Tic and Habit Disorders
Repetitive behavior disorders, including tic and habit disorders, are thought to be relatively common among children and adolescents. Tic disorders are characterized by repetitive, sudden movements and/or vocalizations that are seemingly purposeless in na
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Christine A. Conelea · Benjamin T. P. Tucker · Douglas W. Woods
Abstract: Repetitive behavior disorders, including tic and habit disorders, are thought to be relatively common among children and adolescents. Tic disorders are characterized by repetitive, sudden movements and/or vocalizations that are seemingly purposeless in nature. Habit disorders are typified by repetitive behaviors focused on the body and include trichotillomania, skin picking, nail biting, thumb sucking, and cheek chewing. Although these disorders may in some cases be benign and short-lived, clinical attention may be needed for children experiencing psychosocial impairment, physical damage, or emotional distress. The current chapter provides an overview of these disorders, their diagnostic assessment, and their purported etiology. Next, evidence-based psychosocial treatments for tic and habit disorders are described. The final portion of the chapter discusses the basic and expert clinician competencies needed to treat tic and habit disorders. Basic competencies include the ability to accurately implement function-based interventions and Habit Reversal Therapy, while expert competencies generally involve the ability to modify treatment for complex or non-responsive cases. The chapter concludes with suggestions to aid a clinician in the transition from basic to expert competence.
9.1
Overview
9.1.1 Tic Disorders Tic disorders are characterized by repetitive, sudden, and seemingly purposeless motor movements and/or vocalizations. Tics can range from simple behaviors that go unnoticed by the casual observer (e.g., forceful eye blinks or throat clearings) to highly conspicuous and complex vocal and motor patterns (e.g., complete words and phrases or complex hand gestures). Tics are commonly found in pediatric populations, with recent epidemiological studies finding tics in 17–21% of children (Kurlan et al., 2002; Peterson, Pine, Cohen, & Brook, 2001). Estimates of the prevalence of Tourette Syndrome (TS), the most severe tic disorder diagnosis, are relatively varied. However, recent research indicates a prevalence of 0.15–1.1% in school-aged children, and a male to female ratio of 4:1 to 6:1 (Coffey et al., 2000; Kadesjö & Gillberg, 2000). Tic disorders typically develop during early childhood and tend to follow a waxing and waning course, with symptom characteristics changing over time. The onset usually occurs between the ages of 5 and 8 years (Jagger et al., 1982; Leckman, King, & Cohen, 1999; Peterson et al., 2001). Simple motor tics in the head and face region usually appear first, and may be followed by the development of motor tics in the mid-section and extremities, vocal tics, and complex tics (Jagger et al.; Leckman et al., 1999). Also, most children eventually develop bodily sensations (i.e., premonitory urges) preceding their tics, which may be relieved upon tic occurence (Leckman, Walker, & Cohen, 1993; Woods, Piacentini, Himle, & Chang, 2005). Symptoms tend to reach peak severity around the ages of 10–12 years, followed by a st
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