Tic Disorder

Treatment Summary: A child with vocal tic discords usually tic in the forms of loud/soft coughing, clearing of the throat, grunting and forceful exhales just to name a few. Children with chronic vocal tic disorder are often unaware each time a tic or other repetitive behavior occurs, and that repetitive behaviors often follow an urge or feeling of discomfort which is only relieved by engaging in the behavior itself. The way Simplified Habit reversal treatment works is that the child is videotaped shown the videotape of them self and is made aware of their behavior. In treatment over the span of three weekly sessions the child is provided with relief strategies that replaced the unwanted behavior with a less bothersome behavior. Once the tics have been replaced with another behavior child is to practice the new responses in front of a mirror to show that it is not noticeable to others and to become more comfortable with this new behavior. The child should be encouraged to use the competing response whenever he notices himself doing the repetitive behavior or even feels the urge to do so. Parents should praise their child's correct use of the competing response and remind the child to use it when he is engaged in the repetitive behavior. Praise should also be used whenever the behavior is reduced in frequency.

• Reference: JOHN PIACENTINI, S. C. (2005). Habit Reversal Training for Tic Disorders in Children and Adolescents. BEHAVIOR MODIFICATION, 29 (6 ), 803-823.
• Submitter: Shameek Gray-Jones

Open Label Aripiprazole

Treatment Summary: Aripiprazole medication was used to treat students with severe tic disorders. Students began treatment with a small dosage (1.25 mg) and gradually increased dosage (1.25 mg - 2.5 mg) a week, but could not exceed 15 mg. Aripiprazole was well tolerated and showed significant evidence in decreasing the tic severity. Treatment-emergent side effects included headache, nausea, irritability, restlessness, inattention, and urination. All side effects were mild or moderate severity; none was severe enough to cause aripiprazole discontinuation or early study termination. The most common side effect was weight gain.

• Reference: Murphy, TK., Mutch, J., Reid, JM., Edge, PJ., & Storch, EA. (2009). Open label aripiprazole in treatment of youth with tic disorders. Journal of Child and Adolescents Psychopharmacology, 19(4), 441-447.
• Submitter: Anna Vazquez

Habit Reversal Treatment (HRT)

Treatment Summary: Habit Reversal Treatment is a series of steps that include recording a baseline, making the patient aware of the tic through describing and acknowledging tics, interjection of a competing response to tics and antecedents, and support from others (primary caregiver if patient is a child). The supporting person praises and prompts the patient. After the baseline is acquired, the patient is made aware of tics through therapist stimulated tics if necessary. Antecedents are also described by the patient. Then competing response training is begun. The alternate behavior, such as diaphragmatic breathing is modeled and practiced. Lastly social support is provided through praise for follow through of process and through prompting as necessary.

• Reference: Cook, C., & Blacher, J. (2007). Evidence-based psychosocial treatments of tic disorders. Clinical Psychology: Science & Practice 14(3), 252-267. Woods, D. W., & Twohig, M. P. (2002). Using habit reversal to treat chronic vocal tic disorder in children. Behavioral Interventions 17(3), 159-168.
• Submitter: Cynthia Gumbert