Habit Reversal

David, a 14-year-old immigrant from Mexico, repeatedly displayed violent outburst during which he would punch himself in the ribs and neck, often times leaving welts and bruises. Unfortunately, due to lack of finances David’s family was unable to get treatment for these outburst; however, a study conducted by Rich Gilman, Nancy Connor, and Michele Haney allowed for the diagnosis and treatments of what was concluded to be Tourette Syndrome. Tourette Syndrome (TS) “is characterized by sudden, repetitive vocal and motor tics that can be highly distracting to others and incapacitating to the individual.” Pharmacological agents have been used to combat TS in the past, but this method of treatment has many limitations; therefore, researchers have begun to use behavioral methods to control the tics which proved to be successful in the treatment of David.

Researchers are still gathering information on TS and as a result of the dynamic nature of the studies, results often vary; despite the variability, various findings have been cited consistently throughout literature relating to TS. Generally, onset of TS occurs between the ages of 2 and 15 peaking around 7 to 9. According to information collected from David’s family his tics began around 7 years of age and continued to develop in intensity over the years. As a result of David’s family’s “low socioeconomic status, their general lack of understanding regarding tic disorders, and lack of access to services” David had not received treatment prior to the study conducted. David’s tics were immediately identified once he entered school in the United States, “the discernible sound of David’s motor tics often caused the teacher to pause the classroom instruction and elicited negative remarks from David’s classmates regarding his behavior.” The disruptive behavior resulted in referrals to the school psychologist where he was diagnosed with TS and placed in special education classrooms and prescribed three pharmacological agents to suppress his tics, but due to the sedative nature of the medications his dosage was altered to only one agent and after six weeks of adjusting to the medicine Gilman, Connor and Haney began their study taking baseline data and implementing habit reversal.

Given that David’s tics were considered most problematic in class, they were targeted for the habit reversal study. The study was designed and conducted in three phases of data collection: baseline, intervention, and follow up. There were two separate observers who collected data for the study, the first was David’s special education teacher who taught David two classes a day and the other was David’s math teacher. The math teacher was unable to collect data during the intervention phase; however the baseline and follow up data paired with the data from the first observer were adequate to make conclusions for the study.

In order for habit reversal to be successful, the subject must first be made aware of the external and internal conditions that bring forth the tics and is then taught to perform an incompatible behavior that prevents the tic from being carried out. There are two main components to habit reversal, the first being awareness training which includes response description and response detection. During the response description David was asked to make a list of the conditions that bring forth the tics and explicitly describe what happens during the tics. Response detection consisted of Gilman acting out the described tic and David successfully identifying them. After successful completion of the awareness training David was taught an incompatible behavior, which was to grab the bottom of the chair and focus on deep breathing, to use when he identified any of the conditions or experienced a motor tic. Given that one of the main reasons researches have concluded as a reason for failed habit reversal studies was noncompliance, a reward system was implemented in his special education class to encourage compliance. The incompatible behavior was carried out and data collection continued for 3 weeks. Three weeks after the completion of the intervention phase, follow up data was collected and again 3 months post intervention.

Comparison of the baseline data, intervention data, and follow up data proved that the habit reversal was a successful method in reducing the number of tics experienced as a result of TS. David’s baseline data revealed high levels of motor tics in all three classes and was most frequent in social studies and science ( averaging 37.5 and 34.5 respectively) and less frequent in math (9.25). During the intervention phase a significant decrease was noted in his social studies and science class (8.0 and 7.5). The frequency of the tics noticeably decreased even more in the post intervention follow up collection. The consistent decrease throughout the study proved that habit reversal is a successful method in decreasing the frequency of tics in a subject diagnosed with TS.