Do you have children or students that chew on their shirt collar, turn in assignments late, pick at cuticles, twirl their hair, slump down in their chair, tap pencils, smack food or never come prepared?… The list is endless! In this post, I want to help you get to the bottom of those habitual horrors that make you want to pull your hair out.
Is it a Behavioral Response OR a Habit?
There is still debate over how habits should be conceptualized and operationalized, but there is consensus among scholars that habits are acquired through incremental strengthening of the association between a situation (cue) and an action, “i.e. repetition of a behavior in a consistent context progressively increases the automaticity with which the behavior is performed when the situation is encountered” (Verplanken, 2006; Wood & Neal, 2007).
Wow! That is a mouth full of jargon and a mind bender for some! No worries let’s break it down together. Basically, positive and negative behavioral responses occur all day, every day, 24/7. A habit is something that is occurring more frequently because it is getting reinforced or the child is benefiting from it in some way.
Simply put, a habit is a behavior that starts as a choice, and then becomes more like an unconscious pattern that is easily performed without effort. For example, remember when you were learning to drive? That day that you had to consciously think about how to turn on the car, make sure your foot was on the break before shifting to drive or reverse, checking 2 and 3 times for traffic before turning on a road, try to keep the car in the correct lane… It was a mental workout for sure; however, the adrenaline rush and excitement about driving overshadowed the true cognitive energy and processing it took to complete the action of driving for the first time.
Now, you simply get in the car and GO. The entire process is done automatically because it has be practiced many, many times, reinforced, and engrained in memory. The behavior has become a habit.
Every habit, no matter if it is simple or complex, good or bad, has the same basic cyclical loop. This is often referred to as the habitual loop. Initially, there is a cue, an antecedent, a trigger that initiates the automatic brain mode. Next, the physical or emotional routine it put into action. Finally, there is the payoff or reward. Once you understand how a child’s habitual loop is working, you can start putting things in place to promote change! That’s great news, right? ABSOLUTELY!!!
Now let’s not forget those psychological factors. Habits can become disorders such as a class of behaviors called Body Focused Repetitative Behaviors: Trichotillomania (hair pulling) • Onychophagia (nail biting) • Dermatillomania (skin picking) • Compulsive nose picking • Biting of the inside of the cheek • Lip biting or picking • Knuckle cracking
I want to point these out because so many of my students and outpatient clients take various classes of medications. Be aware that commonly prescribed drugs (stimulants) such as Adderall have been known to have side effects such as skin picking. Just be cognizant of med changes in your students. I understand that these are not always reported to teachers; therefore, we should ask questions and have ALL information before making plans to change behavior.
- Dexmethylphenidate (Focalin, Focalin XR)
- Dextroamphetamine (Adderall, Addreall XR, Dexedrine)
- Lisdexamfetamine (Vyvanse)
- Methylphenidate (Concerta, Daytrana, Metadate, Methylin, Ritalin, Quillivant)
- Mixed salts of a single-entity amphetamine product (Mydayis)
Background Information: Applications of habit reversal
A number of researchers have evaluated habit reversal for treating nervous habits (Azrin, Nunn & Frantz-Renshaw, 1980; Miltenberger & Fuqua, 1985). The nervous habits treated with habit reversal procedures include fingernail biting, hair-pulling, thumb-sucking, bruxism, lip biting and lip licking. In each case, the competing response was a behavior that the subject could perform easily but that was physically incompatible with the nervous habit.
When habit reversal is used with children, the parent, teacher or caregiver might use physical guidance to get the child to engage in the competing response. For example, in one case, a 5 year old girl engaged in hair-pulling and nail-biting, usually when she was inactive. The competing response was to fold her hands together and lay them in her lap. Her mother was instructed to say, “Hands in lap,” and physically guide her daughter’s hands to her lap whenever she saw her daughter pulling her hair or biting her nails. Before long, the daughter began to put her hands in her lap as soon as her mother said, “Hand in lap”. Eventually, she started to put her hands in her lap as soon as she began to bite her nails or pull her hair. Whenever she was sitting with her hands in her lap, her mother would praise her verbally and give her a piece of her favorite candy. The habit behaviors decreased with the competing response treatment and were eliminated by implementing a follow up reinforcement schedule.
Speech Banana Case Example
Note: This student is a 12 year old, male student with severe delays in speech and language. The treating school SLP and I (consulting SLP & Behavior Specialist) collaborate to devise a treatment plan that can be implemented within the classroom setting. Evan’s speech and language is characterized by rote phrases and sentences, good tacting skills, and fair intraverbal skills with support.
Behavior: Obsessive Mouth Licking (red dry patches of skin and open sores around the lips)
Function: Anxiety→ Pain Attenuation→ Habitual
After observation, data collection in multiple settings and parent/teacher/SLP input, we devised the following intervention plan to decrease and extinguish the obsessive licking of the mouth/lips.
Initially, the function was anxiety driven; however, a pain attenuation factor definitely played a part after Even chapped the area around his mouth. As the chapped area lingered, the behavior became more habitual. I observed the behavior occurring more frequently during leisure, transition and free time compared to active engagement or teaching settings where demands were constantly placed on him. There were no consistent antecedents to the behavior and the duration of the behavior varied from 3-4 licks to 9-10 licks in a 5 minute time span. Because we couldn’t eliminate the reinforcer that drove the behavior (the pain attenuation sensation Evan felt) we needed to: 1) introduce a competing stimulus that could allow him access to the same type of sensation 2) teach a replacement behavior. I suggested presenting him with various oral stimulators (hiearchal system may move from gum/sucker to oral vibrator with different textured tips, sizes and shapes), soft bristled brushes ect. Allow Evan to explore the objects and encourage him to use them around his mouth/lips. I did’t want to deprive Evan of the sensory input; however, I did feel that we can eliminate the behavior completely with habit reversal training procedures.
What’s The Plan
The plan to decrease the behavior will depend on the immediacy of reinforcement. The time between the occurrence of a behavior and the reinforcing consequence is important. For a consequence to be most effective as a reinforcer, it should occur immediately after the behavior occurs. This is going to be the most difficult part of the intervention plan; therefore, we will choose blocks of time to implement the intervention plan. The longer the delay between the response and the consequence, the less effective the consequence will be because the contingency or connection between the two is weakened. If the time between the response and the consequence becomes too long and there is no contingency, the consequence will have little or no effect on the behavior.
Intervention Plan Step 1: Awareness Training
Initially, we will draw attention to the mouth licking. It is important that Evan become aware of the behavior before we use other behavioral techniques due to lack of self control. Choose 30 minute blocks of time throughout the day in which you will have the time to catch every mouth lick. Again, it is very important that you reinforce each lick immediately after it occurs. For example, you might say, “You just licked your mouth.”, “Hey Evan try not to do that so much.”, “You just licked.”, “Try not to lick.”, “Oops, you licked again.”. Record how many times you reinforce the behavior in the 30 minute block. This data will be very helpful in tweaking the schedule of reinforcement used in the next step of the intervention plan. Implement this strategy for 5 consecutive days before moving to the next step. Try to implement the plan at least four times a day.
DON’T PANIC: You will likely see an increase in the behavior during this awareness training phase.
Intervention Plan Step 2: Teaching A Competing Response
It is important to introduce a behavior that Evan can engage in instead of the mouth licking. Typically, I might suggest lightly holding the top and bottom teeth together for a couple of minutes; however, this might spawn another unwanted behavior…grinding teeth! NOTE: Interventions are student specific! Know the student! If you are not familiar with the student it is imparative to complete multiple observations, data collections and gather information from ALL teachers, support staff and parents. The team could teach him to tightly close his lips, rub his tongue on the back on his teeth, lightly cover his mouth with is hand, chew gum (choose something that is easy to imitate)… It doesn’t matter, we just need to choose one and stick with it. The competing behavior will help promote self-awareness that will allow us to reinforce appropriate behaviors. In school settings, it is important to utilize something that is appropriate for the setting and easily modeled by staff members. The competing response will be introduced with photos, modeling procedures, and shaping procedures. For example, present photos of the behavior and discuss the competing response. It might go something like this:
Every time you want to lick your mouth (Point to the photo of his chapped mouth) do this (point to the photo or show a video of you modeling the competing response). You will choose 30 minute blocks of time to implement this step. If Evan licks, take out the photos, give the statement about the competing response and require Evan to practice the response. You may want to use an intraverbal type of statement in order to reinforce the comprehension of the statement. For example: “You are NOT going to ___.” Evan would say “lick my mouth.” “If you feel like you need to lick you ARE going to ___.” Evan will fill in the blank with the competing response. This step should be implemented for 5 consecutive days with data collect. You will need to record the number of times you needed to present him with the photos of the competing response (which is also the number of time he engaged in the licking behavior) and the number of times Evan engaged in the competing response. If Evan engages in the competing response, make sure you highly reinforce the behavior. You may want to give him a token or a break (things previously determined to be reinforcing)!
Intervention Plan Step 3: Differential Reinforcement Of Other Behavior (DRO)
In DRO, the reinforcer is contingent on the absence of the problem behavior. The reinforcer is delivered after an interval of time in which the problem behavior does not occur. The logic behind the DRO procedure is that if the reinforcer is delivered only after periods of time in which the problem behavior is absent, the problem behavior decreases through extinction, and time periods without the problem behavior should increase. It is important to note that the name of the procedure can be confusing. Although the name of the procedure suggests that you will reinforce other behavior, in fact, you will reinforce the absence fo the problem behavior. Although other behaviors may occur when the problem behavior is not occurring, you do not identify other behaviors to reinforce in the place of the problem behavior. You will need to choose a specific reinforcer to use when implementing this step. You will want to choose an interval of time that will allow you to reinforce the absence of the behavior. For example, you may need to start with a time interval of 5 to 6 minutes in order to have adequate opportunities to reinforce the absence of the behavior. After the problem behavior is decreased and Evan is receiving the reinforcer after almost all intervals, it is time to increase the length of the intervals.
After these three steps have been completed, we will discus Evan’s progress and devise more aggressive procedures. Response interruption procedures and response cost systems typically completely eliminate the habitual behavior after these initial steps are implemented. It is always important to try the least intrusive intervention and them more toward more aggressive intervention plans.
DISCLAIMER: This is a case example to provide a learning experience and should not be recreated without the help and guidance of licensed professional.
Verplanken, B., Myrbakk, V., & Rudi, E. (2005). The measurement of habit. In T. Betsch, & S. Haberstroh (Eds.),The routines ofdecision making(pp. 231–247). London: Erlbaum.
Verplanken, B., & Orbell, S. (2003). Reflections on past behavior: A self-report index of habit strength.Journal of Applied SocialPsychology,33, 1313–1330.
Verplanken, B., Aarts, H., van Knippenberg, A., & van Knippenberg, C. (1994). Attitude versus general habit: Antecedents of travelmode choice.Journal of Applied Social Psychology,24, 285–300.
Wood, W., & Neal, D. T. (2007). A new look at habits and the habit-goal interface.Psychological Review,114, 843–863.