Tourette’s Syndrome (TS) and Tics
Tourette’s Syndrome (TS) and Tics are neurobiological conditions that is defined by multiple motor tics and one or more vocal tics. Other kinds of Tic Disorders do might have motor but not vocal tics. A tic is “a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization” (DSM-5). The onset of TS has to be before the age of eighteen. To make the diagnosis of TS, tics have to have been present for more than one year without a tic-free period lasting more than three months. The most publicized symptom of TS is explosive cursing (coprolalia), however, this problem is not found in most of those with this diagnosis.
CBT for TS and Tics involves modifying thoughts and behaviors that trigger tics, as well as learning strategies to control tics. Specifically, Habit Reversal Training (HRT) and Comprehensive Behavioral Intervention for Tics (CBIT) are evidence supported CBT interventions for tics. These protocols involve awareness training and learning competing responses, among other skills. CBT can be used in combination with pharmacological or allied medical therapies. It can be tailored for young children or those who have additional psychological or developmental issues. Whether or not a child or adult with TS or another Tic Disorder is a good candidate for CBT depends on a number of factors, such as if they “feel” a tic coming (premonitory sense) and if they are willing to tolerate the discomfort that such treatment often entails. The response of family members is also important. Telling someone with tics to just stop or shaming them will backfire, as this creates stress and stress exacerbates tics. Having TS or tics can easily damage self-image, so helping affected individuals, especially children, understand and communicate about symptoms effectively is essential. Medications can play an important role in a comprehensive treatment plan for TS and Tic Disorders, but this must be evaluated on a case-by-case basis, weighing the potential benefits in respect to such variables as side effects, patient age and other medical or psychological conditions, and patient motivational level.