Ask An Expert / Treatment

Is my son getting the right treatment for his Tourette’s syndrome?

There are four key components to look for

Shelley Avny, PhD

If a therapist states that she is doing CBIT for Tourette's syndrome, but wasn't trained by one of the recommended institutes, is that ok? She also hasn't worked with children diagnosed with TS, is that ok? My son has really bad tics so he was placed on medication and we started working with a therapist, but I was not happy with her service. First she said she was doing CBIT for TS, then she changed to CBT. There were no defined goals, no homework, no parent or teachers involvement, and his tics were not improving.

You’ve clearly done a lot of great research and have a good understanding of what treatment should look like. You’re absolutely right that CBIT is an effective treatment for tic disorders. And, it’s always ideal to have a therapist who has received specialized training and certification in a specific protocol. However, given the rigor involved in such certification, it’s not always easy to find local providers with this intensive training. This doesn’t mean that those without certification are not knowledgeable, competent therapists in the treatment of tics. You want to make sure that the therapist has adequate training in Habit Reversal Therapy (HRT) since CBIT is based on traditional HRT mechanisms. You should really be looking for the therapist to include four key components:

  1. Psychoeducation – teaching you and your son about tic disorders (e.g., causes, typical course, and normalizing the experience of having a tic disorder)
  2. Awareness training – understanding where the tics occur in the body and which muscles are involved, and then learning to become aware of when the tic is about to occur
  3. Functional intervention – identifying environmental events that make tics worse or maintain them, and then reduce or get rid of tic-increasing situations
  4. Competing response – identifying a bothersome tic and training your son to perform an intentional movement, which means that the tic cannot happen.

Other recommended treatment components include setting up a reward system to recognize and encourage your son’s effort in identifying and controlling tics, and relaxation training.

If the therapist is using these components as the foundation of her treatment, she likely has training and experience in treating tic disorders. It may be helpful when exploring therapists to ask for specifics about their treatment approach and plan. You’re also right to question the lack of homework, goals, and parental involvement. If your son is in treatment once weekly, the rest of the practice comes between sessions—that’s really how he’ll master the skills. And for most children, they frequently need parents to coach them through the skills and prompt them to use the skills.