Age/Grade: Preschool – High School
Setting: School, Home, Clinic, In-patient
Individual or Group: Individual
Tier: 2 & 3
Desired/ Appropriate Behavior:
Reduction in repetitive (habit) behaviors, thumb sucking, hair twirling, hair pulling, stuttering, tics, etc.
Skill Level: Acquisition to Generalization
NOTE: This intervention is best implemented by someone with behavioral training (e.g., school psychologist, behavior therapist, behavior interventionist). Individuals without prior behavioral training
should seek the assistance of someone with the appropriate training to implement this intervention.
Habit disorders can be defined as repetitive behaviors that serve no recognizable social function but may negatively affect the individual. Due to the repetitive nature of the behavior, habit disorders in children may cause social distress as well as physical injury.
Four main “classes” of habit disorders are recognized by professionals and observed in children: vocal and/or motor tics, “nervous” habits, stuttering, and Tourette's Disorder. Although some debate exists as to the actual terminology, most experts would agree with the areas of research that fit into these classes.
Tics are habitual, potentially involuntary movements of small groups of muscles that are caused by spasms, chorea, or tremors. Some examples of motor tics include shoulder shrugging, arm or neck jerking, facial grimacing, or excessive eye blinking. Examples of vocal tics include persistent coughing or throat clearing not caused by illness, barking, or coprolalia (i.e., repetitive use of obscene
language). These vocal tics may be maintained by muscle tension reduction following a tic occurrence, which negatively reinforces the tic behavior. That is, once the tic occurs, the muscle tension reduces. Thus, the likelihood of the tic reoccurring to remove the muscle tension in the future is increased. Two reasons may explain why controlling tics can be problematic. One, the person may not be aware that he or she is displaying the tic and therefore may encounter difficultly trying to control it. Second, the negative reinforcing properties of “ticing” to reduce muscle tension are difficult to control without intervention.
“Nervous” habits can be defined as constant, repetitive behaviors that serve no social function but may serve a self-stimulatory function and/or an environmental restriction (e.g., when presented with an environment with motor restrictions like sitting in a dress, the “nervous” habit is more reinforcing than in other environments). The term nervous has implications that the behaviors are to reduce anxiety. Little empirical evidence directly links all of the behaviors to anxiety. These behaviors/habits often involve manipulation of some part of the body, such as the hands or mouth. Examples of “nervous” habits include nail biting, hair pulling/twirling, thumb
sucking, chewing on lips or cheeks, constant scratching, skin picking, or bruxism (i.e., chronic and/or acute teeth grinding). Another type of habit is stuttering. Stuttering involves whole and part-word repetitions, blocking, hesitations, and prolongations during speech.The fourth type of habit disorder is Tourette's Disorder. This disorder involves both motor and vocal tics that seem to occur in clusters, with the tics being active for a period of time and then dissipating. The factors underlying the development and maintenance of Tourette's are unclear, a number of potential explanations have been offered. One explanation is that the person experiences a tension reduction after the occurrence of the tics associated with Tourette's Disorder. Habit Reversal has been shown to reduce habit disorders with children. The original work and procedures are provided below. Habit Reversal is a package intervention, meaning that it has several components. Several studies have used variations of the procedures. In the adaptation/modification section, these variations are discussed