Negative Reinforcement and Premonitory Urges in Youth With Tourette Syndrome: An Experimental Evaluation.
Tics are escape responses that turn off an internal urge, so teach kids a new, less noticeable way to get the same relief.
01Research in Context
What this study did
Ellingsen et al. (2014) asked kids with Tourette syndrome to hold back their tics. Some kids could stop the hard task and leave the room right after a tic. Other kids had to keep working even if a tic slipped out.
The team counted tics and asked kids how strong the pre-tic "urge" felt. They wanted to see if getting away from the task made tics happen more often.
What they found
Kids who were allowed to escape the task ticced more often. They also said the urge felt smaller right after the tic.
The results show that tics are not just habits. They are little escape moves that give quick relief from an inside itch.
How this fits with other research
Austin et al. (2005) and Fine et al. (2005) both praise habit reversal training for tics. Their reviews say teaching kids to do a competing movement works well. The new study does not fight this—it explains why the competing move must also kill the urge, not just block the tic.
McConkey et al. (1999) ran a similar lab test with kids who had escape-maintained problem behavior. They also saw that short escape periods made the behavior stronger. The 2014 paper repeats this idea with tics, showing the same rule works across very different topographies.
Shahan et al. (2021) warn that big, sudden drops in reinforcement make problem behavior return. Their data line up here: if you remove tic escape too fast during treatment, tics may jump back just like destructive behavior did in their study.
Why it matters
Your treatment plan should give the child another way to shut down the premonitory urge. Try adding a brief, competing movement that also provides relief, then thin that escape slowly. Watch for tic spikes each time you make the task longer—those jumps tell you the urge is still driving the behavior.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Pick a short competing response the child can do anywhere; let them use it to earn a 10-second break, then stretch the work time by 30 seconds each day.
02At a glance
03Original abstract
Tourette syndrome (TS) is marked by the chronic presence of motor and vocal tics that are usually accompanied by aversive sensory experiences called "premonitory urges." Phenomenological accounts suggest that these urges occur before tics and diminish following their occurrence. This has led some to suggest that tics are negatively reinforced by removal of premonitory urges. This hypothesis has proven difficult to test experimentally, however, due in part to challenges in measuring premonitory urge strength. We tested predictions of the negative reinforcement conceptualization of premonitory urges using novel experimental tactics within the context of the "tic detector" paradigm. We compared tic rates and ratings of premonitory urge strength exhibited by youth with TS or chronic tic disorder under free-to-tic baseline (BL), reinforced tic suppression (RTS), and reinforced tic suppression with escape (RTS + E) conditions. Results were consistent with previous research and hypotheses of the present study. Participants rated the strength of their premonitory urges as higher during RTS conditions than during BL conditions. Within RTS + E conditions, tic rates were higher during escape portions when the contingency supporting tic suppression was inactive than during components where the contingency was active, and ratings of urge strength were higher at the onset of break periods than at the offset. All participants engaged in some level of escape from reinforced suppression during the course of the experiment. Results of this study support the notion that tics may be negatively reinforced by removal of aversive premonitory urges. Future directions for basic and clinical research are discussed.
Behavior modification, 2014 · doi:10.1177/0145445514531015