Though tic disorders were once considered extremely rare, recent studies show they affect as many as 20 percent of children and 1 percent of adults. Despite this, no clear medical guidelines exist for the best course of treatment, and every doctor has his or her preferred course of action for treating a patient’s tic disorder.
Most doctors, however, start with a “wait and see” approach. Tics often operate in a cycle, waxing and waning on a two-week basis. The majority of tics go away on their own after a few cycles, meaning no treatment is necessary.
Even if the tic doesn’t go away on its own, some patients still choose not to pursue treatment. If the tics are not severe, or don’t cause intense embarrassment, most patients become used to them and see treatment as unnecessary.
If treatment is deemed necessary, patients have a few options:
The therapy of choice for tic disorders is called habit-reversal therapy, or HRT. In HRT, the individual learns to recognize the “trigger” feeling leading up to the tic — in most cases, a feeling of “tension” or “pressure” that can only be relieved by carrying out the tic. Once a patient successfully identifies her trigger, she can learn to respond to this feeling by engaging in a behavior that is incompatible with the tic — reducing the tension without resorting to the tic.
An example given by the authors of a study published in the Archives of General Psychiatry is a patient whose tic is shoulder twitching. “The competing response might involve isometric tensing of arm muscles while pushing the elbow against the torso,” the study’s authors write. “Thus, the competing response encourages the patient to respond to the urge to tic in a new way.”
HRT also teaches patients to identify stressors that can make their tics worse, giving them coping mechanisms or strategies to avoid the stressors entirely. HRT is highly effective, in both children and adults — multiple studies have shown a 17 to 50 percent reduction in tics after 6 weeks of behavioral therapy.
A common misconception hypothesizes that having children acknowledge and actively attempt to suppress their tics will make them worse or lead to other tics, but countless studies have shown the opposite to be true. In fact, a study on vocal and motor tics showed that, even when treatment focused solely on vocal tics, motor tics still decreased by 26 percent as a result.
In mild cases, tic disorders can be treated with informal relaxation exercises that help children and adults reduce the stress that can exacerbate tics. Examples of these techniques include deep breathing, visual imagery, and guided muscle relaxation. While these techniques are seldom as effective as formal behavioral therapy, they can help patients improve their outlook on the condition and feel more in control of symptoms.
Medication is also used to treat tic disorders — generally only when tics interfere with functioning and when all non-medical interventions have been tried. Tic disorders, like other conditions, should only be treated with medication while a patient is under the supervision of a medical doctor.
Several medication options exist, and it’s difficult to tell how a patient will respond to a medication until he or she tries it out. The first drug of choice is usually haloperidol, a typical antipsychotic. Other options include risperidone, an atypical antipsychotic, or non-stimulant medications often used to treat ADHD — including Strattera and guanfacine. Some patients also experience positive results with antidepressants, including SSRIs and tricyclics.
These medications should be started at the lowest possible dose to reduce the risk of side effects. Side effects vary for each medication, but generally include things like weight gain, dizziness, problems sleeping, gastrointestinal distress, and headaches. In some rare cases, the side effects can be more troubling than the tic disorder itself — in those cases, the patient is advised to focus on other forms of treatment.
In the meantime, many doctors recommend that patients cut back on or entirely eliminate caffeine from their diets. Caffeine has been shown to make tics worse, and can also raise stress levels — further exacerbating tics.