Teacher Professor

May 21, 2010

Itchy Replacements

Filed under: Autism,Tourette's Syndrome — Teacher Professor @ 10:47 am

I just read a fascinating research study that finds that teaching children with Tourette’s to replace their tics with alternate behaviors WORKS!  Called Comprehensive Behavioral Intervention for Tics (CBIT), the therapy suggests using a reward system to teach children to a) recognize when their tics are about to happen, b) replace the tic of choice with a more societally-acceptable movement, and c) encourage deep breathing.  The therapy is more effective than medication. 87% of children and adults were helped with this therapy, and follow-up evaluation found that it lasted at least six months.

I’m particularly excited about this because we already have proof that it works.  Elizabeth went through a period where she was chewing her fingernails.  Bitten down to the quick, her fingers would bleed, while she continued to gnaw on them.  I knew that kids with autism often have anxiety issues where they “stim”, or produce a movement that reduces the anxiety.  When she was chewing up her fingers at four years old, I told her that I knew that her fingers had “tingles” and that she really, really wanted to chew, but that it was so bad for her and ewww- made BLOOD (she’s afraid of blood, so I was using this fear).  I told her that when she felt the “itches”, she should press down on her fingertips, or roll her elbows on a table and focus on waiting out the “itches”.  I PROMISED her that the fingernail itch would go away in 2-3 minutes.  There were several months where she would come to me crying “Mommy, chew… Mommy chew!” and I would hug and tell her that I knew those darn itches were bothering her, but let’s try the pressing and elbows for 2 minutes.  Because she was so little, “2 minutes” was a flexible concept.  We might snuggle with her and focus on rolling her elbows for 5-7 minutes of “real” time and then, she’d get distracted by something else and all would be well.

We did a lot of replacement behaviors- gum for hair chewing, gum for chewing on her knees and arms and gum for chewing on- well, just about everything.  When she’s anxious, she goes into what we call “shark” mode, and walks around gnashing her teeth, looking for something to stim on.  I wish I had bought stock in Wrigleys before- she goes through a lot of gum.  But it generally does the trick- gum is much more acceptable than hurting herself!

I understand autism stimming- I could see Elizabeth’s need for stimulation and her need to vent it somehow and I could see how the replacement behavior could allow it to go somewhere else.  I knew that we couldn’t get rid of the need, but we could find an alternative.  I knew that it worked for us.

But Ray’s Tourette’s tics are different.  They don’t seem to emerge as a result of a need- they just appear.  He’ll sit down and “pop” with his mouth.  He’ll be talking to me and grimace, pulling his lips over his teeth.  He’ll be running and stop to spit.  His tics don’t appear to have a lot of lead time, but appear out of nowhere.  Elizabeth’s stims looked intentional, but Ray’s tics appear to be just mixed neurological signals.  You can almost SEE the electical shorts in his brain. They look very different from autism.

But the more I read about Tourette’s, the more I see the similarities.  Tourette’s tics are “itchy” as well- they release stress.  They hijack a child’s sensory system and create a fixation on a particular muscle movement.  They increase the more a child is stressed out.

Add this to a fascinating research study I also read recently where cursing actually works better than a pain reliever in releasing pain.  A good “DAMN- that HURT!” is better than Tylenol!  It works because the explosion of the curse word relieves the “fight or flight” feeling and decreases the adrenaline that your brain produces when you’re in pain- or stressed, or anxious.  A good, swift curse word is a very effective means of emotional regulation- and it works at a biological level.  Holy sh$t- isn’t that interesting?!

Although there is no study that connects them, my guess is that this research shows why approximately 15% of people with Tourette’s have “coprolalia”, where they curse as a tic- it’s the “Tourettes” that often appears on television shows.  The curse words they’re using act like the curse words that I say when I’m slamming on the brakes when the idiot in front of me cuts me off- they release stress.  But the stress of a person with Tourette’s is more pent up, rather than being immediate and released at the moment.  The brain of a Tourette’s child doesn’t know how to let go of the stress at the moment and remains in “fight or flight” mode.

And my other belief is that curse words work because they’re “forbidden”- the very “rebellious” thing that your brain gets enjoyment from doing- and the dopamine/other pleasure chemicals counterbalance the stress cortisols.  The enjoyment of the illicit, the wrong-but-it-feels-so-right pang.  It’s why chocolate works for me.  Perhaps part of why alcohol and drugs work for others.  We know we shouldn’t be doing it, but it feels good, so it’s very, very hard to stop and very, very hard to find a replacement. 

The last thing I found fascinating was the use of deep breathing.  Studies have found that cravings tend to last 20 minutes and that deep breathing can help.  The increased oxygen reduces stress cortisols as well and helps regulate anxiety as well- anxiety that the body is literally fighting.  “Take a deep breath” is Grandmother wisdom that has signfiicant scientific basis.  But then, yogis have known this for millennia…

So- my new plan… is to help Ray learn how to find a replacement behavior for spitting.  We will pick one at a time and find a replacement behavior to help him breathe through it- until the “bubble” of anxiety adrenaline pops.  He can’t take the need to tic away- but he can replace it.   Heck, I’ll give it a try with chocolate, too, so that he’s not alone in this process.  I feel energized with that wonderful feeling of “There is something I can DO about this!”

I would suggest that you invest in Wrigley’s.  Take a deep breath… Damn, I hope this helps…


  1. […] research behind it.  Recently, there’s evidence that it helps with Tourette’s tics and we’ve been trying that with Ray.  (Not entirely effectively- that’s another post […]

    Pingback by I’m Not Her « Professor Mother Blog — September 11, 2010 @ 5:10 pm | Reply

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