Mary Baker-Ericzen, PhD Engaging Kids in CBIT Mary Baker-Ericzen, PhD Intricate Mind Institute (IMI) Child & Adolescent Services Research Center (CASRC) Rady Children’s Hospital (RCHSD)

CBIT Core Components Tic Identification and acknowledgement Mary Baker-Ericzen, PhD CBIT Core Components Tic Identification and acknowledgement Observation Measurement tools Rating Scales Function-based Intervention Awareness (premonitory urge) Competing Response Environment/functional assessment Behavioral reward program All must be done in “typical life” which will require multi-tasking Critical to start with 1 tic and build up Critical to start with limited time periods and environments and build up stamina and skill Critical to monitor decreased frequency in first targeted tic prior to moving on to next tic Repeat ALL steps for all remaining tics, 1 at a time (it will go faster ) All new tics need to start with identification, measurement and tracking before battle moves 8-12 sessions Collateral effects will be observed (decrease in non-targeted tics)

Mary Baker-Ericzen, PhD CBIT for Children! Adaptations of CBIT to make the intervention more engaging and motivating for kids: Add Visuals Include Fun Skill-Based Games Sized Rewards / Reinforcements Child Language Limit time in practicing the skills Signs to prompt them (make battle signs & place in environment)

Mary Baker-Ericzen, PhD CBIT for Children! Attend to self-awareness and sensitivity from the beginning Start with education about what tics are with videos & other media- normalize condition, provide psychoed, ostracize tics Talk about tics they are both aware & unaware of (include the family) Decide which tics are most “annoying” & frequent Name them! Characterize them! EX: “Noisy Nose” - “Le John James Spinner” “Throat Thrasher” - “Lick a Tic”

Battle Moves to Combat Tics! Mary Baker-Ericzen, PhD Battle Moves to Combat Tics! Battle Move #1 – Use your special ability to feel it coming (the urge or feeling you get) before the tic occurs Battle Move #2 - Do an action that makes it impossible for the tic to come out (competing response – keep doing it until the tic feeling goes away) Battle Move #3 – Be aware of the situation/setting when tic comes out and makes changes to the environment or be ready to battle the tic/s in those places Battle Move #4 – Get points for battling tics (reinforcement) when others (or self) see the battle moves Battle Move #5 – Watch out for Emotions! Calm down with deep breathing, movement, break or relaxation.

Mary Baker-Ericzen, PhD Battle Move #1 Purpose is for child to learn and be aware of premonitory “urge”, “warning signs” or “tic signals Teach tic tracking game (play during “life”) Child uses special power to know when tic is coming before it is observed Model tics and model game playing Play game and teach family how to play Keep score!

Mary Baker-Ericzen, PhD Battle Move #2 Competing response is an action done with intention that naturally competes with tic and makes it impossible to do CR is NOT suppression. It is a purposeful action. Model it. Practice it in session. Practice doing it in multiple environments during multiple activities as in “life”

Mary Baker-Ericzen, PhD Battle Move #3 Explain that tics have battle moves too. Know your opponent well! Use Tracking Form Identify antecedents Identify consequences Look for patterns Look for triggers (emotions, tired, stress) Look for associations, linkages (setting/situation) Make Environmental Changes Be prepared and ready to battle in certain settings/situations Tics have battle moves too. They look for a weakness (sad, worried, upset). They look for an unfamiliar setting or a favorite task when more preoccupied. They are strategic about their attacks. Know your opponent well and out smart them. Battle them before they have a chance to attack.

Battle Move #4 Use a reward program Mary Baker-Ericzen, PhD Battle Move #4 Use a reward program Child and family members monitor use of battle moves 1-3 and records points for each one used Create point chart and “cash in” list of reinforcers Model and practice in session giving points Teach parents how to give points judiciously Insist on receiving rewards Setting child up for success This is the stage when we stop the time limitations on battling and open it up to “Battle ON” full out war!

Battle Move #5 Monitor Emotions and Calm down Use feeling thermometer Mary Baker-Ericzen, PhD Battle Move #5 Monitor Emotions and Calm down Use feeling thermometer Calming down with deep breathing Relaxation Taking a break

Questions? Intricate Mind Institute www.intricatemindinstitute.com Mary Baker-Ericzen, PhD Questions? Intricate Mind Institute www.intricatemindinstitute.com 858-205-9809 intricatemindinstitute@gmail.com