This post by Johanna Ryan touches on the problems of compulsive gambling and other compulsive behaviors that are linked to Abilify, SSRIs and Dopamine Agonists and also to Dopamine Agonist Withdrawal Syndrome (DAWS).
It was Lester Grinspoon’s 1975 book The Speed Culture that introduced me to the concept of “punding”: a drug-induced compulsion for repetitive, sometimes elaborate but essentially useless busywork. I read it, and something clicked: “Punding” explained an awful lot about my own behavior and that of other Adderall users in 2015.
The word was coined by a Swedish forensic psychologist, G. Rylander, who studied chronic IV amphetamine abusers. Here’s one account of punding behaviors among “speed freaks” in the 1960’s, which often centered on taking apart and re-assembling objects:
Watches, doorknobs, television sets, radios and phonographs, typewriters and children’s toys were among the common items of curiosity and analysis. Some were valueless … Many were quite expensive; one man dismantled a $1,200 hi-fi set. Another sorted, filed and put on display repainted electronic parts. This same man tiled his apartment, including the walls, in Armstrong vinyl pebble tiling, then painted the individual pebbles red, yellow, gold and black.
The Speed Culture, pp. 103-04. Punders usually seemed to enjoy their projects, but often were unable to stop even when they became unrewarding or counter-productive. Rylander described a burglar who began punding in the middle of a job and persisted, despite “an increasing fear that someone would discover him.” These human compulsions dovetailed with the “stereotypic” repetitive behaviors he noted in lab animals given amphetamines.
All this sounded a bit too familiar. I’d picked up The Speed Culture as part of my attempt to give up Adderall, the amphetamine I’d been prescribed as an “adjunct” when antidepressants failed or stopped working. In the process, I’d discovered an online community of recovering Adderall addicts at www.quittingadderall.com, about evenly divided between black-market “abusers” and people with doctor’s prescriptions for the stuff. Compulsive behaviors were a problem for many of them as well. A few of these – collecting, cleaning, scrapbooking – sounded just like the punding of Sixties speed addicts.
But by far the Top Two compulsions discussed on QA were excessive Internet use, and compulsive shopping. Were these the 21st century forms of punding? I’d found myself wasting plenty of hours on both: compulsive bargain-hunting that could at best save only trivial amounts of money, endless Googling of sometimes random topics that caught my attention. These “projects” seemed fun or practical at first, but quickly became like irritating and embarrassing itches it was impossible not to scratch. The link to Adderall was hard to deny, once it was pointed out.
If my own Web-surfing amounted to borderline punding, others in QA had been real master punders. Most were younger “digital natives,” totally at home with Facebook, online communities and Internet shopping. Some were also into complex gaming or virtual worlds such as Second Life. The opportunities to descend into punding seemed endless.
Many of these people worked in IT or in other jobs that required long hours on the computer. The Adderall-induced personality traits they disliked in themselves – indifference and impatience with people, compulsive fascination with tasks and things – were not always liabilities on the job. They could even be assets. Web-surfing and shopping (two closely related activities tightly integrated into American life) could be hiding a world of drug-induced punding among stimulant users, but the same could apply to long work hours and “getting ahead,” I realized.
So I started a new punding-project: searching the medical literature on punding. I found very little on amphetamines, most of it focused on methamphetamine addicts. However, the problem has really “come out of the closet” recently thanks to a new class of drugs called dopamine agonists, which stimulate the dopamine system even more powerfully than amphetamines. They’re mainly used to treat Parkinson’s Disease, which (unlike ADHD or depression) is clearly linked to a shortage of dopamine in the brain. These drugs have also been prescribed to treat Restless Legs Syndrome.
The drugs (Mirapex or pramipexole, Requip or ropinirole and others) first raised alarms for their ability to trigger two obviously dangerous compulsions: addictive gambling and compulsive sexual behavior or “hypersexuality.” As these were acknowledged and studied, other problem behaviors came into view: binge eating, compulsive shopping and a wide range of punding activities or “hobbyism.” There were studies and case reports from the US, UK, Ireland, Italy, France, Japan, Korea, Turkey and several other countries. I had no trouble finding references to compulsive computer use as a form of punding. Endless web-surfing was mentioned, along with compulsive production of spreadsheets and charts.
Punding, it seems, can take many forms. Often it’s a longtime hobby or occupation that escalates into a disruptive compulsion, making it hard to spot at first. The carpenter tinkers endlessly in his basement shop; the weekend card player spends hours playing solitaire or online games; the person who once simply kept a nice clean house now obsessively scrubs and organizes closets. And for those who spend a large part of their day online, Web searches and social media can also spin out of control. (Gambling and hypersexuality could also be indulged awfully easily online.)
Then I checked Twitter, and uncovered the Punding Motherlode. Here are just a few of the confessions I found posted under the hashtag #AdderallProblems:
These odd behaviors were a college in-joke for some, a genuine problem for others … but they were eerily similar to the “punding behaviors” of Parkinson’s patients on dopamine agonists. They appeared alongside Tweets about other Adderall and Vyvanse problems like tooth-grinding, heavy sweating, cigarette cravings, loss of appetite and insomnia. They seem to equally affect students “abusing” stimulants to cram for exams, and those “using” them as approved treatments for ADHD.
Young adults on Twitter clearly know a lot about the downsides of prescription stimulants, even if their doctors don’t. It’s little wonder QuittingAdderall.com now has several thousand registered users.
Why does punding matter? First, it can cause dysfunction and distress all by itself. It can waste enormous amounts of time, cause shame and embarrassment in the sufferer and interfere with work, sleep and personal relationships. If the cause is not understood, it may be seen as a character flaw for which punders blame themselves and are blamed by others.
It may also hold important clues to the problem of addiction and withdrawal. A problem called DAWS – Dopamine Agonist Withdrawal Syndrome – afflicts some of those who try to stop the drugs, plunging them into agonizing depression and causing a range of physical and cognitive problems. DAWS sufferers have a lot in common with amphetamine addicts, and some Parkinson’s researchers have compared DAWS to methamphetamine and cocaine withdrawal.
Since DAWS does not strike everyone, several studies have tried to determine who is most at risk. They have found a strong link between developing “impulse control disorders” (ICD’s) like punding, gambling or compulsive shopping while on these drugs, and developing DAWS symptoms on stopping them. In one study of patients who stopped dopamine agonists, 100% of the DAWS sufferers listed ICD’s as their reason for stopping, compared to just 41% of patients in general. Another study found strong correlations among DAWS, overuse of dopaminergic medication and ICD’s, especially punding.
Could this link between punding and addiction exist in Adderall and Vyvanse users as well? Certainly not all users get hooked. Many who use (or abuse) these drugs in college put them away when they leave school without much trouble. Others struggle with their addiction for years. Are Adderall users who get riveted to the computer, color-code their study notes and organize their closets at 2 am more likely to suffer from withdrawal symptoms when they try to quit?
If so, spotting punding and other ICD’s early might be very important, perhaps serving as a signal that the individual should taper off the drug as soon as possible. (One study linked punding not only to gaps in “executive function” but to thinning of the cerebral cortex. It’s possible, though far from proven, that we should regard punding as a marker for more serious damage.) Patients could be educated to recognize punding behaviors (as well as more shocking ICD’s like gambling or hypersexuality) as adverse drug reactions rather than personal flaws or quirks, and discuss them with their doctors.
The final reason to take punding seriously is the clues it could give us to a wide range of mood and behavioral problems. Take, for example, the recent popular fascination with Asperger’s Syndrome. Why do psychiatrists report increasing numbers of seemingly well-adjusted people seeking treatment for self-diagnosed Asperger’s – while other self-identified “Aspies” band together seeking acceptance? Why does it have such currency as a pop-psych diagnosis for difficult people (males especially) in our daily lives, while still being a rather “cool” problem to have?
The “Aspie” or “geek” traits most people find irritating – indifference or cluelessness as to others’ feelings, preoccupation with the technical details of one’s work or favorite pastime, rigid habits and obsessive leisure interests – overlap heavily both with punding and with the “Adderall personalities” our QA friends grew to hate and are trying to shed. In other words, stimulant-induced traits and behaviors. I’d like to know how many people who are diagnosed with Asperger’s syndrome in adulthood, or who identify with the disorder on hearing about it, have a history of stimulant use.
These traits aren’t limited to a geeky few. They’re found among society’s in-crowds as well as the folks we pigeonhole with pop-psych labels. Stimulants like Ritalin and Adderall aren’t the only drugs that can cause them. The “emotional blunting” piece of this puzzle—social withdrawal and reduced ability to care about others— is a common feature of SSRI anti-depressants. And while those drugs have been used to treat compulsive behaviors in some people (ranging from habits like skin-picking and hair-pulling to compulsive shopping and binge eating), they also have a pretty fair track record for causing them.
Of course, there are many pressures in the economy, workplace and culture that promote “Adderall” or “Aspie” traits and punding behaviors. It can’t possibly be just a drug-induced problem; some blame digital technology itself. But the drug component may be large enough to both magnify the numbers, and influence our attitudes towards the behavior. Learning to recognize punding-style compulsions, and their links to various drugs, might help many people who feel trapped in a depressing lifestyle without quite knowing why to name their problem and find a way out.
Hopefully it would not pathologize a whole new crop of people for their chosen pastimes or personalities. Still, de-normalizing and de-glamorizing some of these behaviors a bit might help us all. More than a few QA members will tell you they used Adderall to improve their performance on a job that required endless, exhausting screen-time … and now their efforts to kick the habit are making work a struggle again. “You cannot DO my job without Adderall,” they moan—and fellow “Adderallics” reassure them that “it’s OK to suck at work for awhile.” If our economic system is generating jobs that seem to cry out for Adderall (or Vicodin or Xanax, for that matter), maybe it’s the system that has a problem, not us.
Johanna, thanks for another thought-provoking article. As I read, I kept thinking along the lines of ‘autism’ – and then came to your section on Asperger’s Syndrome. Very interesting. However, I would suggest that the traits are very similar to those seen across the whole of the autistic spectrum, not singly in Asperger’s.
Having worked with children with Specific Learning Difficulties ( dyslexia etc.), ADHD
or autism, the majority of whom had not been on any sort of medication, I would suggest that the link is elsewhere. Maybe linked to pre-birth exposure to certain stimulants or toxic substances? If so, there lies the link. If there is no link to be found, is it possible that Adderall etc. CAUSE the brain to take on the features of the autistic brain in some way?
Children who have these compulsive behaviours often take comfort from them – they give them a pattern of behaviours which become automatic, doing away with the need to ‘think’ in the usual way about occupying their time. It even does away with the ability to conform to rules etc. – maybe making life easier in some instances?
To onlookers, it feels as if their compulsions are restrictive – but to the child, they are comforting. Could this be true of adults too? (I do not mean to say that anyone – child or adult – CHOOSES to become compulsive but rather that the compulsive behaviour starts off as a comforter in some way before developing into anything more serious). I’ve yet to come across a child who is irritated by their compulsive behaviour – the ‘irritation’ is an adult trying to distract them from its grip!
I’m afraid that I still firmly believe that the MMR vaccine is responsible for many cases of autism. I also firmly believe that Foetal Alcohol Syndrome is linked to very many cases of autistic spectrum disorder. If these two facts are true then it is much easier to accept that Adderall etc. can produce similar features in adults as well as children. Of course, we live in an age of denial – therefore we’ll probably never know where exactly the link is. Instead, we’ll just keep feeding with the pills and forget all about the causes. Pills sales create wealth, cures don’t.
Some good points here! I tend to think adult compulsive behavior – especially when drug-induced – is only superficially similar to the behavior of autistic children. “Punding” and related compulsions can be enjoyable or interesting in some cases, and sufferers often feel anxious when they’re interrupted. Yet the activities themselves are sometimes anxiety-producing and often devoid of pleasure. It’s possible to be fully engaged in them while asking yourself, Why on earth am I doing this? Why? I was intrigued with that 1960’s tale of the burglar who could not stop his punding despite his conscious mind telling him, “for chrissake get out of here before someone discovers you!”
The accounts of “Internet punding” due to dopamine agonists had a very similar feel: “The patient had the feeling he was forced into a disruptive and unproductive behavior, and he made several attempts to quit without succeeding,” one author wrote. Another wrote that compared to other patients, the Internet punders “described significantly more effort to resist Internet use (p = 0.0002), thoughts about Internet use (p < 0.0001) and its interference with their life functioning (p = 0.0025).” There’s anxiety involved in giving in, and even greater anxiety involved in resisting. My own experiences match this fairly well.
It’s also possible for the same basic behavior pattern to be caused by very different factors in different people. Hoarding is another compulsion (fairly similar to punding) that has been clearly tied to dopamine-stimulating drugs. Yet it can also be pretty persuasively linked to emotional and financial anxieties, grief, isolation (and in some cases dementia) in older adults especially, who are not on any stimulant drug.
This is Peter Hitchens’s Mail on Sunday column
Now we’re addicted to stupidity
Can nobody think any more? The word ‘addiction’ is plainly meaningless, as supposed ‘addicts’ so often give up the things they are said to be enslaved by, using willpower.
And it is surely obvious that when someone says he is a ‘gambling addict’, there is no possible chemical or biological explanation for his behaviour. He’s just looking for an excuse for his selfishness and greed. So what ninny decided it was a good use of our money to prescribe such people a pill – Naltrexone – which is normally given to drug abusers and heavy drinkers?
People who do bad things are not ill, and should not be treated.
They are wicked and should be punished.
Someday, we shall all gather together and discuss our stories and experiences. Eventually, we shall all reach a stage in our life, when we will all come to some form of an agreement, that many medicines have impacted people’s minds, behaviours and ruined people’s lives.
In 2012, determined parents, Maurizio and Antonella Bocca, have proved to medical professionals as well as the legal fraternity, that the MMR jab induced autism in their 9 month old son.
At 9 months old, Valentino Bocca was ‘bright as a button’.
The parents claim that their son was never the same after the jab in his arm
He developed autism.
In a provincial Italian court, there was a landmark judgement. The judge has ruled that Valentino’s devastating disability was provoked by the inoculation against measles, mumps and rubella (MMR).
With time, our voices will also be heard.
Antidepressants and other dangerous medicines will also go through the vigorous law courts.
Like I said in my previous accounts, these poisons remain ‘lodged in some part of the brain’ and damage parts of the brain that were once functioning ‘normal’.
I can associate with the residual symptoms of ‘punding’. The devil comes in many forms and once the ‘horns’ are out, this ugly side can be a nightmare to live with.
Before I ingested valium, I had no:
-cognitive impairment (lots of mental gymnastics- very frustrating indeed)
– picking disorder
– compulsive shopping disorder
– when putting clothes on the line there has to be a sequential colour code of pegs on the line
– colour order. Placing the pinks with pinks, white with whites, blues with blue in a particular order in my wardrobe.
If anyone was to look in my wardrobe they would say that something very ‘odd’ is going on right here.
– then there is the straightening of items in one perfect line. This is really incredibly frustrating.
-other obsessions that were never part of my persona (incredibly annoying!)
I can understand children who have developmental delays and disorders. If they were born or had these disorders induced from a young age, of course they would not know any better,
The point I am trying to make is that they should not have these problems in the first place.
We should all come out into this world, without being tampered.
Unfortunately, so many things are out of control. When the brain is impacted, there is no turning back- the damage is done.
Before I ingested valium, I use to be relatively carefree and trusting.
I wonder if all the jabs I had in my youth impacted my learning.
I survived and got through the educational system the best way I could.
What I am trying to say is that these ‘poisons’ do alter the brains ‘normal’ function and if I could wave a magic wand and get rid of all these ridiculous compulsions, I have today, I would do it in a heartbeat.
It is frustrating, awkward, embarrassing and a totally ‘dysfunctional’ way of living.
Peter Hitchens, needs to comprehend that many do not like these disorders they have developed.
How many times have I exercised will power only to find that one bad memory or stress can ‘trigger’ or make these compulsions worse.
I am sure that many positive experiences will ‘lighten’ up these OCD.
The slip of the tongue can be very persuasive especially, if the individual concerned has not experienced a life threatening situation or have to deal with health issues, which were never once part of my life.
Talking nonsense comes easy for some but walking a mile in another person’s shoes takes a lot of compassion and empathy.
Oh dear! Johanna, I reckon Peter Hitchen needs a copy of your posts of these last two weeks slapped in his ‘in tray’ pronto!
Annie – well, well, he was doing so well too wasn’t he; we liked his comments regarding Restoring Study 329 if I recall correctly?
Guess we’d all agree that to extend the use of these drugs, like an elastic band, to take in more and more conditions is not acceptable BUT to call people with such real problems ‘wicked’ is absolutely disgusting. They should be punished – punished? I thought ‘punishment’ came as a result of a ‘crime’? didn’t know gambling was a crime as such!
Ah well, I suppose it was too much to expect the leopard to change its spots and become a cuddly pussycat.
Innocent people are being punished for ingesting these ‘poisonous’ drugs. The ones who are ‘evil’ are those sneaky, cunning, sly and greedy vultures who don’t CARE about what happens to peoples lives. The tobacco, alcohol and drug industry are profiting from the vulnerable and creating mass delinquency on a very large scale. They are the ‘ones’ who should be held accountable not the innocent man trying to do the right thing.
One thing I should have made clearer: I think those who diagnose themselves with Asperger’s in adulthood, or seek a doctor’s diagnosis, are usually mistaken. Drug-induced compulsive behavior or lack of sociability/interest in others could be one reason they feel the way they do. It would be easy to read a few news articles on Asperger’s, take a “quiz”, and think this might be your problem. The behaviors might also look similar enough from the outside to tempt coworkers and friends to casually label you as “Aspie.”
It’s unlikely that long-term stimulant use actually “causes Asperger’s” or any other form of autism. That’s a whole different condition, usually apparent from an early age, which feels entirely natural to the people who have it even if others are disturbed or annoyed. As Mary pointed out, repetitive behaviors in autistic kids are often a response to anxiety, and give them some relief. By contrast, I think most people with drug-induced personality and behavioral changes are NOT happy with their lives, even if they don’t always spot the source of the problem.
As for Peter Hitchens … yeah, I think knee-jerk Tory conservatism is getting in the way of common sense there. Some “bad behaviors” are conscious choices, and others are anything but … then there’s a vast interesting gray area in between.
Too true Johanna, that it’s so easy to read a few articles and find yourself with Asperger or any of many other conditions – all in the name of selling you some ‘wonder potion’ such as Adderall. From everything you say, it does sound as if these drug-induced personality/behavioural changes are mimicking the true Asperger or autism range in some way doesn’t it? It has to be said that most, if not all, of us can at times find ourselves using compulsive, repetitive behaviours. Have me sitting in a waiting room and I will soon be scouring the room for things to count – be it the number of blooms in the floral arrangement or adding the telephone numbers listed on a wallchart. I don’t find myself doing the same elsewhere but, in that situation, it is both compulsive and repetitive which, I suppose means that becoming compulsive is natural in humans; it only becomes problematic once the ‘short spurts’ become profound and totally out of control, causing real concerns for all concerned.
Drug induced Asperger’s can occur.
Many professionals would not want to categorize ‘drug induced autism’ as a condition because then it would ‘open up’ a new can of worms.
I agree that anxiety may be one of the patients conditions however, I also believe Johanna, that certain drugs can impact the neural pathways, which induce Asperger type conditions. There are many shades of Asperger’s. We can never say never because it can happen, just like Valentino Bocca.
Some unusual behaviours are not always ‘bad choices’- I don’t agree with this assumption.
There could be so many underlying issues that have been overlooked.
We have to ask ourselves this very important question:
1) “Why is Asperger’s induced when some children are given the MMR inoculation?”
2) Certain types of Asperger’s can also be induced in certain adults.I wonder whether some medications are capable of inducing certain Asperger type conditions in certain individuals. Certain drugs have the capability of damaging certain areas of the brain and gut lining. We have to keep this in mind, also.
Just talk to people who have certain traits or characteristics of Asperger’s. You might be surprised by what you may learn.
It is all too easy for some professionals to categorize ones condition as anxiety.
If a patient c/o heart irregularities, is it also considered some form of anxiety? Sometimes, this may be the case however, we can not generalize someone condition, as it may be life threatening.
Some medicines create abnormal heart rhythms and I understand that many professionals tend to dismiss that a drug can induce so many abnormalities.
It can’t always be in the patients mind.
I wonder what forms of assessments professionals use to differentiate between anxiety and drug induced autism?
I personally believe that vaccinations and certain types of medicines induce many forms of ‘irrational type behaviours’ from the autistic spectrum disorder groups.
Try to put things into perspective and try to understand that these class of drugs damage and impair the brain.
It is so easy for many professionals to dismiss the underlying cause and just classify ones unusual behaviours as anxiety, sign of boredom or bad choices.
Carla, it seems to me that many professionals go for the safe option without digging into any depth regarding possible drug-impaired traits. Autism in childhood is diagnosed purely by assessment. Parental assessment, school-based assessment, familial assessment, pre-school assessment; in-class observations , outside play observations, interaction within peer-group observations – the list is endless. Notes on which any teacher worth her salt will have at her fingertips – but will that satisfy the ‘professionals’? – oh no. THEY must assess and THEY must observe and then turn round with the same answers as you had all along! A mother may state that ‘all changed after the MMR jab’ or you may suggest that a mother ‘has had alcohol-related problems’ but the ‘professionals’ choose not to hear the comments and no link whatsoever is made. What seems so obvious to the ones who REALLY know the child is thrown aside with no mention made in the final report of there being any ‘additional contributing factors’. A golden opportunity missed.
Mary, I went through so many challenges with the educational/medical system.
If I knew what I know today, I would of declined all the vaccinations.
You think you are doing what is best for your children however, it is not until you look back and appreciate what one knows now.
With knowledge and awareness, I would have done things differently.
As for myself, I would have declined all the ‘poisons’ that were given to me, also.
‘Golden opportunities missed’.
I agree with you whole heartedly on this comment.
Unfortunately, we can not turn back the hands of time however, we have to look forward and be optimistic.
Yes, Carla, we do have to look forward. Hopefully, the more we repeat the things that we have encountered, the more likely it is that we’ll reach the notice of ‘future sufferers’ and enable them to have the courage to ‘do things in a different way’. As you say, we cannot turn back time but it’s only by appreciating that mistakes were made that we can hope to make a difference to the future surely? ‘Future sufferers’ are not going to hear of the dangers, or the reality of the situation, from anywhere else are they.
Thank you, Mary.
The description of “punding” I’ll generalize as over-focused, obsessive interest in a task despite recognized consequences or diminishing utility.
This “punding” and the tweets posted are all too reminiscent of being over-medicated.
I’ve been there personally. I still chose to take Adderall, as this has largely been resolved for me. I certainly respect everyone’s right to make their own choices however.
If you’re having these issues, consult with your Dr. about dosage. Also be mindful of what else you’re taking – Watch out for p450 metabolism routes. Also Antacids, PPIs, etc. increase amphetamine availability.
Hello, I found this article while searching for some answers to what I think I already knew and this confirmed it. I just quit the stimulant Phentermine , diet pill, and was pretty darn happy on it ! But I did a large amount of shopping on it. My love for casinos also hit an all time high. I had an “aha” moment when I read a celebrity had a shopping problem when she did cocaine. I wondered if this stimulant I took could do the same. I sort of knew in my gut but curious on any research. Thank you for the article. I can only blame myself but kind of relieved to know it sort of wasn’t my fault totally. I hope I get back to “normal” soon.
thank you again
I’m fretfully disappointed in many of these comments and even a bit suggesting that autism spectrum disorder (which Aspergers is now included under) is either something diagnosed for fun or God forbid caused by vaccines .. Don’t get me started on THAT.
Now look. I’ve got three kids. I’ve never done a drug in my life. I don’t smoke. I don’t take stimulants or antidepressants or prescription pain medication or anything. I haven’t had surgery except to get my wisdom teeth out a year after my oldest was born. So you can wash your hands of blaming drug use for my children’s problems. That said, my two oldest children have ADHD and my youngest has autism. They’re very much connected. The three of them all have similar issues that have overlapped in curious ways. I came here because my daughter who had been on adderall for about a month now and just started taking a higher dose this week started compulsively organizing everything in the house. At first I was amazed by the change in her behavior – she’s in 3rd grade and can’t read, was struggling in subjects she’s good at like math and science, and was getting in trouble daily for being distracting and disrespectful. Now rather than take hours to do 15 minutes of homework with me frustratedly trying to walk her through it (I’m a tutor, I have the academic patience of a saint) she walks to the library after school and does her homework independently and then reads! Except yesterday she had a meltdown when my husband asked her to clean her room sms she sobbed for hours because she couldn’t get it organized right. She takes everything out of the fruit bowl and repacks it, reorganized the food boxes on the shelves, and even switched bunks with her brother because the baby keeps messing up her stuffed animals… She’s only been on 10mg of adderall for a week! Guess I’ll call the psychologist and talk to her about it because the change in her classroom performance has been amazing but I don’t want her to end up with chronic compulsive behavior. The baby does that enough.