Children Can Be Taught to Manage Tourette Syndrome Tics

Yale School of Medicine researchers and their colleagues have used a non-medication behavioral intervention to reduce chronic tics in children and adolescents with Tourette syndrome (TS).

The team found that a specialized form of behavior therapy called Comprehensive Behavioral Intervention for Tics (CBIT) reduced tics in a sample of 126 subjects.

The results of the multi-site study, conducted by investigators at Yale and several other leading U.S. medical centers, are published in the May 19 issue of the Journal of the American Medical Association (JAMA).

TS, which affects about six children per 1,000, is a chronic neurological disorder characterized by motor and vocal tics. Common tics include eye blinking, facial grimacing, head jerking, throat clearing, sniffing and grunting. Tics begin in mid-childhood and peak at the start of adolescence. In some cases, tics pose only minor interruption in daily living, but in others they are bothersome, disruptive and socially isolating.

TS has historically been treated with antipsychotic medications, which reduce tics, but have side effects that often limit their usefulness in children. CBIT is based on the idea that tics are often preceded by unwanted feelings or sensations. These unwanted sensations are temporarily relieved by tics. In CBIT, children learn to recognize when a tic is about to occur and to engage in an alternative voluntary action until the unwanted sensation passes. Parents are taught ways to promote these management strategies in their children.

“The development of an effective non-medication treatment for children with the disorder is a real therapeutic advance,” said principal investigator Lawrence Scahill, a professor at the Yale Child Study Center and Yale School of Nursing. “This study makes a strong case for behavior therapy, either as a stand-alone treatment or as an adjunct to medication.”

The study included 126 children ages nine to 17 with moderate to severe TS who were randomly assigned to receive either CBIT or supportive counseling and education about TS. About one-third of the children in the study were on a stable dose of anti-tic medication.

In the study, 52.5 percent of children receiving CBIT were rated as significantly improved, compared to 18.5 percent of those receiving supportive counseling and education. The degree of improvement with CBIT was similar to that found in recent anti-tic medication studies.

“This is an important study because it expands the range of clinicians who can treat this condition—medication is no longer the only treatment,” said Scahill.

Scahill and his colleagues are currently working with the Tourette Syndrome Association and the Centers for Disease Control and Prevention to teach CBIT to clinicians who treat children with tic disorders. Studies using neuroimaging and related techniques are also underway at various centers to examine how CBIT works.

The work above was funded in part by the National Institute of Mental Health, with additional support from the Yale Clinical and Translational Science Award (CTSA) grant from the National Center for Research Resources at the National Institutes of Health.

Other authors on the study included James Dziura at Yale; and John Piacentini, Douglas W. Woods, Sabine Wilhelm, Alan L. Peterson, Susanna Chang, Golda S. Ginsburg, Thilo Deckersbach, Sue Levi-Pearl and John T. Walkup, M.D. from collaborating institutions.

Citation: JAMA Vol. 303, No. 19 (May 19, 2010)

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