My friend John has a toddler named Joey.  Joey is a little over 2 years old and, to quote Mary Poppins, is practically perfect in every way.  In fact, the running joke among our friends is that the moment that John and his wife start to worry that something is delayed or not quite on track, Joey will start doing it the next day.  He is a bright, charming, lovely child who (unfortunately) has developed a whangdoodle of a bad habit: he bites his lip so hard that he breaks the skin and bleeds.  All over the house.  All over the crib.  All over the car.  All over a friend’s house.  When that play-date turned into an outtake from Psycho, John asked for some help.

As his wife puts it, “freaking out” is not helping.  What they started to do was to re-direct the biting behavior every time they noticed Joey doing it by getting him to do something else.  This was a better approach than yelping in disgust when their little boy absent-mindedly began chewing his mouth to bits, but they still needed some cleaning up in order to really get that behavior out of Joey’s repertoire.

I had assessed (after observation and getting his mom and dad to record what was happening when Joey is biting) that Joey is NOT biting to get attention (even though he is getting heaps of it) and that he is doing it for the simple reason that he likes the way it feels (like hair-twirling or biting fingernails).  This type of behavior is considered a “sensory” behavior which is maintained by “automatic reinforcement” (it feels like it does a body good). Therefore, simply ignoring the behavior isn’t going to make it go away; it is independent of his environment.

His parents might be able to punish the behavior so that he does it less, but this is the LEAST preferred option for a behavior like this (it makes about as much sense as the nuns rapping your knuckles for jiggling your foot—you’d probably stop jiggling your foot, but man would you hate those nuns…).  There are gentler, more sensitive and more productive ways to stop bad habits than punishment.  In fact, almost every approach trumps punishment by leaps and bounds.  Besides, how many of us have asked a 2-year old to stop doing something and they just stopped doing it?  None of us?  Right.  Most kids need a little steering, and a course that does not make him feel badly or ashamed about what he is doing, especially when it is a behavior that he has not yet developed control over and does not hurt anyone else.

Joey’s parents chose the time-honored most AWESOME thing a kiddo can do with his mouth–the raspberry!!!!!—as something to do instead of biting. You try biting your lip while giving a good razz…it’s not possible!  I asked them to stop trying to draw Joey’s attention to his lip once he is already biting it, but to find (in behaviorspeak, we would call this “capturing”) the times that he is not biting his lip and ask him to engage in that “competing behavior” (raspberry). I watched his mom start to move away from correcting the behavior toward preventing it by saying, “Joey, do this!” and blowing a magnificent plllppphhht which he joyfully imitated.  This brought the lip-mangling down from about 30 times per day to about 20.  It was a good start, but not nearly good enough to make a meaningful difference in Joey’s life (or his parents’ lives!).  As behavior analysts, we need to make sure that our interventions and solutions are effective, and not just making everyone feel better because we are doing something.

The next step is to give the new behavior a name: Joey’s dad started calling it “Silly Lip” and now, instead of having to say, “Hey, buddy, do this,” they could just call out “Silly Lip!” from across the room.  That week, the biting went way down again: from 20 times per day to 5.  The sheets in Joey’s room are now pristine, and the mean-looking bruises on his lip are fading.  I told his parents to watch for something really specific: I thought there might be a point when Joey started to bite his lip but turned it into “Silly Lip” on his own.  Sure enough, within a few days, the new behavior was replacing the old behavior and he was not biting at all.  He was aware that he had something else to do and was choosing to do that.

Before you panic and worry that poor little Joey is going to be bereft and friendless because he blows raspberries all the time, let me assure you that typically the replacement behavior drops off soon after the target (biting) behavior.  It simply does not have that je ne sais quoi that the biting does—it just does not feel as good.  Imagine that Q-tips are banned—you are no longer allowed to go spelunking in your ears (we all know that’s what you do with a Q-tip).  If you were then encouraged to scratch your earlobe instead of diving for cotton-tipped joy so you didn’t get in trouble, the scratching would help you break the habit, but would never really hit that sweet spot, that neural groove, that you went looking for.  As a result, you probably wouldn’t do it very much.  If, for some reason, poor Joey really gets hooked on the raspberries, his parents can simply repeat the “prevent and replace” approach with progressively more innocuous behaviors until those biting episodes are long forgotten.

This approach works with behaviors that are not being done in order to get attention or to get a “thing.” How can you tell?  If Joey only bit his lip so that his mom would come and yell and clean him up, he would not have done it while alone, nor would he have done it while his parents were already paying attention to him (both of which he did).

Sensory-seeking behaviors are tough if they get out of hand and damage starts to occur (we all have that friend with grody fingernails or really picked-at zombie skin) but they can be replaced without punishment or shaming.  In some cases, the behaviors will never truly disappear, but will go down to “near-zero” levels that do not cause a problem.

The short version of all of this is:

• Find a replacement behavior that is incompatible with the one you are trying to change
• Model the new behavior (the one that is better/less dangerous)
• Name the new behavior
• Replace the old behavior
• Repeat until the levels are near-zero or an acceptable (non-weird) behavior has taken the place of the original (dangerous) behavior
• Track all of these changes to make sure that you don’t just think it is getting better or worse

This is just one case, so if your family is dealing with something that feels more serious than this, address it with your pediatrician and ask for a referral to a qualified (Board Certified) behavior analyst or cognitive behavioral therapist with experience in these areas.

Happy Razzing!– Liz Schwandt