Habit Reversal versus Object Manipulation Training for Treating Nail Biting: A Randomized Controlled Clinical Trial.
AbstractObjective: This is a parallel, three group, randomized, controlled clinical trial, with outcomes evaluated up to three months after randomization for children and adolescents with chronic nail biting. The current study investigates the efficacy of habit reversal training (HRT) and compares its effect with object manipulation training (OMT) considering the limitations of the current literature .
Method: Ninety one children and adolescents with nail biting were randomly allocated to one of the three groups. The three groups were HRT (n=30), OMT (n=30), and wait-list or control group (n=31). The mean length of nail was considered as the main outcome
Results: The mean length of the nails after one month in HRT and OMT groups increased compared to the waiting list group (P<0.001, P<0.001, respectively). In long term, both OMT and HRT increased the mean length of nails (P<0.01), but HRT was more effective than OMT (P<0.021). The parent-reported frequency of nail biting did show similar results as to the mean lengt of nails assessment in long term. The number of children who completely stopped nail biting in HRT and OMT groups during three months was 8 and 7, respectively. This number was zero during one month for the wait-list group .
Conclusion: This trial showed that HRT is more effective than wait-list and OMT in increasing the mean length of nails of children and adolescents in long terms.
Ghanizadeh A. Nail biting; etiology, consequences and management. Iran J Med Sci, 2011; 36: 73-79.
Ghanizadeh A, Shekoohi H. Prevalence of Nail Biting and Its Association with Mental Health in a Community Sample of Children. BMC research notes 2011; 4: 116.
Sousa D, Pinto D, Araujo R, Rego RO, Moreira-Neto J. Gingival Abscess Due to an Unusual Nail-Biting Habit: A Case Report. The journal of contemporary dental practice 2010; 11: 085-091.
Pereira LJ, Pereira-Cenci T, Del BelCury AA, Pereira SM, Pereira AC, Ambosano GM, et al. Risk Indicators of Temporomandibular Disorder Incidences in Early Adolescence. Pediatric dentistry 2010; 32: 324-328.
Bello J, Nunez FA, Gonzalez OM, Fernandez R, Almirall P, Escobedo AA. Risk Factors for Giardia Infection among Hospitalized Children in Cuba. Annals of tropical medicine and parasitology 2011; 105: 57-64.
Williams TI, Rose R, Chisholm S. What Is the Function of Nail Biting: An Analog Assessment Study.Behaviour research and therapy 2007; 45: 989-995.
Ghanizadeh A, Derakhshan N, Berk M. N-Acetylcysteine Versus Placebo for Treating Nail Biting, a Double Blind Randomized Placebo Controlled Clinical Trial. Anti-inflammatory & anti-allergy agents in medicinal chemistry 2013.
Leonard HL, Lenane MC, Swedo SE, Rettew DC, Rapoport JL. A Double-Blind Comparison of Clomipramine and Desipramine Treatment of Severe Onychophagia (Nail Biting). Archives of general psychiatry 1991; 48: 821-827.
Koritzky G, Yechiam E. On the Value of Nonremovable Reminders for Behavior Modification: An Application to Nail-Biting (Onychophagia). Behavior modification 2011; 35: 511-530.
Moritz S, Treszl A, Rufer M. A Randomized Controlled Trial of a Novel Self-Help Technique for Impulse Control Disorders: A Study on Nail-Biting. Behavior modification 2011; 35: 468-485.
Azrin NH, Nunn RG. Habit-Reversal: A Method of Eliminating Nervous Habits and Tics. Behaviour research and therapy 1973; 11: 619-628.
Long ES, Miltenberger RG, Ellingson SA, Ott SM. Augmenting simplified habit reversal in the treatment of oral-digital habits exhibited by individuals with mental retardation. J Appl Behav Anal 1999;32: 353-65.
Woods DW, Murray LK, Fuqua RW, Seif TA, Boyer LJ, Siah A. Comparing the Effectiveness of Similar and Dissimilar Competing Responses in Evaluating the Habit Reversal Treatment for Oral-Digital Habits in Children. Journal of behavior therapy and experimental psychiatry 1999; 30: 289-300.
Silber KP, Haynes CE. Treating Nailbiting: A Comparative Analysis of Mild Aversion and Competing Response Therapies. Behaviour research and therapy 1992; 30: 15-22.
Allen KW. Chronic Nailbiting: A Controlled Comparison of Competing Response and Mild Aversion Treatments. Behaviour research and therapy 1996; 34: 269-272.
Flessner CA, Miltenberger RG, Egemo K, Kelso P, Jostad C, Johnson B, Gatheridge B J, Neighbors C. An evaluation of the social support element of simplified habit reversal. Behavior Therapy 2005; 36: 35-42.
Woods DW, Miltenberger RG. Habit Reversal: A Review of Applications and Variations. Journal of behavior therapy and experimental psychiatry 1995; 26: 123-131.
Tanaka OM, Vitral RW, Tanaka GY, Guerrero AP, Camargo ES. Nailbiting, or Onychophagia: A Special Habit. American journal of orthodontics and dentofacialorthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 2008; 134: 305-308.
Ghanizadeh A, Mosallaei S. Psychiatric Disorders and Behavioral Problems in Children and Adolescents with Tourette Syndrome. Brain & development 2009; 31: 15-19.
Ghanizadeh A. Association of Nail Biting and Psychiatric Disorders in Children and Their Parents in a Psychiatrically Referred Sample of Children. Child and adolescent psychiatry and mental health 2008; 2: 13.
Ghanizadeh A. Can Behavioral Sensory Processing Problems Guide Us to a Better Pharmacological Management of Children with Attention Deficit Hyperactivity Disorder?: A Case Report. Psychiatry (Edgmont (Pa: Township)) 2009; 6: 40-43.
Dufrene BA, Steuart Watson T, Kazmerski JS. Functional Analysis and Treatment of Nail Biting. Behavior modification 2008; 32: 913-927.
Twohig MP, Woods DW. Evaluating the Duration of the Competing Response in Habit Reversal: A Parametric Analysis. Journal of applied behavior analysis 2001; 34: 517-520.
Azrin NH, Nunn RG, Frantz SE. Habit Reversal Vs. Negative Practice Treatment of Nailbiting. Behaviour research and therapy 1980; 18: 281-285.
Twohig MP, Woods DW, Marcks BA, Teng EJ. Evaluating the Efficacy of Habit Reversal: Comparison with a Placebo Control. The Journal of clinical psychiatry 2003; 64: 40-48.
Woods DW, Miltenberger RG. Tic Disorders, trichotillomania, and other repetitive behavior disorders. behavioral approaches to analysis and treatment. USA: Springer; 2006.
Goodman R. The Strengths and Difficulties Questionnaire: A Research Note. Journal of child psychology and psychiatry, and allied disciplines 1997; 38: 581-586.
Ghanizadeh A, Izadpanah A, Abdollahi G. Scale validation of the strengths and difficulties questionnaire in Iranian children. Iran J Psychiatry 2007; 2: 65-71.
Goldberg DP, Hillier VF. A Scaled Version of the General Health Questionnaire. Psychological medicine 1979; 9: 139-145.
Kelley ML, Heffer RW, Gresham FM, Elliott SN. Development of a modified treatment evaluation inventory. Journal of Psychopathology and Behavioral Assessment 1989; 11: 235-247.