McKesson Clinical Reference Systems: Pediatric Advisor 2002.1

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Habit reversal training is a method used to help people deal with their habits. This method has been used very successfully with 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.

Make Your Child More Aware of the Habit

1. Have your child look in a mirror while performing the habit on purpose. Do this every day. Help your child to become aware of how his body moves and what muscles are being used when he performs the habit.

2. 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.

3. Your child should record each time he does the habit on a 3x5 index card. Keeping track of how often the habit happens is the only way that you and your child can tell when progress is being made.

Practice the Competing Response Daily

1. 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:

   __________________________________________________________.

2. 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.

3. Encourage your child to use the competing response when he feels the urge to start the habit.

4. Encourage your child to use the competing response in situations where he is likely to start his habit.

5. Encourage your child to use the competing response for 1 minute after each time he performs the habit.

Help Your Child

1. Feedback: Work with your child to help him be aware of his habit by helping him identify the habit when it occurs.

2. Support and Encouragement: Encourage your child to use the competing response and praise him when he does. Praise your child when you notice the habit is starting to go away.

3. Effort: Remember, although many children and teens 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.