Yale School of Nursing, Yale University's Graduate Nursing Programs

Teaching Children with Tourette Syndrome to Control Tics

May 1, 2010

Professor Lawrence Scahill.A study co-led at Yale University found that children and adolescents with Tourette syndrome (TS) can manage chronic tics using a form of behavior therapy as an alternative to medication. Results of the study, conducted at several leading US medical centers, were published in the May 19 issue of the Journal of the American Medical Association (JAMA).

Severe cases of TS are traditionally treated with antipsychotic medications, which are effective but come with side effects. Principal investigator Professor Lawrence Scahill, Professor at the Yale Child Study Center and Yale School of Nursing, explained, "The development of an effective non-medication treatment for children with the disorder is a real therapeutic advance. This study makes a strong case for behavior therapy, either as a stand-alone treatment or as an adjunct to medication."

TS, which affects about six children per 1,000, is a chronic neurological disorder characterized by motor and vocal tics such as eye blinking, grimacing, head jerking, throat clearing, sniffing, and grunting. Their severity can range from a minor interruption in daily living to being disruptive and socially isolating.

Researchers developed a specialized form of therapy called Comprehensive Behavioral Intervention for Tics (CBIT) to help children recognize when a tic is about to occur. Children as young as nine can recognize an urge that comes before the tic, like a sneeze or an itch. The children in the study, aged 9 to 17, were taught to replace the tic with a voluntary action until the urge passed. The study found that of the 126 children studied, more than half (52.5%) experienced significant improvements, compared with 18% in the control group.

Scahill and his colleagues are working with the Tourette Syndrome Association and Centers for Disease Control and Prevention to teach CBIT to clinicians who treat children with TS. Other current studies are using neuroimaging to examine how CBIT works. "This study expands the range of clinicians who can treat this condition—medication is no longer the only treatment," said Scahill.

The work above was funded in part by the National Institute of Mental Health, with additional support from the Yale Clinical and Translational Science Award grant from the National Center for Research Resources at the National Institutes of Health.