Tic Disorder

Treatments

Treatment Summary: A child with vocal tic discords usually tic in the forms of loud/soft coughing, clearing of the throat, grunting and forceful exhales just to name a few. Children with chronic vocal tic disorder are often unaware each time a tic or other repetitive behavior occurs, and that repetitive behaviors often follow an urge or feeling of discomfort which is only relieved by engaging in the behavior itself. The way Simplified Habit reversal treatment works is that the child is videotaped shown the videotape of them self and is made aware of their behavior. In treatment over the span of three weekly sessions the child is provided with relief strategies that replaced the unwanted behavior with a less bothersome behavior. Once the tics have been replaced with another behavior child is to practice the new responses in front of a mirror to show that it is not noticeable to others and to become more comfortable with this new behavior. The child should be encouraged to use the competing response whenever he notices himself doing the repetitive behavior or even feels the urge to do so. Parents should praise their child’s correct use of the competing response and remind the child to use it when he is engaged in the repetitive behavior. Praise should also be used whenever the behavior is reduced in frequency. 

• Reference: JOHN PIACENTINI, S. C. (2005). Habit Reversal Training for Tic Disorders in Children and Adolescents. BEHAVIOR MODIFICATION, 29 (6 ), 803-823. 

• Submitter: Shameek Gray-Jones 

Open Label Aripiprazole 

Treatment Summary: Aripiprazole medication was used to treat students with severe tic disorders. Students began treatment with a small dosage (1.25 mg) and gradually increased dosage (1.25 mg – 2.5 mg) a week, but could not exceed 15 mg. Aripiprazole was well tolerated and showed significant evidence in decreasing the tic severity. Treatment-emergent side effects included headache, nausea, irritability, restlessness, inattention, and urination. All side effects were mild or moderate severity; none was severe enough to cause aripiprazole discontinuation or early study termination. The most common side effect was weight gain. 

• Reference: Murphy, TK., Mutch, J., Reid, JM., Edge, PJ., & Storch, EA. (2009). Open label aripiprazole in treatment of youth with tic disorders. Journal of Child and Adolescents Psychopharmacology, 19(4), 441-447. 

• Submitter: Anna Vazquez 

Habit Reversal Treatment (HRT) 

Treatment Summary: Habit Reversal Treatment is a series of steps that include recording a baseline, making the patient aware of the tic through describing and acknowledging tics, interjection of a competing response to tics and antecedents, and support from others (primary caregiver if patient is a child). The supporting person praises and prompts the patient. After the baseline is acquired, the patient is made aware of tics through therapist stimulated tics if necessary. Antecedents are also described by the patient. Then competing response training is begun. The alternate behavior, such as diaphragmatic breathing is modeled and practiced. Lastly social support is provided through praise for follow through of process and through prompting as necessary. 

• Reference: Cook, C., & Blacher, J. (2007). Evidence-based psychosocial treatments of tic disorders. Clinical Psychology: Science & Practice 14(3), 252-267. Woods, D. W., & Twohig, M. P. (2002). Using habit reversal to treat chronic vocal tic disorder in children. Behavioral Interventions 17(3), 159-168. 

• Submitter: Cynthia Gumbert 

Medications 

Treatment Summary: The medications guanfacine and clonidine are two alpha2 adrenergic agents that were originally developed to lower blood pressure in adults. The main side effects of these two drugs are sedation, sometimes accompanied by irritability and unwanted effects may need dose reduction or a change of the drug. Several typical and atypical neuroleptics are frequently used for treatment of Tourette’s. Pimozide, haloperidol, sulpiride and tiapride are the most frequently used typical neuroleptics and risperidone and ziprasidone are atypical neuroleptics. Sulphide is a substituted benzamide and a dopamine-2 antagonist, which has been widely used in Europe. According to research, neuroleptics drugs rarely show additional improvement in tics and very often produce bothersome side effects. The side effects include sedation, dysphoria, weight gain, separation anxiety and refusing to attend school. The medication olanzapine has been proven to also be helpful in treating Tourette’s syndrome. Olanzapine administration was associated with noticeable improvement by reducing total tic frequency, intensity, interference impairment and severity. In addition, it decrease disruptive behavior and reduced frequency of aggressive outburst. 

• Reference: Leckman, J. F. (2002). Tourette’s syndrome. The Lancet, 360(9345), 1577-1587. McCracken, J. T., Suddath, R., Chang, S., Thakur, S., & Piacentini, J. (2008). Effectiveness and tolerability of open label olanzapine in children and adolescents with Tourette syndrome.Journal of Child and Adolescent Psychopharmacology, 18(5), 501-508. 

• Submitter: Valerie Parker 

Temporomandibular Joint Balancing Appliance 

Summary of Treatment: A new approach focusing on the temporomandibular joint and its effects on Tourette Syndrome was the focus of a study (Kwon et al., 2018) that aimed to assess the effect of orthopedic skill combined with traditional medicine. The balance of the temporomandibular joint can be diagnosed and treated through a technique called functional cerebrospinal technique (FCST). Three participants were diagnosed, then fitted with a customized oral orthopedic device. Concurrently, they received acupuncture treatments, and herbal medicines. Three assessments were taken. Visual analogue scale (VAS) analysis, the Yale Global Tic Severity Scale (YGTSS), and video analysis. Treatment lasted between 357 and 450 days. Tics were reduced almost immediately, and treatment concluded with the loss of almost all symptoms. The herbal medicines did not have a noticeable effect. 

• Reference: Kwon, O. S., Lee, S. M., Choi, K.-H., Lee, Y. J., & Jung, J. Y. (2018). Effects of orthopedic treatment using temporomandibular joint balancing appliance (TBA) at improving the symptoms of tic/Tourette syndrome: case report. Integrative Medicine Research, 7(4), 381–386. https://doi-org.tamuct.idm.oclc.org/10.1016/j.imr.2018.06.003 

• Submitted by: Tanja Vaughn