You can ask us questions about Tourette syndrome and other tic disorders by replying to this post. If one of you has a question, you probably aren’t the only one with that question, so we will post it and an answer here so other counselors may benefit, too. If you don’t want your name to show on this page, let us know in the body of your reply, and we’ll try to quote your question rather than publishing your comment directly.
We have a lot of experience with tic disorders and school counseling, and we’ll do our best to give appropriate information. Our replies, however, are just general advice and should not be assumed to apply to every child’s or professional’s specific situation. Please don’t construe our comments as medical or educational or legal advice for any individual.
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Post your question by replying to this post. Please note, it may be several days before we reply. To reply, please copy and paste the list below into the “Leave a reply” / “Comment” box at the bottom of this page, edit it, and click on “Post Comment.” Please note: We ask about you and your work situation because the CDC wants to know if we’re reaching a wide audience, and equitably. We will report the answers only in aggregate. However, you may choose to reply “prefer not to disclose” to any of these questions.
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A webinar attendee asked these 2 questions:
1. “Do you think c-bit therapy helps with tic reduction?”
Answer: you don’t have to trust what I think on this question, because the U.S. National Institutes of Health (NIH) supported two large-scale randomized, controlled treatment studies of CBIT compared to supportive therapy. CBIT did much, much better in terms of improving tic frequency and severity, and had no side effects. Follow-up studies show that CBIT can have lasting benefit months to years after active treatment ends. More recent studies from Europe confirm the efficacy of CBIT and another behavior therapy, Exposure and Response Prevention (ERP) for tics. The American Academy of Neurology reviewed the strength of the scientific information about all treatments for tics and for most children recommends CBIT before any other specific treatments.
2. “What medication or herbal things are best to help aide in tic reduction?”
Answer: The appropriate response will differ depending on the child’s individual situation. The U.S. FDA has approved 3 medications for Tourette syndrome: pimozide, haloperidol and aripiprazole. All of these 3 reduce tics, but in 2024, I think only of aripiprazole as a possible first medication step, mostly because it usually has fewer side effects than the other two. Before aripiprazole, guanfacine or clonidine may be appropriate for many children, as they can also help with ADHD. Risperidone or antiobsessional-dose SSRIs may be a first choice for a child whose OCD is the main problem. Stimulants (especially methylphenidate and derivatives) may be an appropriate choice for the child with problematic ADHD who also has tics, because on average (i.e. across 100 children with both tics and ADHD) methylphenidate improves both ADHD symptoms and tics. There are a number of other options, as well.
As to herbal products, there are only two kinds that have any meaningful evidence for benefit for tics. The first is two mixtures of herbs used in traditional Chinese medicine. Most American tic experts retain some doubt as to when they may be most appropriately used in the care of children with tics, in part because they are mixtures of numerous potentially brain-active substances and in part because we have more data for the options listed above. The second is cannabis products. There is some evidence that THC and other cannabinoids can help with tics, but in general they are inappropriate for children and adolescents, whose brains are more sensitive to potentially serious side effects from these products.