If you’re reading this, you already know that having a child with a tic disorder is tough. So I’ll cut right to the chase and let you know that there’s a highly effective treatment that can make a real difference, often within weeks. It’s called habit reversal training (HRT), and it’s helped innumerable kids overcome this particularly cruel condition and get back to socializing with friends, making progress in school, and setting themselves up for future success.
What’s important to remember about HRT is that the more a child’s parents and other caregivers participate in this process, the greater the likelihood they have of overcoming their tic disorder. In this article, I’ll explain how HRT works, its deceptively simple structure, and your important role in amplifying its effectiveness. Before I do, though, let’s first talk about the nature of tic disorders.
Understanding tic disorders
Tic disorders are conditions characterized by involuntary and repetitive movements or sounds known as tics. Tics are sudden, rapid, and often brief actions or vocalizations a person makes, often in an involuntary manner. These tics can vary in intensity, frequency, and complexity from person to person. How they show up can also change in the same person over time.
There are two main types of tics: motor tics and vocal tics. Motor tics involve physical movements, such as eye blinking, head jerking, or shoulder shrugging. Vocal tics involve making sounds with one’s voice, including throat clearing, grunting, or repeating certain words or phrases. People with tic disorders experience a “premonitory urge”—a state of tension or unease just before the tic occurs. Sufferers sometimes compare these urges to an itch that’s begging to be scratched.
Tourette syndrome (TS) is the most well-known tic disorder. It’s characterized by multiple motor tics and at least one vocal tic persisting for over a year. As with other tic disorders, TS often begins in childhood and can vary widely in terms of the tics’ severity, frequency, and complexity. Interestingly, boys are around three to four times more likely to develop TS than girls.
Tics can be both simple and complex. Simple tics involve brief and uncomplicated movements or sounds, while complex tics are more elaborate and may involve a sequence of actions or words. The severity of tic disorders varies among people, with some experiencing mild tics that don’t interfere with daily life, while others may have more severe tics that can be disruptive.
Kids in the crosshairs
While adults can experience tic disorders, youth is prime time for these conditions to make their presence known. Tic disorders can appear in kids as young as two, though the average age of onset is six. Now, the good news about tic disorders is that many kids naturally outgrow them by the time they become adults. If tics are left untreated, however, they can increase the risk of functional impairment as well as additional mental health challenges.
Most tics are quite noticeable to others and can lead to intense feelings of embarrassment, affecting kids’ friendships, school performance, and overall well-being. Another aspect of tic disorders often overlooked is the physical toll that repetitive movements and vocalizations can take on the body. As you might expect, identifying and addressing tic disorders early on can significantly improve your child’s well-being and minimize these impacts on their daily life.
It’s worth mentioning that tics can come and go, sometimes seemingly out of the blue. Your child may develop a tic, like blinking or shoulder jerking, that becomes a problem but disappears after a few months. While this isn’t always the typical course, it shows that tics can be unpredictable.
For a TS diagnosis to be made, the tics usually need to persist for at least one year, but such a diagnosis is not required for you to pursue effective treatment for your child—thankfully, they don’t have to suffer from their motor and /or vocal tics for a significant time before effective treatment can be delivered.
Habit Reversal Training (HRT) Explained:
Habit Reversal Training (HRT) is a practical and effective treatment for tic disorders. It includes multiple components, though the two main ones are awareness training and competing response training.
Awareness training
When we ask a child who is experiencing tics, “What brings these tics on?” The most common answers are, ”I don’t know” and “ They just happen.”
During the awareness training part of HRT, we help your child become conscious of the warning signs or triggers that precede their tics. Initially, identifying these signals might be challenging, but with therapy sessions, we can uncover common patterns in the antecedents to the tics. For example, most children will be able to hone in on that premonitory urge—the feeling of tension or unease just before the tic occurs. By developing awareness of the events and situations that precede that urge, your child will gain the first of two powerful tools for managing their tics effectively.
Competing response training
The second component is competing response training, which teaches your child alternative behaviors that make it unlikely for the tic to happen. For instance, if your child has a blinking tic, we might encourage them to focus their gaze straight ahead on a specific object or person to suppress the repetitive blinking tic. Competing response training gives your child a physical or behavioral response that counteracts the tic, empowering them to regain control over their symptoms. These strategies become their “secret weapon” against tics, helping them feel more confident and in charge.
When I’m training a room of therapists in HRT, one of the most common reactions I get is: “Is treatment really that simple?” My answer is, essentially, yes. Treating this condition successfully boils down to a) becoming more aware of when a tic is going to happen, and b) proactively doing something to prevent it from happening. While there are a few more ingredients to the process of HRT, awareness training and competing response training are truly its key components.
How you can help stop your child’s tics
While awareness and competitive response training are practiced during therapy sessions, the work certainly doesn’t stop there. Given that it’s unreasonable for an eight-year-old child to diligently perform their HRT homework all by themselves, the encouragement, assistance, understanding, and support of parents, older siblings, and other peers and caregivers is crucial to HRT’s success. By coming together, we can create a supportive environment that fosters the consistent practice and application of HRT techniques and accelerates their recovery.
Duration of treatment and long-term benefits
The length of HRT treatment can vary depending on the individual and the severity of their tic disorder. Typically, it involves around 10 to 20 sessions. However, it’s worth noting that significant benefits are often seen around the 10-12 session mark. NOCD’s own outcomes data has consistently shown positive outcomes within this timeframe. While relapses can occur, successful HRT often leads to long-lasting results, relieving your child of symptoms and helping them get back to a normal, healthy development. Regular follow-ups and ongoing support help monitor progress and address any setbacks along the way.
HRT has shown remarkable success in reducing the frequency and severity of tics, improving overall functioning, and boosting self-confidence in children with tic disorders. Your child gains control over their symptoms by increasing awareness of tic triggers and implementing competing responses, developing practical strategies that lead to reduced emotional and physical distress. With your support and professional guidance, your child can overcome their tics, develop resilience, and thrive, leading a fulfilling and empowered life.
Get help today
If your child is struggling with a tic disorder, schedule a free call today with the NOCD Care Team to learn more about how a licensed therapist can help. NOCD Therapists receive specialty training in treating tic disorders with HRT, plus ongoing clinical supervision and consultation.
Remember, you’re not alone in this journey. With HRT, we can empower your child with the tools to conquer their disorder and live a tic-free life.