleeds.
The fidgetiness and lack of impulse control of ADHD lends itself to repetitive behaviors. These repetitive behaviors are called Body Focused Repetitive Behaviors and are a form of something called strimming⁴.
These strimming behaviors are no different from the strimming that we commonly see in Autism Spectrum Disorders. In fact neurotypical individuals will also strim. Examples of strimming can include relatively 'normal' behaviors such as tapping feet, twirling hair, tapping fingers, humming, and drawing a repeating pattern.
Other examples of repetitive behaviors seen in ADHD include hair pulling, lip biting, and nail biting. While ADHD does seem to co-occur with skin picking disorders, the skin picking and the the ADHD are different conditions.
Those with ADHD are at risk of developing repetitive behaviors due to poor impulse control, inattention, and the low levels of dopamine in their brain. Low dopamine drives them to carry out tasks that stimulate dopamine release, like picking, to combat boredom and self soothe⁴.
Are these body focused repetitive behaviors the same as OCD?
Body focused repetitive behaviors are a subset of Obsessive Compulsive and Related Disorders. They are not overtly classified as OCD in the traditional sense.
Specifically for nose picking (and nail biting, lip biting, and hair pulling) they are classified as Skin Picking Disorders, which is a type of OCD-related disorder.
Nose picking is different from OCD in that in OCD there are obsessions (recurrent and persistent thoughts that cause distress, which the individual will try to ignore or fix) and compulsions (repetitive behaviors they feel forced to do to address the obsession)⁵.
What's the treatment for nose picking in ADHD?
Using stimulant medications such as amphetamines or methylphenidates to treat ADHD may also reduce the impulsivity of nose picking as it provides the brain with a supply of dopamine and norepinephrine that is otherwise lacking. Stimulants could therefore help curb skin picking behaviors and other body focused repetitive behaviors by addressing the chemical imbalance occurring in ADHD.
Failing that, non-stimulant medications such as Atomoxetine, Clonidine, or Guanfacine could also help, as addressing the ADHD itself could address the associated nose picking behaviors too. There was one case study that showed that treating ADHD with a non-stimulant, Atomoxetine, improved the nose picking behavior and reduced the number of nosebleeds that the child was having⁶.
Non-medication alternatives to stopping nose picking in ADHD
Wrapping a bandage around the tip of the offending finger could serve as a memory device to help the child remember not to pick their nose. The benefit here is that other children will not necessarily know the function of the bandage which should help with any embarrassment associated with the nose picking.
Managing stress with exercise, meditation, adequate sleep, and deep breathing can help curb repetitive behaviors especially if they are associated with stress and anxiety. If the nose picking is associated with boredom, then substituting with a fidget toy could help adjust the behavior to something that isn't causing damage to the nose.
Habit reversal training (HRT) is a good therapy to try. The goal of habit reversal training is not just to stop the unwanted habit but to replace it with a healthier or more productive behavior, thereby improving the individual's overall well-being.
Cognitive Behavioral Therapy (CBT) can be effective in addressing compulsive nose picking by helping children identify and modify the thoughts and emotions that trigger nose picking behavior. Through CBT, children learn strategies to manage their urges and replace maladaptive behaviors with healthier coping mechanisms.
Conclusion
Increased Risk of Nosebleeds in ADHD: Children with ADHD may experience more nosebleeds due to associated bleeding disorders like hemophilia. If a bleeding disorder is suspected (for example, it runs in the family or your child really isn't not picking their nose), follow up with your child's healthcare provider so that they can do any necessary testing.
Nose Picking Behaviors: Repetitive behaviors such as nose picking, common in ADHD, are a form of Body Focused Repetitive Behaviors (BFRBs). These behaviors, which include actions like hair pulling and nail biting, stem from poor impulse control and low dopamine levels that drive activities to increase the amount of dopamine in the brain.
Treatment Options: Addressing nose picking in children with ADHD can involve stimulant medications like amphetamines, which might reduce impulsivity by balancing dopamine and norepinephrine levels. Non-stimulant medications may also help by rebalancing brain chemicals in ADHD.
Behavioral strategies like wrapping a bandage around fingers or using fidget toys could also help.
Behavioral Therapies: Habit reversal training (HRT) and Cognitive Behavioral Therapy (CBT) can be effective in replacing nose picking with healthier behaviors by helping children recognize and manage the triggers associated with their repetitive behaviors.
This site is for general informational purposes only and does not constitute the giving of medical advice. The contents do not constitute the practice of medicine, nursing, or other professional health care services. No provider–patient relationship is formed. Please consult with your child's healthcare provider when considering supplementation for children.
⁵DSM-5-TR; Diagnostic and Statistical manual of Mental Disorders. Fifth Edition. American Psychiatric Association. American Psychiatric Association Publishing.
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