15 Apr Tourette Syndrome

Understanding a child with TS

Children with Tourette Syndrome and Tic Disorders may display a wide array of symptoms that are difficult to control. Vocal tics (for example, humming, clearing the throat, or yelling out a word or phrase), and multiple motor tics (for example, blinking or shrugging the shoulders) can disrupt classroom activities, but there are ways to minimize this impact. Keeping in mind that the child may have additional challenges associated with Tourette Syndrome could be a first step towards ameliorating difficulties that arise in your classroom.

The following provides a general overview, however, for in-depth strategies for understanding and managing Tourette in the classroom, click here.

• Tics are not intentional attempts at gaining attention or to be disruptive
• Tics are not the student’s fault (or the fault of parents)
• Tics should not be taken personally
• Tics are not simple habits that can easily be replaced or stopped
• There is no one-size-fits-all “cure” for tics

Tics Can Change, Wax and Wane

A student may have a sniffing tic for a time; then, for example, a squealing tic develops which may replace or be added to the sniffing tic. Tics may be quiet early in the day and become more noticeable and interruptive as the day progresses. Tics may be quieter in one specific class and increase in another; increase prior to lunch or decrease after eating; worse when the student is tired, angry or stressed. Commonly, if a person with TS is engrossed in an enjoyable activity, like playing a musical instrument, tics may dissipate or disappear entirely. The only truly consistent nature of TS is the inconsistency.

Tics May Appear to Be Purposeful

However, tics are neurological in nature, often described as urges that must be completed. Even when they appear to be expressed in reaction to a current situation, they are not within the control of the student with TS. Reminding the student not to tic may, in reality, be counterproductive.

Medical Treatments

Each person with Tourette Syndrome is an individual and will require an individualized treatment plan. It is important to note that not everyone with Tourette will need medical treatment and medical treatment needs can vary over time. While there is no cure for Tourette Syndrome, there are a number of treatments, including non-medicine behavioral treatments as well as medications, that can be effective at reducing tics or helping to manage co-occurring conditions. When making any treatment decisions, it is important to consult with a licensed medical provider. While TAA cannot make medical recommendations, we have provided some general information on available treatments below.

Medications for Tics

The goal of treatment with medications is to reduce tics to a point that they are no longer causing distress to the patient or interfering with function. The medications we have currently available for TS are not cures and the tics may not completely resolve. Tics still wax and wane in frequency and severity and fluctuations will continue to occur whether or not medication is used.

Sometimes, what may seem to be an initial response to a medication may simply have been a coincidence if tics were beginning to wane at the same time the medication was introduced. All treatments have potential side effects or risks and a doctor will weigh what is known about the potential benefit of a therapy versus the potential risks for the individual patient. Once a medication plan is decided, a doctor will monitor the patient’s response and any adverse reactions. It is important to note that medications may take some time to work. It is not unusual to have to go through some trial and error to determine which medication (or combination of medications) works best for the patient as each patient will respond differently.

Haloperidol (Haldol), pimozide (Orap), and aripiprazole (Abilify) are currently the only medications approved by the U.S. Food and Drug Administration (FDA) to treat tics. However, physicians may start with “off-label” use (not FDA approved specifically for treatment of tics) of guanfacine or clonidine, both of which are alpha- adrenergic agonist medications that are approved for use in the treatment of high blood pressure. These medications have been found to be moderately effective in reducing tics and to be better tolerated.

For a full summary on the available evidence on different medications for Tourette Syndrome, please view the 2019 American Academy of Neurology Tourette Treatment Guidelines (ref below)

American Academy of Neurology (2019). Practice Guideline: The treatment of tics in people with Tourette syndrome and chronic tic disorders. Minneapolis, MN: Author. Retrieved from www.aan.com/Guidelines/home/GetGuidelineContent/964.

Medications for co-occurring conditions

Co-occurring conditions, such as ADHD and OCD, often require medication, which can improve quality of life in patients with TS. It is not unusual for the treatment of these conditions to result in a reduction of tics. Inattention, impulsivity, and hyperactivity are common symptoms seen in patients with ADHD and can be an obstacle for school-aged children. Stimulant medications, such as methylphenidate, can be effective in children who have TS and ADHD. Other non-stimulant medications, such as guanfacine, clonidine, and atomoxetine, may also be beneficial. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline, and fluvoxamine, are effective in youth and adults with anxiety/OCD. Side effects are generally tolerable. Be aware of the risks and benefits of these medications and share this information with your healthcare provider.

Comprehensive behavioral Intervention for Tics ( CBIT)

Tested in two parallel multi-site randomized clinical trials, the Comprehensive Behavioral Intervention for Tics (CBIT) procedures combine elements of habit reversal training with psycho- education and function-based behavioral interventions. The results of the child study were published in 2010 in the Journal of the American Medical Association (JAMA) and showed that 52.5% of the children who received CBIT showed significant symptom improvement compared to 18.5% receiving the control treatment. The adult study was published in the journal Archives of General Psychiatry in 2012. In this study, 38% of those receiving CBIT showed significant improvement, compared to just 7% who did not receive CBIT treatment. In both studies improvement was sustained for at least 6 months after the end of the study.

Article courtesy of Tourette’s Association of America