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Treatment of Tic Disorders and Recommended Reading

Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

Not surprisingly, children and families affected by Tic Disorders are often frightened and confused by symptoms, and are distressed about what these symptoms might mean for the children's long term adjustment and functioning. Accordingly, one of the very first treatment tasks a therapist will take on is educational in nature. By educating children and families concerning the nature of Tic Disorders, therapists are able to alleviate some distress.

father and son talkingEducation about Tic Disorders is followed up by teaching affected children effective methods for controlling their tics. Habit Reversal Training, the most common behavioral treatment for Tic Disorders, consists of multiple coordinated treatment components including Awareness Training, Competing Response Training, Relaxation Training, Relaxation Training, Generalization Training, and Contingency Management.

In Awareness Training, affected children are helped to become aware of the time, duration, and complexity of their tics through self-monitoring (e.g., recording when and what occurred, and how long the behavior continued), and by watching video recordings of themselves. As a part of learning how to self-monitor, children are taught to identify and note any situations that improve or worsen (trigger) tic symptoms.

In Competing Response Training, therapists teach children to engage in activities which are incompatible with Tic Behaviors. Incompatible behaviors cancel out tic behaviors and keep them from occurring. For example, to combat vocal tics, a child can practice breathing through his nose in long slow breaths while keeping his mouth closed. It is not possible to act out vocal tics when doing this breathing exercise. Of course, a breathing technique which interferes with vocal production doesn't work for motor tics. Instead, some other behavior capable of interfering with movement would need to be identified and used.

Therapists also teach children Relaxation Training, or techniques such as deep breathing, visual imagery (imagining calming places), and progressive muscle relaxation. These tools can help children maintain a calm, focused demeanor during stressful events, which can combat tic behavior. Because tics are typically stress-linked (i.e., they occur with greater frequency and are triggered by stress), children who can learn to remain calm under fire will tend to produce less tic behaviors.

Coping techniques such as competing response and relaxation strategies help children gain better control over their tics, but sometimes treatment gains remain localized to particular settings. For instance, children may be able to use a relaxation technique within the home, but have difficulty using that same technique at school, where there is less privacy and more stress. Therapists use Generalization Training to encourage children to practice their skills in all of the relevant environments where they display tics, modifying each technique as necessary to allow its application within different settings. As practice makes perfect, children are also encouraged to practice tic coping measures repeatedly within and across all settings so as to encourage mastery and over-learning of those techniques. The goal is to make children's application of coping techniques second nature in all relevant settings.

Contingency management training, the final component of habit reversal training, occurs when therapists and children conduct periodic reviews of progress in controlling tic behaviors. In the course of these reviews, children receive praise from family, friends, and therapists for their accomplishments, and are challenged to learn and test out new coping techniques in different settings.

In addition to habit reversal training, family therapy and other school-based interventions, psychoactive medications are sometimes prescribed with the goal of reducing the amount and severity of children's tics. Antipsychotic medications such as Haloperidol and Risperidone which are commonly used to treat schizophrenia, mania, aggression, and self-injurious behavior have also been used to treat Tic Disorders. Caution is warranted when these medications are used as they are associated with serious side effects such as akathisia (an unpleasant subjective sensation of "inner" restlessness that makes people unable to sit still), Parkinson's like behaviors (such as a shuffling walking style and tremors), insomnia, weight gain, depression, and panic attacks.

For more information on Tic Disorders, you may want to visit the Family Doctor's website on Tics and Tourette's Syndrome in children. You can also visit our Tourette's Syndrome topic center for more information on this condition.

Recommended reading:

Tics and Tourette Syndrome: A Handbook for Parents and Professionals by Uttom Chowdhury and Isobel Heyman

Children With Tourette Syndrome: A Parent's Guide, Edited by Tracy Lynne Marsh

I Can't Stop!: A Story About Tourette Syndrome, by Holly L. Niner

 

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