May 18, 2010 / 2:20 PM / 9 years ago

Behavior therapy matches drugs for calming tics

NEW YORK (Reuters Health) - Special behavior therapy can help reduce tics in children and teens with Tourette syndrome about as well as medications typically given for the neurological disorder, according to new research published in JAMA/Journal of the American Medical Association.

This finding was “pretty exciting to us,” Dr. John Piacentini of the University of California at Los Angeles, who was involved in the research, told Reuters Health. “One of the benefits of the behavior treatment is it was also associated with no side effects,” he explained.

This is in contrast to the medications for Tourette syndrome, which, at times, can have “serious” side effects, the researcher noted. Medications used to treat Tourette syndrome include drugs typically used to treat psychotic adults, such as risperidone (Risperidol) and haloperidol (Haldol); their adverse effects can include sedation, weight gain, and movement problems.

People with Tourette syndrome may have physical tics, vocal tics, or both. Typically, Piacentini explained, a person will feel an unpleasant sensation they can relieve by performing the tic. This reinforces the tic, which eventually becomes virtually automatic.

The new behavior therapy, developed by Piacentini and his team and based on decades-old strategies for behavior modification, involves helping a person recognize when they are feeling the urge to tic, and training them to perform a voluntary movement instead.

A child who jerks his arm outward might be instructed to gently tense their arm muscles and hold the arm into their stomach or chest, the researcher said; with vocal tics, such as sniffing, grunting, or saying words, “We would have them do slow rhythmic breathing in a pattern opposite to what they would need to do to make the sound.” This is in contrast to trying forcefully to suppress a tic, the researcher noted, which can actually make it worse.

The second part of the therapy requires identifying situations that can trigger tics or make them worse, and helping children and their parents find ways to avoid them or cope with them. For a child who’s teased, this could mean speaking to family members and teachers to make sure it stops; for a child whose Tourette’s worsens when he’s anxious, this could involve teaching him relaxation techniques.

In the study, 126 children with moderate to severe Tourette syndrome were randomly assigned to undergo the behavior training — dubbed comprehensive behavioral intervention for tics, or CIBT — delivered in 8 sessions across 10 weeks, or to a control group who spent the same amount of time in supportive therapy and education sessions. All of the children were between 9 and 17 years old.

Piacentini and his team used the Yale Global Tic Severity Scale to assess severity of tics before and after treatment.

Almost 53 percent of the children who received CIBT were rated as “very much improved or much improved,” compared with 19 percent of those who did not receive CIBT and the degree of improvement with CIBT was similar to that seen in recent anti-tic medication studies, the researchers report.

The children who got the behavior therapy also saw greater improvements in psychological, social and school functioning than children in the control group.

The results “certainly suggest that the child that received CIBT significantly improved in terms of the overall quality of their lives,” Piacentini told Reuters Health.

At follow up, 87 percent of the children who had responded to treatment were still showing benefit six months later.

With drugs, the Piacentini noted, symptoms usually return when a person stops taking the medications. And while Tourette syndrome often improves as a child gets older, many people experience a waxing and waning of symptoms. According to Piacentini, CIBT doesn’t “cure” Tourette’s, but gives people a tool to manage their symptoms that they can turn back to any time when their tics worsen or reappear.

“Many of the children and families found this to be a very empowering experience,” he said. “These are lifelong skills they are learning.”

Tourette syndrome affects an estimated 148,000 U.S. children, many of whom have other disabilities such as attention deficit hyperactivity disorder, according to a survey by the Centers for Disease Control and Prevention released last year.


JAMA/Journal of the American Medical Association, May 19, 2010.

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