Austin & Carr Chapter 6: Assessment & Treatment of Habit Disorders PDF

# Chapter 6: Assessment and Treatment of Habit Disorders ## Habit Disorders - Repetitive or stereotyped responses that serve no apparent social function. - Maintained by operant contingencies. - Can result in physical damage or poor social acceptability. - Defined topographically rather than funct...

# Chapter 6: Assessment and Treatment of Habit Disorders ## Habit Disorders - Repetitive or stereotyped responses that serve no apparent social function. - Maintained by operant contingencies. - Can result in physical damage or poor social acceptability. - Defined topographically rather than functionally. ## Types of Habit Disorders - **Tic Disorders:** - Motor tics: Repetitive, jerking muscle movements. - Vocal tics: Sudden, rapid, nonrhythmic vocalizations. - Tourette's Syndrome: Characterized by motor and vocal tics. - Prevalence: - Motor tics: Approximately 1% of the population. - Vocal tics: Unclear but may be as high as 6.5% of college students. - Tourette's Syndrome: 0.04-0.05%, more common in males. - **Trichotillomania:** - Chronic hair pulling resulting in noticeable hair loss. - Often followed by rubbing, chewing, or eating the pulled hair. - Feelings of tension/anxiety often precede hair pulling. - Prevalence: 1-4% of the population, more common in females. - **Thumb Sucking:** - Occurs in up to 46% of children under the age of 4. - May continue in up to 19% of children over the age of 5. - More common in females. - Can cause physical damage such as dental malocclusion. - **Nail Biting:** - Common among children and adults. - Can result in damage or inflammation of the tissue around the nail. - Can cause infection and shortening of the roots of the teeth. ## Etiological Theories ### Tic Disorders - Biological: - Genetic component with a high concordance rate in monozygotic twins. - May involve an excess of the neurotransmitter dopamine. - Behavioral: - Tics may be reinforced by tension reduction in tic musculature. - Tics can be increased by positive and negative reinforcement. - Tics can be increased by the presence of an anxiety provoking person. ### Trichotillomania - Biological: - May be related to a serotonin deficiency. - May involve differences in brain function. - Behavioral: - Hair pulling may produce automatic reinforcing consequences such as tactile stimulation or tension reduction. - Hair pulling may be maintained through social consequences. ### Thumb Sucking - Behavioral: - Learned behavior, may modulate arousal (i.e., comfort or excite). - Maintained by an arousal modulation function. ### Nail Biting - Biological: - Familial link among nail biters. - Behavioral: - Functions to reduce tension/anxiety or increase arousal. ## Assessment of Habit Disorders ### Measurement Strategies - **Direct Observation:** - Most favorable method. - Use frequency or partial interval recording for short duration behaviors (e.g., tics). - Use duration scoring procedures for longer duration behaviors (e.g., thumb sucking). - **Indirect Observation:** - Use physical trace measures for behaviors that leave physical evidence (e.g., nail biting). - Less desirable and may have methodological problems. - Avoid using: - Self-report - Self-monitoring - Parental report ### Social Validity - Assess: - Acceptability of treatment procedures. - Noticeability of treatment outcomes. - Treatment effectiveness. ### Functional Assessment - Focus on the function of the habit behavior. - Identify antecedent and consequent events that maintain the behavior. - Use functional analysis or functional assessment. ## Treatment of Habit Disorders ### Tic Disorders - **Medical Treatments:** - Haloperidol, clonidine, and pimozide are common medications. - May have significant side effects. - **Behavioral Treatments:** - **Massed Practice (MP):** - Engaging in the target behavior rapidly and with great effort. - Efficacy is questionable. - **Habit Reversal (HR):** - A multi-component procedure that includes: - **Awareness Training:** - Response Description - Response Detection - Early Warning Cues - Situation Awareness - **Competing Response (CR) Training** - **Motivation Enhancement:** - Habit Inconvenience Review - Public Display - Social Support - Symbolic Rehearsal - Effectiveness is well-established. - Simplified versions of HR have been developed. ### Trichotillomania - **Medical Treatments:** - Limited success with medications such as fluoxetine and clomiprimine. - May be related to a serotonin deficiency. - **Behavioral Treatments:** - Habit reversal is the most extensively evaluated treatment. - Other treatments include: - Self-monitoring - Aversive conditioning - Contingency management ### Thumb Sucking - **Medical Treatments:** - No medications are effective. - **Behavioral Treatments:** - Bitter substance applied to the thumb. - Habit reversal. ### Nail Biting - **Medical Treatments:** - Limited research, clomiprimine may be effective. - **Behavioral Treatments:** - Habit reversal - Aversive treatments (e.g., electric shock, bitter substance, and MP) - Self-monitoring. ## Conclusions - Habit disorders are a common and often overlooked problem. - Treatment of habit disorders is often effective. - Habit reversal is the most effective behavioral treatment for many habit disorders. - Functional analysis and assessment are important tools for understanding and treating habit disorders. - Future research on the neurobiological basis of habit disorders is needed. ### References - 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Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980bq). Habit reversal procedures: A critical comparison in the treatment of tics. *Behavior Research and Therapy*, *18*, 437-439. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980br). Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980bs). Habit reversal procedures: A critical comparison in the treatment of tics. *Behavior Research and Therapy*, *18*, 437-439. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980bt). Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980bu). 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Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980ca). Habit reversal procedures: A critical comparison in the treatment of tics. *Behavior Research and Therapy*, *18*, 437-439. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cb). Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cc). Habit reversal procedures: A critical comparison in the treatment of tics. *Behavior Research and Therapy*, *18*, 437-439. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cd). Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980ce). Habit reversal procedures: A critical comparison in the treatment of tics. *Behavior Research and Therapy*, *18*, 437-439. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cf). Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cg). Habit reversal procedures: A critical comparison in the treatment of tics. *Behavior Research and Therapy*, *18*, 437-439. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980ch). Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980ci). Habit reversal procedures: A critical comparison in the treatment of tics. *Behavior Research and Therapy*, *18*, 437-439. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cj). Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980ck). Habit reversal procedures: A critical comparison in the treatment of tics. *Behavior Research and Therapy*, *18*, 437-439. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cl). Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cm). Habit reversal procedures: A critical comparison in the treatment of tics. *Behavior Research and Therapy*, *18*, 437-439. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cn). Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980co). Habit reversal procedures: A critical comparison in the treatment of tics. *Behavior Research and Therapy*, *18*, 437-439. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cp). Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cq). Habit reversal procedures: A critical comparison in the treatment of tics. *Behavior Research and Therapy*, *18*, 437-439. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cr). Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cs). Habit reversal procedures: A critical comparison in the treatment of tics. *Behavior Research and Therapy*, *18*, 437-439. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980ct). Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cu). Habit reversal procedures: A critical comparison in the treatment of tics. *Behavior Research and Therapy*, *18*, 437-439. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cv). Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cw). Habit reversal procedures: A critical comparison in the treatment of tics. *Behavior Research and Therapy*, *18*, 437-439. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cx). Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cy). Habit reversal procedures: A critical comparison in the treatment of tics. *Behavior Research and Therapy*, *18*, 437-439. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980cz). Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980da). Habit reversal procedures: A critical comparison in the treatment of tics. *Behavior Research and Therapy*, *18*, 437-439. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980db). Habit reversal procedures: A critical evaluation in the treatment of tics. *Behavior Research and Therapy*, *18*, 425-435. - Azrin, N. H., Nunn, R. G., & Frantz, R. L. (1980dc). Habit