- New research debunks Tourette’s syndrome myths and lays the groundwork for a behavioral intervention.
It is agreed by most researchers, Tourette’s syndrome is mainly biological. Some of the characteristics of the disorder are tics such as head jerks, eye blink and grunts, which all stem from the basal ganglia or with dopamine function. People with the disorder experience these tics usually involuntarily which would make Tourette’s a poor candidate for behavior therapy.
“For the last 50 years, Tourette’s has been considered a neurological disorder with very little role for behavioral interventions,” Piacentini says.
However, previously people believed that the tics of Tourette’s could only be stopped by medication, new research indicates that environmental contingencies play a role in tic expression. For instance, people suppress tics if they are rewarded for doing so, according to several recent studies. Unfortunately, many medical professionals still falsely believe that holding in tics leads to an explosion of tics later.
The treatment, known as the Comprehensive Behavioral Intervention for Tics, (CBIT) combines behavior therapy with an attempt to root out anything that might be inadvertently rewarding tic attacks.
The findings also show that people can control their tics–especially if rewards are involved, Woods adds. That is an important foundation for therapy; however, chasing after clients with a coin-dispensing “tic suppressor” would not be a good way to help them control their behavior, he notes.
“Behavioral interventions for tics…have never been shown to have more than modest potential benefit,” he notes. For that reason, people with Tourette’s are generally prescribed medications like risperidone, an antipsychotic, or clonidine, a blood pressure medication. The drugs do reduce tics, but the side effects are often worse than the symptoms they treat, says Woods. Unfortunately though, the antipsychotics have a 70-80 percent tic reduction and children may experience weight gain, fatigue, and dry mouths. Also many parents just do not want to put their children on medication.
Therefore, the National Institute of Mental Health, with help from the Tourette Syndrome Association is looking for an alternative treatment. Currently, they are testing CBIT with 120 adults and 120 children in a randomized controlled trial. The intervention hinges on findings that show Tourette’s tics can be affected by environmental and internal reinforcement. While a tic attack in the lab might be discouraged by a token reward system, in school it might be discouraged by the likelihood of teasing. Or, alternatively, a child who gets out of doing household chores due to a tic attack might tic more when it’s time to wash dishes, notes Joyce Chang Lee, PhD.
Lee and her colleagues also teach children to break the internal reward system for doing tics. Many people with Tourette’s syndrome report a premonitory urge or sensation right before they flinch or flail, notes Lee. So, over the course of eight one-hour sessions, she teaches them to be aware of that feeling and then perform a quick countermeasure to quash the tic. These alternative methods do not get to the root causes of tics but it is a way to have a reduction in tics with an improvement of the same amount that medication will offer.
Dingfelder, S. (2006). “Nix the Tics” Voc 37, No. 11. Pg. 18. American Psychological Association.