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Question about eliminating a head shaking tic

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  • Question about eliminating a head shaking tic

    Background: my almost-12yo son and I have recently read and watched together some of the materials on Duncan McKinlay's Leak Brakes site. Also, he has a little bit of experience with using a competing response to eliminate a tic that was damaging his skin and bothering him. From another thread, here's what we did for that one:

    My son and I have tried a bit of this. I felt he was not old enough (age 10) to do this in a formal comprehensive way.

    The first tic he chose to try to replace with a different behavior was this: he was scraping his teeth over the skin below his lower lip. This was damaging his skin and when he tried to practice his beloved trombone, he cried after a few minutes because it hurt. The replacement behavior we chose was to purse his lips instead of doing the scraping thing. Whenever I saw him starting to move his mouth to start scraping, I would look purposefully at him (meaning, I looked him in the eye and raised my eyebrows a bit) and purse my own lips. This was something I could do in public without embarrassing him! It worked.
    My son currently has a head shaking tic that tires him out and sometimes gives him a headache by the end of the day. After looking at some Leaky Brakes materials, he told me he'd like to do something about his head shaking tic because of the headaches and the tiredness.

    There's no one trained in CBIT or HRT in our area.

    I preselected a couple of videos and a couple of PDFs. I wanted to spread them out, so we looked at a couple of things one day, a little more the next, and I'm planning to continue.

    During the first such session, my son tried out, on his own initiative, an alternate head movement he cooked up himself. The next evening, when we sat down to look at some more materials, he proudly told me he had been using his alternate movement, and as a result, he didn't feel as tired, and he didn't have a headache.

    The original tic grew out of squinting and turning the head from side to side in combination with squinting, blinking and winking, to look at someone or something in slightly different ways, in a sequence. Eventually it became a vigorous head shake. There's also some eyebrow movement involved, and still plenty of blinking, etc.

    The development of the head shake happened shortly after we reduced the dosage of Tenex from 6 mg/day to 4, because of an unusual side effect.

    The alternative head movement he came up with involves a gentle rolling motion, where you sort of draw a biggish circle with your nose. I didn't say anything about his alternate movement one way or the other -- I felt it was premature.

    We haven't had time to talk about it for a few days, or look at any more Leaky Brakes materials yet. I have seen more head shaking than gentle rolling in the last few days.

    My question is, what do you think of that gentle rolling movement -- do you think it might work as a competing response? Or do you think it would be better to do something involving a tensing and relaxing, or something isometric?

  • #2
    Re: question about eliminating a head shaking tic

    he has a little bit of experience with using a competing response to eliminate a tic
    I believe most medical practitioners would prefer to say that a competing response (CR) is intended to manage a tic. There may be a reduction in the frequency of a tic occurring, because as the child (person) becomes experienced in recognizing the premonitory urge, and employing the CR to block the tic, the neural pathways between the prefrontal cortex and the basal ganglia become strengthened, thereby allowing greater control at a less conscious level. The tic is not eradicated, but the child (person) develops brain circuitry to better manage the expression of the symptom.

    As a lay person who had the opportunity to attend a CBIT training seminar for medical practitioners, I can say that in order to benefit from the comprehensive approach used in CBIT, it should be directed by a trained and accredited medical professional. The comprehensive approach takes factors such as psychoeducation, self awareness training, tic analysis and CR training all combined with a guided program of social support.

    Those of us (adults) who serendipitously figured out ways to manage our tics over decades using some of the strategies taught in CBIT, did it by trial and error, and with a great deal of frustration because there was no guidance nor assessment of progress.

    That being said, to effectively benefit from a CR, the candidate has to learn how to be aware of the premonitory urge for that particular tic and must understand the full dynamic of the tic. The therapist will "reverse engineer" the targeted tic to fully understand its dynamics from start to finish, and will participate with the candidate in formulating the appropriate CR, based on some specific guidelines.

    You may wish to obtain the Therapist's Guide to Managing Tourette Syndrome, the book used as the adjunct in training CBIT practitioners for insights into the guidelines and criteria for successful application of these techniques.

    I don't believe CBIT should be a do it yourself endeavor, and it would probably facilitate your son's progress to have a mental health professional working with him in a consultant capacity. Have you checked with the TSA National office, where a database of trained accredited CBIT practitioners is maintained.

    I will send you by PM the contact information of the person who handles CBIT training at TSA and who knows all the therapists.
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