Tics are involuntary, repetitive movements such as eye blinking, facial grimaces or sniffling noises. Onset of tics can occur as early as age 3, and tics can worsen in teenagers and sometimes persist into adulthood. Tourette's disorder is a neurological condition characterized by both motor and vocal tics. Regardless of the type of tic disorder, tics can be debilitating and have a tremendous impact on a child's self esteem and emotional well being.
CBIT, or cognitive behavioral intervention for tics, is a behavioral therapy which decreases tics. CBIT is the first line treatment for Tourette's disorder and other Tic Disorders. For doctors who specialize in treating Tourette's disorder, CBIT is a welcome addition to our toolkit of treatments for tics. Many of the medications that are used to treat tics can cause sedation and other long term side effects. Understandably, many parents are hesitant to accept medication and as a psychiatrist, I am always weighing the risks of medication with the benefits related to decreased tics. If your child has distress or impairment related to their tics, CBIT is a great option to decrease tics and improve quality of life. CBIT has been studied extensively and can be effective in children as young as 6 years old.
CBIT is a manual based therapy that takes place over the course of a few weeks. 8-10 sessions are usually adequate, although treatment can be shorter or longer, depending on the case. It is very important for family or a support network to be involved in the treatment. The first component of CBIT is awareness training. The therapist works with the child to understand which tics cause the most difficulty, and to gain a greater awareness of the premonitory urge-the warning signs that a child feels before he or she tics. Once the child is more aware of the tics, she will work with the therapist to identify a competing response: an action to perform whenever she feels the urge that will physically prevent her from performing the tic.
Developing an appropriate competing response can be challenging--the therapist will work with your child to identify a behavior that is less distracting than the tic, and that can be performed anywhere and at anytime. For instance, the therapist may help develop a competing response to a vocal tic that involves rhythmic breathing. The next step is practice, practice, practice. As the child practices the competing response, he will be able to retrain his brain not to respond to the premonitory urges. Tics can be greatly reduced.
The final aspect of this treatment is a functional intervention. Although tics are involuntary movements with a neurological basis, they wax and wane: they worsen or improve depending on the situation. For example, tics may worsen at the dinner table when everyone focuses and comments on them, leading the child to have increased stress. A functional intervention would involve changing the way that family members respond, and teaching the child relaxation techniques for high stress environments.
Once a child completes CBIT, he can often generalize the skills he has learned to help with new tics that arise in the future. This is a wonderful therapy, and I would encourage parents to consider this treatment. Of course, not every child will succeed with treatment. A child must be motivated to practice the skills he or she is learning in therapy. Sometimes, tics can be more distressing to parents than they are to children. ADHD, OCD and other anxiety disorders can frequently co-occur with Tourette's disorder. If a child is unable to focus or more distressed by other symptoms, it may make sense to start treatment focusing on the most distressing symptom: medication and skills training for ADHD or treatment for anxiety.
I recently attended an intensive training course on CBIT at Northwell LIJ hospital sponsored by the Tourette's Association of America. I received training from the foremost experts in the field and was delighted to meet professionals in many other fields such as neurology, occupational therapy, and psychology. We all have the common goal of making this treatment more accessible. This treatment has revolutionized the landscape for treating Tourette's and I am delighted to offer CBIT, along with many other treatments for Tourette's and associated conditions, in my private practice.