What is Tourette Syndrome? What are Tics?

Tourette Syndrome is a neurodevelopmental disorder affecting children, adolescents, and adults. Symptoms of Tourette’s consist of sudden, involuntary movements and/or sounds referred to as tics. Severity of tics can range from mild to severe and can be incredibly debilitating for those suffering. There are three Tic Disorders; they are classified based on the types of tics (motor, vocal/phonic, or both) and the length of time they are present.

Diagnosis:

Tourette Syndrome (TS),also known as Tourette’s Disorder: 1)At least 2 motor tics and at least 1 vocal (phonic) tic have been present, not necessarily at the same time. 2) Tics may come and go in frequency but have occurred for more than 1 year. 3) Tics started to appear before the age of 18.4) Tics are not caused by the use of a substance or other medical condition.
Persistent (Chronic) Motor or Vocal Tic Disorder: Either motor tics OR vocal tics have been present for more than 1 year; cannot be both motor and vocal tics.
Provisional Tic Disorder: Motor and/or vocal tics have been present for less than1 year, and have not met the criteria for TS, persistent (chronic) motor, or vocal tic disorder.
The causes of TS and other Tic Disorders remain unknown. These conditions tend to occur in families, and research has indicated a strong genetic link. There is a possibility that an individual’s environment and development may also contribute. Researchers are still working to understand how genes and other factors play a role in the development of Tic Disorders. 
In 86% of cases, those suffering from Tic Disorders also have been diagnosed with at least one of the following conditions: 
  • Attention Deficit/Hyperactivity Disorder (ADHD)
  • Obsessive Compulsive Disorder (OCD)
  • Behavioral or Conduct Issues
  • Anxiety
  • Learning Disability
  • Social Skills Deficits and Impaired Social Functioning
  • Sensory Processing Issues
  • Sleep Disorders

Treatment for TS and other Tic Disorders at CalmOCD

Treatment may be appropriate when tics become problematic and interfere with daily functioning.

Research has demonstrated that behavioral interventions and/or medication are effective in the treatment of TS. At CalmOCD the individual can work alongside a specialist to determine an appropriate treatment plan that fits the individual. The specialist may recommend first treating one of the co-occurring conditions if it is interfering with functioning to a higher degree.

Comprehensive Behavioral Intervention for Tics (CBIT)

CBIT is a behavioral therapy approach consisting of three components:

  • Training the client to be more aware of their tics and urge to tic
  • Training the client to do a competing behavior when they experience an urge to tic
  • Making changes to daily activities and the environment to help reduce the frequency of tics

CBIT Explained

Before treatment, many sufferers have already worked to utilize some of these strategies so your specialist will build off what you have already used to develop effective concepts and new techniques. Even though these disorders are neurological and involuntary, tics are often extremely sensitive to the environment in which they occur. Each person has experienced certain situations that increase their tics while also experiencing times where they have a reduction in tics. CBIT educates clients on how to create environments that are stable and predictable. A recent study showed 87% of clients who participated in CBIT continued to do well six months after leaving treatment. CBIT can not “cure” TS; however, it can be a very effective management strategy to utilize as needed.
CBIT is a highly structured treatment that is administered at least once a week by a specialist. The protocol requires at least eight sessions over ten weeks; however, treatment is adapted based on the client's needs. First, the client learns to familiarize themselves with their tics and the urges themselves. The client is then taught a competing response (Step two) to use when they notice an urge or doing the tic. The competing response makes it more challenging to complete the tic behavior. If someone struggles with frequent throat clearing, for example, their competing response may include slow rhythmic breathing. Someone with a head-shaking tic may tense their neck muscles instead. Over repeated practice, the competing response prevents the tic from being reinforced in the brain and the urges to tic eventually reduce and sometimes stop altogether. Step three, a functional intervention is implemented. During this stage, the individual identifies the daily situations that increase or decrease their tics. Times, where there is an increase in tics, may include during homework or during work presentations. The client then learns effective new strategies for managing their distress and environment. The goal is to help TS sufferers to become more self-aware of their tic urges and utilize a competing response which in turn allows them to feel more in control, confident, and empowered.

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