Researchers have confirmed that a specialized form of behavior therapy can significantly reduce chronic tics and tic-related problems in children and adolescents.
But such drugs usually don’t eliminate all the tics, and worse, they can often have side effects, acting as sedatives, causing weight gain and impairing cognitive function.
The multisite study led by a UCLA researcher used an approach called comprehensive behavioral intervention for tics, or CBIT. The non-medication treatment has shown improvement similar to that found in recent anti-tic medication studies.
Lead study author John Piacentini, a UCLA professor of psychiatry, and his colleagues at seven sites around the nation found that almost 53 percent of children receiving CBIT were rated as significantly improved, compared with 19 percent of those receiving a comparison treatment, and the degree of improvement with CBIT was similar to that found in recent anti-tic medication studies.
The study appears in the Journal of the American Medical Association (JAMA).
Tourette syndrome, which affects approximately six out of every 1,000 children and adolescents, is a chronic neurological disorder characterized by motor and vocal tics, including eye blinking, facial grimacing, head jerking, throat clearing, sniffing and grunting.
Although the repetition of curse words is often portrayed as the defining feature of the syndrome, cursing is an uncommon symptom and is not required for diagnosis of the disorder.
“Besides its physical manifestations, Tourette syndrome can cause a number of other problems,” Piacentini said.
“It is often associated with other psychiatric problems, difficulties in school, work and social functioning, and, in severe cases, can be disabling.
“Historically, Tourette syndrome has been treated with antipsychotic medications, which reduce tics but are associated with side effects that often limit their usefulness in children. So the development of an effective non-medication treatment for children with this disorder is a major therapeutic advance,” he said.
CBIT is built on the observation that tics are preceded by unwanted feelings or sensations which in turn are temporarily relieved by the tics. In this treatment, children learned to recognize when a tic was about to occur and to engage in a voluntary action incompatible with the tic until the unwanted sensation passed.
In addition, parents were taught how to promote these management strategies in their children and to minimize stressful situations in their children’s environments associated with tic worsening.
“The fact that CBIT works about as well as the standard medications for tics but without the negative side effects greatly expands the available treatment options for chronic tic disorders,” said Susanna Chang, a UCLA assistant professor of psychiatry and a study author.
“Importantly, CBIT also emphasizes the development of skills that foster autonomy and empowerment, allowing for patients and their families to take a more active role in treatment than previously indicated.”