Clinical Reference Systems: Pediatric Advisor 10.0
Habit Reversal Training
Habit reversal training is a set of procedures that have
been used very successfully with trichotillomania (hair
pulling), nail biting, thumbsucking, chronic motor tics, and
the tics associated with Tourette's disorder. After
your physician or psychologist has shown you the procedures
in the office, use the following outline for your daily
practice sessions at home.
Increase Your Child's Awareness of the Habit
- Have your child look in a mirror while performing the
habit on purpose every day. Help your child to become
aware of how his body moves and what muscles are being
used when he performs the habit.
- Have your child identify each time he starts his habit
by raising his hand when the habit occurs or by saying,
"that was one," when the habit occurs. If you see your
child doing the habit and your child does not notice,
signal him with a gesture or expression that you both
have agreed to use.
- Your child should record each occurrence of the habit on
a 3x5 index card. Keeping track of how often the
habit occurs is the only way that you and your child can
tell when progress is being made.
Practice the Competing Response Daily
- A competing response is an action your child does in
place of his habit. The muscles used to do the new
action make it impossible to perform the old habit. For
example, instead of doing an eye blink tic, the child
would be encouraged to very gently close his eyelids and
hold them closed for 10 seconds.
Your child's competing response is
___________________________________________.
- Have your child practice his competing response in the
mirror. This helps him become comfortable with the
response and assures him that the competing response is
not noticeable socially.
- Encourage your child to use the competing response when
he feels the urge to start the habit.
- Encourage your child to use the competing response in
situations where he is likely to start his habit.
- Encourage your child to use the competing response for 1
minute after each time he performs the habit.
Help Your Child
- Feedback: Work with your child to help him be aware of
his habit by helping him identify the habit when it
occurs.
- Support and Encouragement: Encourage your child to use
the competing response and praise him when he does so.
Praise your child when you notice the habit is starting
to go away.
- Effort: Remember, although many children and
adolescents will notice a decrease in their habit within
a couple of days, the greatest change from using these
habit reversal procedures occurs during the second and
third month. Don't give up after only a couple of days
or weeks.
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