Psychological Assessment and Treatment of Children and Adolescents

Archive for the Habit Disorders Category

Published on: August 30, 2015  

Changing Unhealthy Habits

The Difference Between Habits Vs. Routines
The difference between a “habit” and a ”routine” is that habits are a pattern of behaviors that are repeated while routines are sequenced activities that are followed. Habits are typically coping or self-soothing mechanism for children to decrease feelings and anxiety or depression. These behaviors often go hand in hand with changing circumstances that evoke stress. The good news is that habits tend to fade out as children develop and mature.


Kids and teens can decrease feelings associated with stress in a multitude of ways like exercising, playing with friends, engaging in a fun activity, setting goals, listening to music, and thinking about or planning fun activities and experiences.

What Habits, Like Hair Pulling Looks Like
Nail biting, hair twirling and other habits are simply behaviors that people do to decrease stress, depression, or anxiety. The thing about habits is that the child or teen is often unaware of these behaviors. For example, many years ago when I taught English in Barcelona, a student of mine would wrap her hair around her finger and pull. She’d release her hair and twist and pull again. It was like clockwork. Whenever she was reading or lost in thought she would do this combination of behaviors.

I was struck that she seemingly had no idea she that she was twisting and pulling her hair and was genuinely embarrassed when I brought it to her attention. I thought for sure she would notice the discomfort of pulling her hair but she wasn’t.

When Habits Become More Than Just a Habit
As a child Psychologist, I see kids that take habits a bit further and will actually pull their hair, eyebrows and eyelashes out. When the eyebrows are thinned out or disappear all together, eyebrows are penciled in, hats and wigs are worn, and other creative strategies to hide the bald spots and avoid detection. Like my student, they are mostly unaware of the habit until they look down and see hair on their lap or look in the mirror or when someone notices that something just doesn’t look right. They don’t know how to stop these habits and are acutely aware that something is not quite right which then increases their anxiety and overall stress. This cycle can build up over years and be quite challenging to notice and then treat (there are some very good secret keepers out there).

Anecdotally, I’ve found that this behavior tends to occur when their minds are engaged in another activity like watching television, reading, studying, daydreaming, and being on the computer. Hair pulling, nail biting, nose picking, thumb sucking, cutting, and other habits tend to surface when they are disengaged. It’s like they just “check out” for a period of time. Identifying this process and interrupting it in some way becomes a large part of the treatment process early on. Getting past the shame and embarrassment of what’s happened is sometimes poses the greatest challenge.

Some Solutions
Punishment is not the way to go. Bringing attention to the habit directly might result in the child experiencing more stress and thus perpetuating the behavior. If they feel they might get punished, they might try and hide it, which can become a real challenge later on, especially if there are medical implications. The bottom line is that the punishment approach is not an effective way to decrease the intensity and frequency of habits.

Rewards and praise work. The trick is to do just the opposite of punishment….reward them with praise or tangible rewards for behaviors you want developed. Decide what behaviors you like and then notice your child doing them by verbally praising and rewarding them. Showing how much you value their behavior by developing a rating scale that is posted in a common area of the home where then can choose and stick stickers for doing the desired behavior, earning time on electronics, a trip to the mall, being king or queen of the remote for an evening, choosing a game that the whole family can enjoy, and other rewards can help to decrease the intensity and frequency of these behaviors.

As the rewards or contingency plans are phased, begin to establish concrete goals for doing the desired behavior. I like to start with them doing the behavior through the course of their morning routine. The goals become more challenging as they begin to show mastery. A progression might be them doing the desired behavior from wake-up to lunch time, then wake-up through dinner and then wake-up to bedtime.

After that, I ask them to do the desired behavior for one full day, then three consecutive days, 5 days, 7 days, 10 days, and then 14 days. Reward menus are created for each of these milestones. These “incentivized programs” can be very effective once the desired behavior is identified, praise is used throughout, and parents have good follow through. It’s like magic!

Get your child or teen involved. Getting your child involved in the problem solving process is always helpful. “I wonder what we can do to stop your fingers from being so sore?” Generate some ideas together and praise them for wanting to make a change, their strategy to solve the problem, and the new behavior that you want to see.

Overcoming this habit will likely result is your child feeling a sense of mastery and increased confidence. The great thing is that the personal problem solving process can be applied to other situations and circumstances. This is what we want…effective strategies that can be used across domains and in varied circumstances.

Take a look at yourself. It’s also important that parents pause and look at their own strategies to relieve stress and their habits as their child might learn that what their parents do is the best way to mange stressful situations (eating, chewing nails, etc…). Kids might also try to get their parents’ attention by engaging in certain behaviors because they know they will get a reaction. Understanding your child’s behavior patterns while looking at your own habits plays an important role in your child learning new and more effective strategies to manage change, stress and anxiety.

Adopting new behaviors can get tricky. Managing habits in teens takes a bit more finesse. Often times, the teen will notice that they are pulling out their hair or picking and be motivated to change this behavior due to the social or medical consequences. Once motivated to change, I help them develop a timeline when these behaviors occur to increase their overall awareness.

Remember, sometimes they don’t even know they’re engaged in the behavior until after the fact. Once they are aware of what they are doing, they can take a deep breath and engage in an alternate behavior, think about something else, or connect with an adult and engage in an activity with them. The process of developing an alternate way of coping is the target behavior we want to see.

Motivating…Comfortably. Rewarding this behavior by praise and other means is important to help your teen stay motivated. Over time, the negative behavior will fade away and the new, healthier behavior will take it’s place. The more consistent we are with rewards the praise the greater the likelihood that the undesirable behavior will be “extinguished” and the new behavior become the new norm.

On the bright side, most childhood habits disappear by the time they enter Kindergarten or the 1st grade because the child has found other ways to manage uncomfortable emotions and circumstances.

Habits may need additional attention if they negatively affect a child’s social relationships, and impacts their functioning at home, in school, or in community-based activities. If this is the case, seeking the support of a professional who has experience managing these behaviors is recommended. You can learn more about hair pulling (Tricotillomania), see book recommendations and other resources in the Helpful Resources section of our website.

If your child’s functioning is negatively impacted by a habit please give us a call, 360-236-0206. We’re here to help!
With Warmest Regards,

Dave Callies, Psy.D.
Clinical Child & Adolescent Psychologist
Gyro Psychology Services
866-616-4976 (gyro)

Published on: June 12, 2013  

A Look at Tourette Syndrome

What is Tourette Syndrome?

Tourette Syndrome is a neurological disorder that becomes evident before the age of 18. This disorder is characterized by multiple verbal and motor tics that are frequent, rapid, repetitive and involuntary. The tics can range from simple, like eye blinking, to complicated tics like kicking or touching. Children can also experience verbal tics like grunting or throat clearing though these usually occur with movements. Majority of cases tend to be mild.

What does Tourette Syndrome Look Like?

Sudden and brief intermittent movements or sounds that are called tics, characterize Tourette’s. There are two types of tics, simple and complex. Simple tics are sudden, brief, and repetitive and involve a limited number of muscle groups.  Complex tics are distinct, coordinated patterns of movement involving several muscle groups.

Common simple tics:

  • Eye blinking
  • Head jerking
  • Eye dating
  • Finger flexing
  • Hiccupping yelling throat clearing
  • Grunting

Common complex tics:

  • Touching nose
  • Touching others
  • Smelling objects
  • Flapping arms
  • Kicking
  • Hopping
  • Using differing voice intonations
  • Repeating one’s own words or phrases

Tics will vary in type, frequency, and severity over time and may worsen during stress, illness or excitement.

How is it Diagnosed?

There are no medical tests to diagnose Tourette’s. A diagnosis is made by observing your child’s symptoms and evaluating the history of their onset.

The diagnostic criteria for Tourette’s are:

  1. Both multiple motor and one or more vocal tics have been present at some time, although not necessarily concurrently.
  2. The tics occur many times a day (usually in bouts) nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months.
  3. The onset of the tics is before age 18.
  4. The tics are not due to the direct physiological effects of a substance or a general medical condition.

Can Tourette’s be Treated?

There currently is no cure for Tourette syndrome but mild tics do not need to be treated unless they start to interfere with normal life. For more severe cases medications may be prescribed to help control the tics. Consult your child’s physician if you believe your child has a more serious case of Tourette’s to see if medication is right for them.

Helpful Resources
Books for Parents:

Children with Tourette Syndrome: A Parents’ Guide by Tracy Lynne Marsh

Living With Tourette Syndrome by Elaine Fantle Shimberg

Quit It by Marcia Byalick

Books for Children:

I Can’t Stop!: A Story About Tourette Syndrome by Holly L. Niner

Adam and the Magic Marble by Adam Buehrens


Learn more about Tourette Syndrome on the Resources page under Tic Disorders. We also post daily articles on a wide range of topics for parents and teens on Facebook and LinkedIn.

If you suspect your child might have Tourrette Syndrome or another Tic Disorder please give us a call, 360.236.0206.  We’re here to help!

Warmest Regards,

Gyro Psychology Services

Olympia, Washington


866.616.GYRO (4976)

Health Disclaimer