The first step, and perhaps the most important, is educating yourself and your family about Tic Disorders. Everyone will be greatly relieved to learn that tics are not indicative of a progressively debilitating condition. On the contrary, most children experience significant improvement with treatment and as they become adults.
The many examples of professional sports figures who have publicly acknowledged having tics underscores that this does not have to be impairing. An invaluable source of support for both patients and their families is the Tourette Syndrome Association, a self help group with both national and local chapters.
The goals of therapy are to eliminate tics and treat the conditions most commonly associated with them, like the inattention, hyperactivity, and impassivity in Attention Deficit/Hyperactivity Disorder and the obsessions and compulsions in Obsessive Compulsive Disorder.
There are a number of medications that can reduce and cure tourette’s syndrome and tics, if not get rid of them altogether. It turns out that many of the medications used to treat psychosis are also effective at suppressing tics, Haldol, Prolixin are the most commonly used.
Medication side effects, like sedation, muscle spasms, and feelings of restlessness are unfortunately also quite common, to some degree limiting their usefulness. It will be interesting to see whether the never atypical anti psychotic medications (Clozapine, Zyprexa) are helpful without the side effects. Clodine, a medication used to treat high blood pressure, and Klonopin, a medication used to treat anxiety and seizures, are less likely to cause side effects but are also often less effective.
A behavioral therapy technique called habit reversal training can be used as an alternative or supplement to medication. The person is taught to actively use an opposing muscle group to counteract the tic movement. For example, someone with a shoulder shrugging tic can actively do the opposite, lower his shoulders, when he feels that the tic is about to happen.
Since tics often get worse when the person is in a stressful environment, interventions that teach stress management can indirectly lower tic frequency. A structured and predictable environment with clear expectations both at home and at school is also helpful. Family therapy may address the strains on the family imposed by the illness.
Up to 60 percent of children with Tourette’s have symptoms of ADHD. Tics and the ADHD symptoms must each be addressed in treatment. One wrinkle is that the most commonly used treatment for ADHD, namely stimulants, often makes tics worse. For such children, behavioural approaches to ADHD may be preferred.