Self-monitoring, external reinforcement, and timeout procedures in the control of high rate tic behaviors in a hyperactive child

A combination of a reversal design and a multiple-baseline design across settings and tic behaviors was employed to determine the effectiveness of a treatment package consisting of self-monitoring, external reinforcement, and timeout in the control of a hyperactive child's multiple tic behaviors. In the clinic the treatment package was applied only to facial tics, with three other tics (shoulder shrugging, rump protrusion, and a vocal tic) observed but never treated. At home facial tics were initially treated, and then vocal tics. Shoulder shrugging, rump protrusion, and "other tics" were never directly treated. Treatment was effective in decreasing the occurrence of facial tics in the clinic to zero. Even though no intervention was placed on the other tics, they also decreased in frequency concomitant with the facial tics. The home data also demonstrated a decrease to zero when the treatment package was sequentially applied to facial and vocal tics, with a concomitant decrease in the untreated tic behaviors. A 32-week follow-up showed maintenance of the treatment effects.