Tics can be a primary focus of treatment or be addressed within the context of the treatment of another condition such as OCD, Anxiety, or ADHD. Individuals with Autism Spectrum Disorder (ASD) may have tics that require treatment as well. Tics are more common than most people might realize. Not everyone with tics has a tic disorder. A disorder implies experiencing significant levels of distress and interference with functioning.

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Tourette Syndrome (TS) is diagnosed when at least two types of motor tics and one kind of vocal tic have occurred for a time period greater than one year, onset is prior to age 18 and tics are not a medication side effect or related to a specific medical condition. Other classifications of tic disorders are Persistent (Chronic) Motor or Vocal Tic Disorder and Provisional Tic Disorder, which reflects the fact that sometimes tics are transitory, or short-lived. The course of tics in any given case can be highly unpredictable. Tics can be lifelong, but many times, tics fade or disappear entirely in the teenage years or by young adulthood. Tics can persist into adulthood, and tics may also tend to be present in family members (e.g., parents and their children often both have them).

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The category of tics includes recurrent, nonrhythmic movements, twitches, sounds and utterances. There may or may not be a premonitory sense that a specific tic is about to occur. Tics present in varying degrees of severity and interference with daily functioning -- from mild to extremely debilitating. Some people are indifferent to having tics, while others are highly distressed or embarrassed by them or their effects. Coprolalia, in which the tic takes the form of curse words or inappropriate language, or harm to self from tics, may occur in a minority of cases (approximately ten percent).

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Some tics are experienced as uncontrollable, while others are perceived as more predictable. Some patients have one dominant tic or very few tics, while other patients have multiple forms (motor and/or vocal). Tics have many nuances; sometimes a person can be relatively or even totally tic-free in one situation and have ‘tic attacks’ in another. Sometimes, this is because he, she or they feel more comfortable expressing tics in one place more than another, (e.g., at home rather than at school or in a social situation), or in the presence of one person rather than another. This should, however, not be misconstrued as indicating that the person “could stop tics if they really wanted to.” Also, stressors such as big life events, school-related anxiety, anger, lack of sleep and emotional irritability can all increase the presence of tics, but this effect is often indirect and not predictable.

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Parental perceptions can play a large role in how a child experiences and deals with tics. Some parents fear that bringing attention to tics might be detrimental. However, educating a child (and parents) about tics, including how to respond to comments or questions from other people, (or bullying, which unfortunately does occur) can be very helpful in many instances. While parents always are the final decision-makers, our stance is that more knowledge and tic management tools are preferable for the long run. However, this should not be construed as that all children with tics need treatment - in many instances tics can be more upsetting and disruptive to the parent than the child. Criticizing a person or making fun of somebody about their tics is never all right in one place-- this will usually just add stress or exacerbate tics. Tics are a “no-fault” condition. Many of the adults who come to us for help with tics wish that they had received treatment earlier in their lives.

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Comprehensive Behavioral Intervention for Tics, better known as CBIT, is a cognitive-behavioral therapy (CBT) that has significant empirical support for its effectiveness. CBIT includes many elements, including tic awareness training, and CBIT encourages learning to engage in competing responses for tics, using a technique called Habit Reversal Training, or HRT. CBIT can be tailored to young children or to those who have additional psychological or developmental issues.

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Whether a child or adult with tics is a strong candidate for CBIT, and which tics have a better prognosis for improving with treatment, both depend on a number of factors,  including the level of motivation, which must be thoroughly evaluated prior to beginning treatment. Engaging parents or significant others in the treatment plan to maximally support the person impacted by tics is a typical recommendation. An initial trial of CBIT may be reasonably be expected to take around 8-12 weeks. However, the recommended overall duration and frequency of sessions and follow-up on a case-by-case basis. CBIT may be conducted in combination with medication(s), as prescribed by a medical practitioner who is experienced in the psychopharmacological treatment of tics (e.g., a psychiatrist or neurologist). Behaviorally speaking, CBIT conducted with children is often enhanced by the use of charts that track daily ‘homework’ (the practice of new skills) and related reward systems.

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Learning how to manage stress effectively, improve detection of a premonitory sense, maintain a positive regard for self, tolerate “urges,” manage distressing thinking related to having tics and, most of all, engaging in life activities despite tics are essential components of an effective treatment approach.

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