Tic Disorder and Tourette Syndrome

Tic Disorders and Tourette Syndrome are neurological disorders associated with motor or vocal tics that can be embarrassing and disruptive.

Tic Disorder

A tic is a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization. Tic Disorders are characterized as frequent involuntary motor or vocal tics, such as head jerking or throat clearing. Tics can occur in flurries and tend to wax and wane in severity and intensity over time. . Simple tics often appear first, with complex tics developing later. Simple tics include eye blinks, head jerks, facial grimaces, coughs, etc. and or complex, slow, and more purposeful ones can include smelling things, touching things, shouting obscenities, counting things, tracing objects, and repeating heard words or phrases. Tics typically begin in childhood, peak in early adolescence and often decrease by adulthood. For some adults, the tics persist and cause substantial impairment. By adulthood, tics tend to abate or be absent entirely. In 15% of adults, tics continue to present moderate problems, and 10% experience severe problems with tics.

Tourette Syndrome

Tourette Syndrome is defined as both multiple motor and vocal tics while a Tic Disorder involves motor or vocal tics but not both. Tourette Syndrome is diagnosed when multiple motor tics and one or more phonic tics are present during the course of the disorder. For tic disorders and Tourette syndrome, the tics may occur many times a day (usually in bouts), nearly every day or intermittently throughout a period of more than one year, and during this period there was never a tic-free period of more than 3 consecutive months.

Despite widespread publicity, the involuntary use of obscene or socially inappropriate words is uncommon with tic disorders.

Involuntary Ticks

The term “involuntary” can be confusing since most people with tics do have some control over their symptoms. Many individuals with tic disorders describe an unwanted urge or sensation prior to the tic that is relieved only by performing the tic. Typically, tics increase as a result of tension or stress, and decrease with relaxation or when focusing on an absorbing task. It is common for people with tic disorders to have co-occurring conditions, particularly attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD).

Treatment

Historically, medication treatment was considered the only treatment for tics. Recent research shows that behavior therapy can help children and adults learn to tolerate their urges and suppress their tics without rebound effects. In the CBT model, the goal is to increase awareness of premonitory urges so the person with tics can gain some feeling of control by learning to tolerate the discomfort of urges without having to give into the urge as well as learning competing responses to the tic. In addition, managing environmental contingencies and stressors can help reduce the frequency of tics.

The two primary evidence-based treatments for tic disorders are CBT intervention called Habit Reversal and Comprehensive Behavioral Intervention for Tics (CBIT).

CBIT

CBIT is a non-drug treatment consisting of three important components:
(a) training the patient to be more aware of tics,
(b) training patients to do competing behavior when they feel the urge to tic, and
(c) making changes to day to day activities in ways that can be helpful in reducing tics.

Habit Reversal

Habit Reversal has two main parts: awareness training and competing response training. In the awareness training part, you will learn to identify each tic out loud. In the competing response part, you will learn to do a new behavior that cannot happen at the same time as the tic. For example, if you have a tic that involves touching a body part such as head rubbing, a new behavior might be to place your hands on your knees, or to cross your arms so that the tic cannot take place.

Resources:
  • (Comprehensive Behavioral Intervention for Tics by Douglas Woods, Ph.D., John Piacentini, Ph.D., A.B.P.P. & John T. Walkup, M.D)