Treatment for Tics and Tourette Syndrome

Tic disorder and Tourette syndrome (TS) are broadly defined as rapid, repetitive, involuntary motor or vocal movements.  A fairly high percentage of school-age children (up to 25%) have tics, but we know that some tics are normal in childhood and should not be considered a problem unless they persist beyond approximately 6 months or unless they begin to significantly interfere with the child’s life (such as symptoms are embarrassing to the child).  The prevalence of tic disorder may be as high as 3 percent in children, while Tourette syndrome occurs in 1-8 children per 1,000.

Dr. Dawn and I attended the Tourette Syndrome Association Training Program to learn about evidenced-based treatments for TS and tics.  The presentation reviewed components of the behavioral approach used to manage TS.  This approach is called the Comprehensive Behavioral Intervention for Tics (CBIT).  CBIT includes components tested from 2 clinical trials that were funded by the National Institutes of Health and published in the Journal of the American Medical Association (JAMA) in May 2010.   These findings were so significant that a partnership between the Tourette Syndrome Association and Centers for Disease Control and Prevention (CDC) was formed 7 years ago to disseminate the research findings to practitioners to use with patients who have tics and TS.

What is CBIT?

CBIT is a behavioral approach that involves the child and family in a series of sessions.  Components of this behavioral treatment include: 1) education of the tics and CBIT treatment; 2) instruction and practicing a behavioral technique called habit reversal; and 3) functional intervention.  Children and parents are taught to become more aware of the tics and instructed in the use of competing responses to their usual tics.  The techniques are specific and the proper implementation of these techniques is critical to ensure the highest probability of success for the child.

How Effective is CBIT?

CBIT has been shown to have a reduction in symptoms for 53 percent of patients with TS compared with only 19 percent of patients who received an alternative treatment in the research study.  A high percentage (87%) of these patients who benefitted from the therapy continued to experience a significant reduction in symptoms 3 and 6 months after CBIT treatment ended.  The degree of improvement was similar to findings from research that used medication to treat TS, but CBIT has no known side effects.  Medication, on the other hand, often has side effects.   There is no medical or psychological treatment that cures TS.

Finding a Qualified Therapist

It is important to find someone who has experience in working with TS and who has received training and understands the CBIT findings.  To find a qualified therapist in your area, please contact the TSA (http://www.tsa-usa.org).  It is possible that qualified therapists may not be on the TSA referral list, but be sure to ask about their experience with CBIT when considering having them care for your child.