On Protocols and Principles in the Case of Hiro

Abstract

Dr. Jeremy Lichtman (2017, in this issue) presents a case of successful behavioral treatment of tics in "Hiro," a 10-year-old boy with Tourette Syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD). This commentary discusses the case of Hiro from a principle-oriented approach, with particular focus on issues related to parental involvement in treatment, addressing comorbidity and therapy-interfering behavior, and planning for generalization and long-term maintenance.

Mechanical/Algorithmic Versus Flexible/Creative Clinical Practice: How Underlying Principles Bridge the Gap

“…While tics are neurobiological in origin, from a behavioral perspective (Capriotti & Woods, 2013), they are maintained by a negative reinforcement cycle in which the individual with TS feels a discomfort around the area of the tic (called the "premonitory urge"), which feels like it can only be alleviated by performance of the tic behavior. Every time the tic behavior is performed, it reinforces the cycle by which the tics are maintained.…”

“…The first is, are manuals useful, and if they are, how so? This question will relate to Capriotti's (2017) article and the ideas that he brings up regarding "flexibility within fidelity" (also see Kendall, Gosch, Furr, & Sood, 2008) as well as his insights regarding "Protocols First" treatment versus "Principles First" treatment.…”