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Have you ever had a client who had a behavior that you, the client, the parent, or someone else called a tic? According to the Centers for Disease Control, “Tics are sudden twitches, movements, or sounds that people do repeatedly. People who have tics cannot stop their body from doing these things. For example, a person with a motor tic might keep blinking over and over again. Or, a person with a vocal tic might make a grunting sound unwillingly.” (CDC 2021) As behavior analysts we can easily make a topographical definition of tic. But what about function?
Generally speaking, a tic is maintained by non-socially mediated negative reinforcement. That is, the person with the tic often has a premonitory urge (they may describe it as feeling uncomfortable), they perform the tic behavior, and that urge goes away (for at least a short time). Therefore, the function of the tic is most likely an escape from that urge. Of course, there may be other functions involved with tics, such as access to attention or escape from a task that may be afforded to the person if they perform a tic in front of others.
For those with tic disorders or Tourette Syndrome, help has been available for some time in the form of pharmaceuticals, but also behavioral training. This training is called CBIT or Comprehensive Behavioral Intervention for Tics. For more information, click here. Most of the people who provide this treatment are psychologists, however much of the research is related to the work of Nate Azrin, Gregory Nunn, Ray Miltenberger, and others, and is decidedly in the behavior analyst’s wheelhouse! If you are interested in this service, sign up for the training and supervision through www.tourette.org. It’s important to note that a large component of CBIT is performed by the individual him/herself. Therefore, it is not an appropriate treatment for those that are non-verbal or intellectually delayed. The individual must really want to get rid of the tic in order for him or her to put in the practice that is necessary to be successful.
But how can you tell the difference between a tic and stereotypy? Generally, the maintaining reinforcer for stereotypy is non-social positive access, in other words, stereotypy just feels good. This is different from the negative reinforcement of removing the uncomfortable feeling that precedes a tic. CBIT would most likely not be effective for a behavior with this function, because it is designed for behaviors that are maintained by negative reinforcement and requires the individual to be committed to changing the behavior.
This blog provides just a small amount of information on tics. To learn more, contact the Tourette Association of America, attend a conference, or seek supervision.
Centers for Disease Control and Prevention. (2021, April 15). Diagnosing Tic Disorders. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/tourette/diagnosis.html