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Treatments

Smiling girl standing with arms crossedAlthough there is no cure for Tourette Syndrome (TS), there are treatments to help manage the tics caused by TS. Many people with TS have tics that do not get in the way of their living their daily life and, therefore, do not need any treatment. However, medication and behavioral treatments are available if tics cause pain or injury; interfere with school, work, or social life; or cause stress.

Educating the community (for example, peers, educators, and coworkers) about TS can increase understanding of the symptoms, reduce teasing, and decrease stress for people living with TS. People with TS cannot help having tics, and are not being disruptive on purpose. When others understand these facts, people with TS might receive more support, which might, in turn, help lessen some tic symptoms.

It is common for people with TS to have co-occurring conditions, particularly attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). People with additional conditions will require different treatments based on the symptoms. Sometimes treating these other conditions can help reduce tics. To develop the best treatment plan, people with tics, parents, and health care providers should work closely with one another, and with everyone involved in treatment and support—which may include teachers, childcare providers, coaches, therapists, and other family members. Taking advantage of all the resources available will help guide success.

Prescription bottlesMedications

Medications can be used to reduce severe or disruptive tics that might have led to problems in the past with family and friends, other students, or coworkers. Medications also can be used to reduce symptoms of related conditions, such as ADHD or OCD.

Medications do not eliminate tics completely. However, they can help some people with TS in their everyday life. There is no one medication that is best for all people. Most medications prescribed for TS have not been approved by the U.S. Food and Drug Administration (FDA) for treating tics.

Medications affect each person differently. One person might do well with one medication, but not another. When deciding the best treatment, a doctor might try different medications and doses, and it may take time to find the treatment plan that works best. The doctor will want to find the medication and dose that have the best results and the fewest side effects. Doctors often start with small doses and slowly increase as needed.

As with all medications, those used to treat tics can have side effects. Side effects can include weight gain, stiff muscles, tiredness, restlessness, and social withdrawal. The side effects need to be considered carefully when deciding whether or not to use any medication to treat tics. In some cases, the side effects can be worse than the tics.

Even though medications often are used to treat the symptoms of TS, they might not be helpful for everyone. Two common reasons for not using medications to treat TS are unpleasant side effects and failure of the medications to work as well as expected.

Learn more about medications »

Behavioral Therapy

Behavioral therapy is a treatment that teaches people with TS ways to manage their tics. Behavioral therapy is not a cure for tics. However, it can help reduce the number of tics, the severity of tics, the impact of tics, or a combination of all of these. It is important to understand that even though behavioral therapies might help reduce the severity of tics, this does not mean that tics are just psychological or that anyone with tics should be able to control them.


Habit Reversal

Habit reversal is one of the most studied behavioral interventions for people with tics1. It has two main parts: awareness training and competing response training. In the awareness training part, people identify each tic out loud. In the competing response part, people learn to do a new behavior that cannot happen at the same time as the tic. For example, if the person with TS has a tic that involves head rubbing, a new behavior might be for that person to place his or her hands on his or her knees, or to cross his or her arms so that the head rubbing cannot take place.


Student and teacher having a conferenceComprehensive Behavioral Intervention for Tics (CBIT)

CBIT is a new, evidence-based type of behavioral therapy for TS and chronic tic disorders. CBIT includes habit reversal in addition to other strategies, including education about tics and relaxation techniques2. CBIT has been shown to be effective at reducing tic symptoms and tic-related impairment among children and adults.

In CBIT, a therapist will work with a child (and his or her parents) or an adult with TS to better understand the types of tics the person is having and to understand the situations in which the tics are at their worst. Changes to the surroundings may be made, if possible, and the person with TS will also learn to do a new behavior instead of the tic (habit reversal). For example, if a child with TS often has a certain tic during math class, the math teacher can be educated about TS, and perhaps the child’s seat can be changed so that the tics are not as visible. In addition, the child also can work with a psychologist to learn habit reversal techniques. This helps to decrease how often the tic occurs by doing a new behavior (like putting his or her hands on his or her knees when an urge to perform the tic happens). CBIT skills can be learned with practice, with the help of an experienced therapist, and with the support and encouragement of those close to the person with TS.

In recent years, more health professionals have recognized that behavioral therapy can be very effective in managing the symptoms of TS. Unfortunately, very few clinicians have been trained in these types of treatments specifically for TS and tic disorders. The Centers for Disease Control and Prevention (CDC) and the Tourette Syndrome Association (TSA) have been working to educate more health professionals in this approach to managing TS symptoms.

TSA is offering FREE training programs on CBIT for Health Professionals

Learn about CBIT training programs »


Parent Training

Children with TS and related conditions and their families also can benefit from parent training, which has been shown to be successful among children with both TS and other disruptive behaviors. Parent training also has been shown to be helpful for children with ADHD. Parent training helps parents better understand their child’s behavioral issues and learn parenting skills specific to these problems. The training might include learning about the effective use of positive reinforcement and discipline that is effective with their particular child.

For More Information

Additional information on treatment for TS can be found at the following links:

Movement Disorders, The Management of Tics (2009)

Pediatric Psychopharmacology: Psychopharmacology of Tic Disorders

Alternative Therapies

National Institutes of Health Fact Sheet

Tourette Syndrome Association

TSA CBIT Video

 

References

  1. Cook CR, Blacher J. Evidence-based psychosocial treatments for tic disorders. Clin Psychol: Science and Practice. 2007;14(3):252–67.
  2. Piacentini J, Woods DW, Scahill L, Wilhelm S, Peterson AL, Chang S. Behavior therapy for children with Tourette disorder: a randomized controlled trial. JAMA. 2010;303(19):1929–37.

 

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