Tourette syndrome is a neurologic condition that often presents in childhood and is characterized by motor and vocal tics that can be simple or complex, and can range from mild to severe. CDC recently published a profile of Tourette syndrome among US children in the Journal of Developmental and Behavioral Pediatrics. [1] Based on parent-reported data from the 2011-2012 National Survey of Children's Health, we found that 1 in 360 children had ever been diagnosed with Tourette syndrome, which is similar to estimates from 2007. Compared with children without Tourette syndrome, children with this condition were three times more likely to have co-occurring neurobehavioral conditions such as attention-deficit/hyperactivity disorder and were two times more likely to have unmet mental healthcare needs. Their parents reported more parenting aggravation and were more likely to be contacted about school problems. Parents also reported having difficulty coordinating the care they needed for their child with Tourette syndrome. This is further evidence that living with Tourette syndrome can affect a person's health, education, family relationships, and well-being.
Until recently, medication was the only option for those with Tourette syndrome who needed treatment to manage their symptoms. However, medication doesn't always work, and side effects can discourage compliance with medication treatment. The good news is that a new behavioral treatment has recently been developed, called comprehensive behavioral intervention for tics (CBIT).
Like other behavioral therapies, CBIT works by teaching people with Tourette syndrome a step-by-step process to become aware of their behavior (in this case, tics), learn how to change that behavior, and identify factors or situations that exacerbate their tics. During CBIT, therapists help patients increase their awareness of tics and their urge to tic, and then to perform a "competing response," which is a behavior incompatible with the tic. For example, a competing response for a head-shaking tic could be gently tensing neck muscles. Practicing the competing response over time can help reduce or even eliminate the tic. This part of CBIT is known as habit reversal therapy.
In addition to habit reversal, in CBIT, the therapist will help the patient identify and address factors that might make tics worse—for example, stress or fatigue, or certain activities such as homework or public speaking. They will help the individual identify strategies to address the factors that are within the person's control—for example, stress relief exercises, or getting more rest.
Two randomized controlled trials[2,3] have shown that CBIT is effective for children and adults with Tourette syndrome. More than half of the children treated with CBIT had significantly less severe tics and had better measures of functioning. Among adults, 38% were much improved or very improved. And a recent meta-analysis[4]showed the effectiveness of habit reversal and CBIT overall for treating tics. These studies also show that CBIT does not work for everyone. Although more research is needed to determine when CBIT works best, and for whom, CBIT is a promising and novel approach to help people manage their tics.
Because CBIT is a relatively new treatment, health professionals are still learning about it. To educate professionals, CDC has partnered with the national Tourette Syndrome Association to provide the necessary training, and also to make sure that people with Tourette syndrome and their families know about CBIT as a treatment option.
I invite you to take a look at the listed Web resources for additional information about Tourette syndrome and CBIT so you can learn more about this treatment option for your patients and their families.
Web Resources
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