Sequential Application of Major Habit‐reversal Components to Treat Motor Tics in Children

Abstract

In this study, we sequentially administered up to four components of the habit-reversal treatment to 4 children with motor tics within a multiple baseline design. The habitreversal components included (a) awareness training; (b) awareness training and selfmonitoring; (c) awareness training, self-monitoring, and social support; and (d) awareness training, social support, and the use of a competing response. Results demonstrated that the combined use of awareness training, social support, and competing response training was effective in eliminating motor tics in 2 of 4 children, that awareness training alone was effective for 1 child, and that a combination of awareness training and self-monitoring was effective for the 4th child. The treatment and ensuing improvement were found to be socially valid. We discuss possible explanations for these results and recommend directions for future research.

Applying Behavior Analysis to Clinical Problems: Review and Analysis of Habit Reversal

“…In research on habit reversal for motor tics, Finney et al (1983) and videotaped participants and later scored the tapes for the occurrence of tics using 10-s or 6-s partialinterval scoring systems. Other researchers have also utilized videotape assessment of tics (Woods, Miltenberger, & Lumley, 1996), hair pulling , thumb sucking (Rapp, Miltenberger, Galensky, Roberts, & Ellingson, 1998), and stuttering (Elliott, Miltenberger, Rapp, Long, & McDonald, 1998) in research evaluating habit reversal. There are a number of benefits of using videotape in assessment.…”

“…Because habit reversal is a treatment package consisting of numerous components, it was not known which components were necessary for the effectiveness of the package. As a result, researchers subsequently evaluated a number of variations of habit reversal for the treatment of tics, nervous habits, and stuttering in an attempt to simplify the procedure, increase efficiency, and identify the essential treatment components (e.g., Elliott et al, 1998;Wagaman et al, 1993;Woods, Miltenberger, & Lumley, 1996). Most researchers evaluated some HABIT REVERSAL combination of awareness training, competing response training, and social support.…”

“…In an attempt to further simplify the procedures, Woods, Miltenberger, and Lumley (1996) sequentially implemented a number of treatment components common to habit reversal. Results showed that awareness training eliminated the motor tic for 1 child, awareness training and self-monitoring eliminated the tic for a 2nd child, and awareness training, competing response training, and social support was necessary for significant reductions in tics for the remaining 2 children.…”

“…More recently, researchers have investigated aspects of this robust treatment package, including simplified versions and variations (Miltenberger, Fuqua, & McKinley, 1985;Wagaman, Miltenberger, & Arndorfer, 1993), limitations (Rapp, Miltenberger, & Long, in press), effectiveness across different populations (Long, Miltenberger, Ellingson, & Ott, 1998), treatment adjuncts (Allen, 1998;Long, Miltenberger, Ellingson, & Ott, 1998;Rapp et al, in press), and mechanisms responsible for its success (Woods, Miltenberger, & Lumley, 1996). The continuing interest in, and research related to, habit reversal speaks to its clinical utility.…”

Habit reversal training as a treatment for refractory OCD – A case study

“…First developed by Azrin and Nunn (1973), this comprehensive treatment protocol is firmly based on behavioural analytic principles and includes the following components: awareness training, competing response training, self-monitoring, social support, and generalisation training (see details below). In some cases not all of these components are necessary (Woods, Miltenberger, & Lumley, 1996). While not unknown in the management of ODC (Claiborn & Pedrick, 2001;OCD Action, 2005), HRT is not routinely used with OCD patients and there are no detailed descriptions or published evidence of effectiveness.…”