Habit reversal for Tourette's disorder
A promising behavioral technique for treating Tourette's disorder is habit reversal.1 Habit reversal training is a set of procedures that have been used very successfully with hair pulling (trichotillomania), nail-biting, thumb-sucking, chronic motor tics, and the tics associated with Tourette's disorder.
It is very important that this therapy is guided by a qualified health professional who has experience with Tourette's disorder and the therapy. Do not use habit reversal therapy without proper training.
After your health professional has shown you the procedures in the office, it may help to use the following outline for your daily practice sessions at home. Set up a time and place to perform habit reversal. Your child will not be able to monitor his or her tics throughout the entire day.
For habit reversal to be effective, your child must be motivated to control his or her tics. Do not assume that because you are bothered by the tics that your child is. If the tics don't bother your child, habit reversal is not appropriate.
Increase your child's awareness of the tic
- Have your child look in a mirror while the tic occurs. Help your child to become aware of how his or her body moves and what muscles are being used.
- Have your child identify when the tic starts by raising his or her hand when it occurs or by saying, "That was one." If you see a tic starting that your child does not notice, signal him or her with a gesture or expression that you both have agreed to use.
- You or your child should record each occurrence of the tic on an index card. Keeping track of how often the tic occurs is the only way that you and your child can tell when progress is being made.
Practice the competing response daily
A competing response is an action your child does in place of the tic. The muscles used for the new action make it impossible to perform the tic. For example, instead of doing an eye blink tic, the child would be encouraged to gently close his or her eyelids and hold them closed for 10 seconds.
- Have your child practice the competing response in the mirror. This helps him or her become comfortable with the response and assures him or her that the competing response is not noticeable socially.
- Encourage your child to use the competing response when he or she feels the tic is about to happen or in situations where the tic is likely to occur.
- Encourage your child to use the competing response for 1 minute each time the tic occurs.
Help your child
- Increase awareness of the tic by helping your child identify the tic when it occurs.
- Encourage your child to use the competing response, and praise him or her for doing so.
Although many children and teens will notice a decrease in their tics within a couple of days, the greatest change from using these habit reversal procedures occurs during the second and third month. Don't give up after only a couple of days or weeks.
[Adapted courtesy of http://dbpeds.org, the Pediatric Development and Behavior homepage.2 All rights reserved.]
| Author: | Debby Golonka, MPH | Last Updated: September 27, 2007 |
| Medical Review: | Michael J. Sexton, MD - Pediatrics Karin M. Lindholm, DO - Neurology | |
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