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Behavior therapy reduces tics in children with Tourette syndrome, study finds

by Jordan K. Turgeon
June 02, 2010

Related Links

Tourette Syndrome Association Behavior Therapy for Children With Tourette Disorder: A Randomized Controlled Trial (JAMA article)

Tourette Syndrome Quick Facts

- Tourette syndrome is "a neurobiological disorder characterized by tics - involuntary, rapid, sudden movements and/or vocal outbursts that occur repeatedly."

- About 200,000 Americans have Tourette syndrome, but the disorder often goes undiagnosed.

- "Coprolalia," or the use of obscene language, is rarer than the public might think. It affects fewer than 15 percent of Tourette syndrome patients.

-Tourette syndrome symptoms typically show between 5 and 18 years of age.

SOURCE: Tourette Syndrome Association

A new behavior therapy could help children with Tourette syndrome manage their tics without use of medications, according to a multi-site study published in the Journal of the American Medical Association.

“The available medications for treating Tourette’s aren’t really that great,” said John Piacentini, lead study author and psychiatry professor at the University of California at Los Angeles. “They are reasonably effective, but most are associated with some pretty significant side effects.”

The non-medication therapy, called comprehensive behavioral intervention for tics – or CBIT – uses two different techniques to treat a child’s tics: functional intervention and habit reversal therapy.

Functional intervention requires taking a look at the child’s environment and altering it to reduce the child’s tics.

“In folks with Tourette’s, the environment they’re in really plays a role in how frequently and how intensely the tics are expressed,” said Doug Woods, University of Wisconsin-Milwaukee professor and study author. “We find the situations that make the tics flare up and then modify the environment.”

For example, a child’s tics might lessen while he’s playing sports. Or, if a child’s tics worsen when teachers or peers comment on them, those individuals would be encouraged to ignore or reduce the number of comments made about the child’s tics, Woods said.

Habit reversal therapy, the second component of CBIT, is something that’s been around since the 1970s, Piacentini said. The child is taught to notice the tics, or the urges to tic, and then do something that physically prevents them from doing so – a “competing response.”

“They describe having an unwanted sensation, a tickle sensation or feeling that occurs before the tic, and then they engage in the tic to make it go away – like the urge to scratch an itch, only much stronger,” Piacentini said.

Say a child has a head-shaking tic, Piacentini explained. When he feels the need to tic, the child is taught to stare straight ahead and gently tense his neck muscles just enough to outweigh or counter the tic. If the child has a vocal tic, they can engage in slow, rhythmic breathing. The child does this competing response for a minute or until the urge to tic goes away.

“What we find is that the urge [the child] reports before the tic will gradually go away over time,” Woods said.

Approximately one-third of the children ages 9 to 17 involved with the study were already taking anti-tic medication. Both these children and children not taking anti-tic medication saw improvement with the CBIT therapy.

Some children diagnosed with Tourette syndrome require no treatment at all, and others with more severe tics can be helped by medication, Woods said. He sees CBIT as best benefitting those children who fall somewhere in the middle.

“A large group of kids with Tourette syndrome, whose parents are reluctant to put the child on medications, but they know [the child] could benefit from something, that’s where CBIT has its best chance of playing a major role in Tourette’s,” Woods said.

Some side effects associated with anti-tic medications include impaired cognitive function, sedation and weight gain, according to the National Institutes of Health.

One concern researchers have about CBIT is the possible backlash it might receive, because it’s a non-medical treatment used to treat a medical condition, Woods said. People might misconceive the tics as voluntary and easily controllable if children are taught to stop them without medication, he said.

Another misconception is the public’s understanding of “coprolalia,” or the use of obscene language. In reality, less than 15 percent of Tourette syndrome patients have this syndrome, according to the Tourette Syndrome Association.

“Oftentimes, the public feels that Tourette syndrome kids may be doing this for attention, or to get out of things, or that they can control the symptoms,” Piacentini said. “Unfortunately, for the kids who do have coprolalia, they tend to say the worst things at the worse time. People wouldn’t do this if they had the choice.”

Researchers are now using neuroimaging techniques to study how CBIT affects the brain. They are also adapting the behavior therapy for use with younger children.

“It’s a very empowering treatment,” Piacentini said. “We’re teaching lifelong strategies that [children with Tourette syndrome] can use to manage their tics.”