Habit reversal (HR) is a behaviorally based treatment that is used to reduce repetitive behaviors which may bothersome and serve no adaptive function, such as tics, hair-pulling and nervous habits. HR was first developed in the 1970s, and has since been used in the treatment of several repetitive behavior disorders, particularly tic disorders. This article will review the principles and procedures of habit reversal as well as some things to consider before beginning this treatment approach.
What are tics?
Tics are sudden, rapid, repetitive movements (motor tics) or sounds (vocal or phonic tics). Tics are involuntary, in that the child cannot control them, but they can be at least partially suppressed for varying periods of time, often during the school day. Tics are classified as either simple or complex. Simple motor tics involve one muscle group, such as eye blinking, neck rolling, or shoulder shrugging. Complex motor tics are characterized by slower, more purposeful, coordinated movements involve more than one muscle group, such as jumping, squatting, or turning around repeatedly. Simple vocal tics are characterized by one sound, such as throat clearing, coughing, or sniffing. Complex vocal tics are characterized by combinations of sounds, such as repetitive words, syllables or phrases, such as "shut up" or "Joey's a chicken."
How common are tics?
Tics are very common in school age children, and most are transient, lasting less than one year. Chronic tics, which persist for more than one year, are less common. Tourette's Disorder is a chronic tic disorder characterized by multiple motor tics and one or more vocal tics that have been present for more than one year. Tourette's Disorder may co-occur with psychiatric and behavioral disorders, such as Attention-Deficit/Hyperactivity Disorder, Obsessive-compulsive Disorder and other anxiety and mood disorders. Tics and the co-occurring disorders may impair a child's social, educational and recreational functioning. The problem that causes the most impairment or distress is often the one that is most amenable to treatment.
Reprinted with the permission of the NYU Child Study Center. © NYU Child Study Center.
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