Michael B Himle

• Ph.D.
• Professor (Associate) at University of Utah

This is the first book to analyze empirically supported treatments by using the newest criteria from the American Psychological Association's Society of Clinical Psychology, Division 12. Clinicians, scholars, and students all need to stay updated on the treatment research, and this book goes beyond providing updated treatment information by pointin...

This study examined predictors of, and associations between, self-concept, demographic variables, and clinical measures in fifty-eight children and adolescents with Persistent Tic Disorder (PTD; 44 males, Mage = 11.9 years, SD = 2.74). Participants completed measures that assessed self-concept, tic severity, tic-related impairment, and comorbid psy...

Introduction: Comprehensive behavioral intervention for tics (CBIT) is an efficacious, first-line treatment for Tourette syndrome (TS) and other chronic or persistent tic disorders. However, CBIT's public health impact has been limited by suboptimal treatment access. Preliminary research has shown that providing CBIT over videoconference (teleCBIT...

Over the past decade, behavioral interventions have become increasingly recognized and recommended as effective first-line therapies for treating individuals with tic disorders. In this article, we describe a basic theoretical and conceptual framework through which the reader can understand the application of these interventions for treating tics....

Tic disorders are a class of childhood-onset neurodevelopmental disorders characterized by involuntary motor and/or vocal tics. This entry describes the clinical presentation, prevalence, and impact of tic disorders across the lifespan and provides a framework for understanding how interacting biological and environmental factors influence symptom...

Importance: Parents play an essential role in the transition to adulthood for autistic youth, yet often feel they do not have adequate training and resources. Objective: To evaluate data on the preliminary efficacy of and collect participant feedback about the Maximizing Adolescent Post-Secondary Success (MAPSS) intervention. Design: Single-group,...

Objective Treatment guidelines for Tourette's Disorder (TD) are based on patients' degree of tic severity and impairment. However, clear benchmarks for determining tic severity and impairment have not been established. This study examined benchmarks of tic severity and tic impairment using the Yale Global Tic Severity Scale (YGTSS) and the Clinical...

Background Parents of autistic youth are highly involved in the transition preparation process, yet the role and influence of parental factors and perceptions is underexplored. In the current study, we aimed to expand understanding of transition preparation and the role and influence of parental factors for autistic youth including perceptions of t...

Objectives: Health care providers and educators play critical roles in supporting healthy sexuality development for youth with autism spectrum disorder. There is limited information about the sexual behavior of these youth, especially girls, and about their access to sexuality education or health care services. Methods: This study addressed thes...

Families are a critical context for healthy sexuality development. This study characterized family sexuality communication for autistic adults (age 18–30) without intellectual disability (n = 117) versus a neurotypical comparison group (n = 319). Parent-reported number of sexuality topics covered did not significantly differ by gender or autism/com...

Families are critical for supporting healthy sexuality and relationship development for youth with autism. The objective of this study was to describe family sexuality communication for adolescent girls with autism. Participants were 141 parents of autistic daughters who completed an online survey about sexuality development. Most parents relied on...

Community stakeholders, researchers, and providers are increasingly focused on individual, family, and systemic factors that contribute to positive outcomes for adults on the autism spectrum. Parent expectations for their youth's future are associated with adult outcomes (e.g., employment, school success, independence), yet the mechanism for this e...

Children with persistent (chronic) tic disorders (PTDs) experience impairment across multiple domains of functioning, but given high rates of other non-tic-related conditions, it is often difficult to differentiate the extent to which such impairment is related to tics or to other problems. The current study used the Child Tourette's Syndrome Impai...

Tic suppression is the primary target of tic disorder treatment, but factors that influence voluntary tic inhibition are not well understood. Several studies using the Tic Suppression Task have demonstrated significant inter-individual variability in tic suppressibility but have individually been underpowered to address correlates of tic suppressio...

Background: Tic suppression is the primary target of tic disorder treatment, but factors that influence voluntary tic inhibition are not well understood. Several studies using the Tic Suppression Task have demonstrated significant inter-individual variability in tic suppressibility but have individually been underpowered to address correlates of ti...

This chapter describes the current state of evidence-based psychological approaches for the treatment of Tourette syndrome (TS) and tics with emphasis on a multicomponent behavioral treatment known as Comprehensive Behavioral Intervention for Tics (CBIT). It also reviews the application of an adapted version of exposure and response prevention (ERP...

In the case of Hiro, Dr. Jeremy Lichtman (2017, this issue) describes how he flexibly employed a manualized behavior therapy protocol to successfully treat a child’s involuntary motor and vocal tics. In doing so, he raises interesting observations and questions regarding manualized psychotherapy treatment protocols, including their intended role, t...

Tic disorders are a class of childhood-onset neuropsychiatric disorders characterized by involuntary motor and vocal tics that vary in frequency, intensity, complexity, and form. Despite their underlying organic cause and involuntary nature, contemporary behavioral approaches have led to a better understanding of how environmental factors influence...

Purpose of Review The past decade has realized substantial progress in understanding and treating Tourette disorder (TD). The goal of this review is to highlight recent research on behavioral approaches for treating TD and to identify limitations to this treatment approach and directions for future research. Recent Findings Two large randomized co...

In this chapter, we provide a brief overview of Tourette syndrome (TS) and tic disorders, including diagnostic information, prevalence, course, and associated features. We then provide a brief summary of evidence-based treatment with a focus on comprehensive behavioral intervention for tics (CBIT). Following this background overview, we then descri...

Obsessive-compulsive disorder (OCD) and persistent tic disorders (TD) are known to be highly comorbid, and recent research has suggested that the combination of OCD + TD may represent a distinct OCD subtype that has a different symptom profile than either disorder alone (Mansueto and Keuler, Behav Modif 29:784–799, 2005). In addition, a subset of i...

Tourette syndrome (TS) is a childhood onset neurodevelopmental disorder characterized by semi-involuntary, repetitive movements and sounds (motor and phonic tics). Transient tics in childhood are common, and their persistence in TS may be due to failure of maturation of frontal-subcortical circuits mediated by genetic predisposition and environment...

This study examined the relationship between core symptoms of autism spectrum disorder, parental romantic expectations, and parental provision of sexuality and relationship education in an online sample of 190 parents of youth 12–18 years of age with a parent-reported diagnosis of autism spectrum disorder. Regression analyses were conducted separat...

Comprehensive Behavioral Intervention for Tics (CBIT) has been shown to be efficacious for chronic tic disorders (CTDs), but utilization is limited by a lack of treatment providers and perceived financial and time burden of commuting to treatment. A promising alternative to in-person delivery is voice over Internet protocol (VoIP), allowing for rem...

Tics associated with Tourette syndrome and other chronic tic disorders (CTDs) often draw social reactions and disrupt ongoing behavior. In some cases, such tic-related consequences may function to alter moment-to-moment and future tic severity. These observations have been incorporated into contemporary biopsychosocial models of CTD phenomenology,...

Although tics are the defining feature of chronic tic disorders (CTD), many children experience comorbid internalizing and externalizing problems that contribute to impairment across several domains, including family functioning. The current study examined clinical correlates and predictors of caregiver strain in parents of children with CTD. Parti...

Comprehensive Behavioral Intervention for Tics (CBIT) is an efficacious treatment for children with chronic tic disorders (CTDs). Nevertheless, many families of children with CTDs are unable to access CBIT due to a lack of adequately trained treatment providers, time commitment, and travel distance. This study established the interrater reliability...

The risk for serious injury and death to children during motor vehicle accidents can be greatly reduced through the correct use of child passenger safety restraints (CPSRs). Unfortunately, most CPSRs are installed or used incorrectly. This study examined the effectiveness of behavioral skills training (BST) to teach 10 participants to install rear-...

Purpose of review: This update summarizes progress in understanding Tourette syndrome clinical characteristics, etiology, and treatment over the past year. Recent findings: Premonitory sensory phenomena were found to have important impacts on Tourette syndrome quality of life. A rare genetic form of Tourette syndrome due to L-histidine-decarboxylas...

While considerable research has focused on promoting independence and optimizing quality of life for adolescents and young adult with autism spectrum disorder (ASD), sexual development and sexuality education have been largely neglected. Experts recommend that parents be the primary source of sex education for adolescents with ASD, and that sex edu...

We analyzed data from 74 male collegiate hockey players. Each athlete's season began with a baseline administration of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) neuropsychology test battery. Fourteen athletes sustained a sport-related head injury and were readministered the test to assess the impact of the injury. A si...

Research has shown that motor and vocal tics fluctuate in frequency, intensity, and form in response to environmental and contextual cues. Behavioral models have proposed that some of the variation in tics may reflect context-dependent interactive learning processes such that once tics are performed, they are influenced by environmental contingenci...

Research on adolescents and young adults with autism spectrum disorders (ASDs) has focused on promoting independence and optimizing quality of life, yet the areas of sexual development and sexuality has been largely neglected. The American Academy of Pediatrics encourages pediatricians to address sexuality issues in youth with disabilities to foste...

Comprehensive behavioral intervention for tics (CBIT) is a safe and effective treatment for managing the tics of Tourette syndrome (TS). In contrast to most current medications used for the treatment of tics, the efficacy of CBIT has been demonstrated in 2 relatively large, multisite trials. It also shows durability of benefit over time. Similar to...

Research has shown that both education about Tourette Syndrome (TS) and self-disclosure have a positive impact on how peers rate the social acceptability of an individual with TS. However, no studies have directly compared generic TS education and personally delivered self-disclosure on how they impact attitudes towards an individual with TS. In th...

Comprehensive Behavioral Intervention for Tics (CBIT) has been shown to be effective for reducing tics in children with chronic tic disorder. Unfortunately, there remain significant barriers to dissemination. The aim of the current study was to examine the effectiveness of CBIT delivered over videoconference. Twenty children were randomly assigned...

The current article describes the phenomenology and empirically supported treatments for Tourette's disorder (TD) and presents data on treatment utilization from two separate national surveys of adults with TD (N = 672) and parents of children with TD (N = 740). Despite a wealth of empirical evidence demonstrating its effectiveness, results suggest...

Habit reversal training (HRT) has been proven effective for reducing tics in children with Tourette's syndrome (TS). However, the availability of the intervention is limited. Videoconference technology represents a promising mode through which HRT may be disseminated to underserved areas. Using a multiple-baseline across participants design, the cu...

This article describes the development and initial psychometric properties of the Parent Tic Questionnaire (PTQ)—a new measure assessing the number, frequency, and intensity of motor and vocal tics in children and adolescents with Chronic Tic Disorder (CTD). Parents of 40 children with a CTD completed the PTQ as part of a larger assessment battery....

This paper describes the phenomenological features of early childhood onset obsessive compulsive disorder (OCD; defined as children meeting DSM-IV criteria for OCD with age of onset <8 years). Fifty-eight children (ages 4-8) were included in the sample. OCD and comorbid diagnoses were determined by structured interview, and OCD severity was measure...

This manuscript is one in a series of invited papers to this journal. The purpose of the series is to highlight and discuss the similarities and differences between various behavioral and cognitive-behavioral approaches to the treatment of obsessive-compulsive disorder (OCD). The first article in this series (Twohig & Whittal) describes the case of...

To examine the relative efficacy of family-based cognitive-behavioral therapy (CBT) versus family-based relaxation treatment (RT) for young children ages 5 to 8 years with obsessive-compulsive disorder (OCD). Forty-two young children with primary OCD were randomized to receive 12 sessions of family-based CBT or family-based RT. Assessments were con...

Chronic tic disorders are characterized by involuntary motor and vocal tics, which are influenced by contextual factors. Recent research has shown that (a) children can suppress tics for brief periods of time, (b) suppression is enhanced when programmed reinforcement is provided for tic-free intervals, and (c) short periods of suppression do not re...

The current study evaluated the effects of tokens delivered on differential reinforcement of zero-rate behavior (DRO) schedules or noncontingently on tic suppression in 4 children with tics. Tic frequency was lower in 3 of 4 children when tokens were delivered contingent on the absence of tics than when tokens were delivered noncontingently.

Tics represent a complex class of behaviors that have a neurobiological origin and are influenced by factors both internal and external to the individual. One factor that has gained recent attention is the premonitory urge. Contemporary behavioral models suggest that some tics are preceded by aversive somatic urges that increase in severity when ti...

This chapter focuses on the tic disorders and trichotillomania. Tic disorders are characterized by sudden, repetitive, non-rhythmic motor and vocal tics. Tic disorders can be categorized into three primary categories: transient tic disorder, chronic tic disorder, and Tourette's disorder (TD). Evidence for automatic negative reinforcement of tics co...

Children with chronic tic disorders (CTD), including Tourette’s Disorder (TD), demonstrate a higher incidence of comorbid conditions, including attention-deficit hyperactivity disorder (ADHD) and obsessive–compulsive disorder (OCD). The relative contributions of tics versus ADHD and OCD symptoms for predicting impaired functioning in children with...

“Evidence-Based Psychosocial Treatments for Tic Disorders” (Cook & Blacher, 2007) provided a current and comprehensive summary of the evidence base for psychosocial approaches to these conditions, and concluded that habit reversal training meets established criteria as an empirically supported treatment. This commentary delves further into the theo...

The term habit disorders describes a broad class of disorders characterized by repetitive, unwanted behaviors that are distressing and often result in significant functional impairment. The two primary classes of habit disorders are tic disorders and body-focused repetitive behaviors (BFRBs). Tic disorders and BFRBs must be assessed across multiple...

Tic frequency was assessed and compared across home and clinic as well as three experimentally-manipulated situations in order to assess the phenomenon of tic reactivity. Forty-three youngsters with chronic tic disorder recruited from two geographically-distinct sites were videotaped over three weekly laboratory visits under each of the following c...

It is well established that Tourette syndrome has a neurobiologic origin. Although pharmacotherapy is the most commonly prescribed intervention, there is considerable evidence to support the use of behavior therapy, specifically habit reversal training, as an alternative or adjunct treatment for some individuals with Tourette syndrome. Unfortunatel...

Behavior analysis has been at the forefront in establishing effective treatments for children and adults with chronic tic disorders. As is customary in behavior analysis, the efficacy of these treatments has been established using direct-observation assessment methods. Although behavior-analytic treatments have enjoyed acceptance and integration in...

This chapter reviewed other behavioral interventions for TS and discussed their efficacy. Clearly, the majority of behavioral interventions (habit/reversal excluded) have not been systematically evaluated enough to be deemed empirically supported monotherapies for TS. In addition to reviewing these interventions, recent advances in behavioral resea...

Although motor tics and/or vocal tics are the defining features of chronic tic disorder (CTD) and Tourette syndrome (TS), older youths and adults often report their tics to be preceded by an unpleasant sensation or "premonitory urge." While premonitory urge phenomena may play an important role in behavioral interventions for CTD/TS, standardized as...

Tourette's syndrome (TS) is a neurobiological disorder consisting of motor and vocal tics that are thought to be temporarily suppressible. Many professionals, however, believe that a paradoxical increase in tic frequency (above baseline levels) occurs when efforts to suppress have ceased (i.e., a rebound effect). To date, little research has invest...

Many patients, parents of children with Tourette's disorder, and professionals have suggested that following a period of suppression, tics will rebound to a rate that will exceed the average rate of occurrence. At present, there are no empirical data to support or refute such an effect. This experiment utilized an A-B-A design with replication to t...

Individuals with tic disorders are at risk for experiencing functional impairment in a variety of domains. However, the impact of tic disorders on family functioning remains unclear partly because psychometrically sound assessment instruments with normative data from a tic disorder population do not exist. The current study provides preliminary nor...

The purpose of this study was to compare two methods designed to produce tic reduction in 4 children with Tourette's syndrome. Specifically, a verbal instruction not to engage in tics was compared to a verbal instruction plus differential reinforcement of zero-rate behavior (DRO). Results showed that the DRO-enhanced procedure yielded greater reduc...

Research has shown that children often engage in gun play when they find a firearm and that this behavior is often involved in unintentional firearm injuries. Previous research has shown existing programs to be ineffective for teaching children safety skills to reduce gun play. This study examined the effectiveness of a behavioral skills training (...

Unintentional firearm injuries threaten the safety of children in the United States. Despite the occurrence of these injuries, few studies have evaluated the effectiveness of child-based programs designed to teach children gun-safety skills. This study compared 2 programs that were designed to reduce gun play in preschool children. A between-groups...

Tourette's Syndrome (TS) and Trichotillomania (TTM) are both subsumed under a large category of repetitive behavior disorders. The purpose of this paper is to provide an overview of the most recent behavioral research on TS and TTM. A description of both disorders is provided along with the most recent research on their etiology and maintenance. Be...

This study examined the effectiveness of momentary DRO (mDRO) and whole interval DRO (wDRO) schedules on high rates of disruptive behavior in a classroom of 22 children. In both procedures, children earned tokens for the absence of disruptive behavior and exchanged tokens for tangible or edible reinforcers. mDRO and wDRO, with tangible reinforcemen...

Previous research has demonstrated that rats’ rates of lever pressing for low-concentration liquid-sucrose reinforcers are increased when food-pellet, rather than sucrose, reinforcement will be upcoming in the same session (i.e. induction). The present experiments were designed to determine whether this induction was the product of ‘anticipatory re...

Typescript. Thesis (M.S.)--North Dakota State University, 2002. Abstract: leaf iii. Includes bibliographical references (leaves 34-37).