May 18, 2010
John Piacentini on Treating Tics Associated With Tourette Syndrome
Announcer: NIMH Radio… from Bethesda.
Dr. Piacentini: CBIT gave the children and families effective tools they could use to manage their tics. And this sense of control that they had over their tics was very powerful.
Announcer: That's Dr. John Piacentini of the University of California Los Angeles, talking about Comprehensive Behavioral Intervention for Tics- CBIT for short. In a study funded by the National Institute of Mental Health, Dr. Piacentini and his colleagues found CBIT successfully controlled tics related to Tourette's Syndrome...in about half of the children tested.
Dr. Piacentini: Tourette's syndrome is a chronic neurologic disorder. It's characterized by motor and vocal tics such as eye blinking, mouth or facial movements, leg movements, arm movements and sniffing, grunting or occasionally repeating words. We know that Tourette's is a biological disorder and that it's had a genetic cause that runs in families. However, it's also important to understand that, while Tourette's is biological in origin, environmental factors play an important role in eliciting tics or maintaining the tics. These would be environmental factors such as attention from others, teasing to being in stressful situations. Historically the most common treatment for Tourette's has been a class of medication called anti-psychotic medications and these worked reasonably well in controlling tics but they were associated with a number of side effects that complicate their use in children. These side effects include sedation or sleepiness...weight gain and difficulty concentrating.
Announcer: CBIT is comprehensive behavioral therapy that involves two components.
Dr. Piacentini: The first component is called habit reversal training and in habit reversal training the goal is to teach children to recognize the initial onset of a tic or the unwanted sensation or urges that typically preceed tics. And once the children are able to recognize this, they are then taught to use a competing muscle response- a muscle response that would be the opposite of the tic they are trying to manage. For example, a child with a vocal tic such as sniffing, grunting or repeating words would be taught to engage in slow, rhythmic breathing that wouldn't allow them to actually engage in the tic. Over time and with practice, then the slow rhythmic breathing- every time the child feels like ticcing serves to break the connection between the premonitory urges which trigger the tics and the tic itself and the tic weakens and in some cases disappears.
Announcer: With additional CBIT research on the horizon, Dr. Piacentini believes this type of behavioral treatment expands the number tools available to therapist treating Tourette's
Dr. Piacentini: CBIT was very well received by the children in the study and their parents because it provided them active management strategies for their tics. And in many cases the children and parents reported feeling empowered by the treatment.
Announcer: Dr. John Piacentini, on NIMH radio.