1. 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)

2. 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)

3. 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)

4. 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”

5. 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.

6. 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!

7. 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”

8. 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.

9. 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!

10. 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

11. Questions? Intricate Mind Institute www.intricatemindinstitute.com
Mary Baker-Ericzen, PhD
Questions?
Intricate Mind Institute