May 18, 2010 – Bayside, NY – A comprehensive behavioral therapy is effective in helping children with Tourette Syndrome manage their tics, according to a study published in the May 19, 2010 special issue of the Journal of the American Medical Association (JAMA) which was dedicated to addressing mental health disorders. The research was funded by the National Institutes of Mental Health (NIMH) and involved several leading universities working in partnership with the national Tourette Syndrome Association, Inc.
Tourette Syndrome (TS) is a childhood-onset neurological disorder that affects approximately 200,000 school-aged children and adults in the U.S. Characterized by involuntary movements and vocalizations called tics, TS symptoms can range from mild to severe and can have a profound negative impact on the lives of individuals with the condition. Current medications for TS are associated with troubling side effects, such as weight gain and sedation, and in many cases drugs do not adequately reduce the severity or frequency of tics. Behavioral therapy has the potential to manage tics without the shortcomings associated with existing medications, but only a few studies have examined the effectiveness of behavioral interventions in people with TS.
“People with Tourette Syndrome experience considerable impairment and social isolation, and effective treatments are limited,” said NIMH Director Thomas R. Insel, M.D. “This study makes a strong case for a specialized behavioral therapy, either as a stand-alone treatment or as an adjunct to medication.”
John Piacentini, Professor of Psychiatry at the University of California Los Angeles and lead author of the JAMA paper, and colleagues compared the effectiveness of a Comprehensive Behavioral Intervention for Tics (CBIT) in 61 children with TS (ages 9-17) against a control group of patients that received supportive therapy and basic education about their disorder. The CBIT therapy was based on habit reversal training that includes two concepts: tic awareness and competing-response training. Tic-awareness training teaches the child how to monitor themselves for early indications (including the urge) that a tic is about to occur. Competing-response training teaches the child how to engage in a voluntary behavior designed to be physically incompatible with the impending tic, thereby disrupting the cycle and decreasing the tic. CBIT also includes a parent management component. Parents in the study were taught how to manage their own and others reactions to their children’s tics, and how to best encourage and praise their children for practicing the behavioral intervention techniques they were learning.
In the JAMA study, the CBIT and control group of TS subjects received eight sessions of therapy over a 10-week period. Those who responded to therapy received monthly booster sessions for three months, and were assessed three months and six months after the 10-week acute treatment ended.
The results of the study showed that 52.5 percent of the children who received CBIT showed significant symptom improvement compared to 18.5 percent receiving the control treatment. The benefits of CBIT also appeared to endure over time—87 percent of CBIT responders who were reassessed six months after the end of the 10-week trial continued to show benefit. Only a few children dropped out of the study, suggesting that the intervention was well-received and tolerated by the children and their parents.
Dr. Piacentini notes that, “the response to CBIT was comparable to results of trials with antipsychotic medications for TS, but without any of the side effects associated with the use of these medications.” Interestingly, the researchers found that 38 percent of children in the study were already taking medication for their disorder when they entered the study and were allowed to remain on the medication. Therefore, behavioral therapy could be used alone or in combination with medications to manage the symptoms of TS.
The authors suggest that future analyses are needed to determine which individuals with TS are most likely to respond well to behavioral therapy, allowing for a more personalized treatment approach. The investigators are also working with the Tourette Syndrome Association and the Centers for Disease Control and Prevention to teach CBIT to clinicians and other health care professionals who treat children with tic disorders. They also aim to develop new versions of CBIT that would be more suitable for younger children with TS.
Other authors on the study included: Douglas Woods, University of Wisconsin-Milwaukee; John Walkup, Johns Hopkins Medical Institutions and Weill Cornell Medical College; Lawrence Scahill and James Dziura, Yale University School of Medicine; Sabine Wilhelm and Thilo Deckersbach, Massachusetts General Hospital/Harvard Medical School; Alan Peterson, University of Texas Health Science Center; Susanna Chang, University of California, Los Angeles; Golda Ginsburg, Johns Hopkins Medical Institutions; and Sue Levi-Pearl, Tourette Syndrome Association.
Founded in 1972, the national Tourette Syndrome Association celebrates 38 years of service to the TS community worldwide. As the only national, voluntary health organization for people with TS, the TSA has a three-pronged mission of education, research and service and directs a network of 31 Chapters and more than 125 support groups across the country. For more information visit http://tsa-usa.org.
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