by Kennedy Krieger Institute

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Researchers at Kennedy Krieger Institute have made significant strides in improving the lives of patients with Tourette syndrome. Their recent publication highlights how behavioral therapies—an approach that teaches patients how to manage certain tics using behavioral strategies—are proving to be the most effective treatment.

The findings are published in the journal Psychiatric Clinics of North America.

Tourette syndrome (TS), a neurodevelopmental disorder affecting up to 1% of the population, is characterized by motor and vocal tics, which are sudden, repetitive movements or sounds that can significantly interfere with daily life. TS often comes with other co-occurring conditions like anxiety, ADHD, and obsessive-compulsive disorder (OCD), which can make managing the condition more complicated.

Dr. Hala Katato, the lead author on the publication from Kennedy Krieger’s psychiatry department, explains that tics can cause significant distress for many patients and that behavioral therapies provide patients with effective tools to manage their symptoms and are the recommended first-line treatment.

“Tourette syndrome can be overwhelming for patients and families,” said Katato. “However, our research shows that behavioral therapies train patients to recognize early signs of an upcoming tic which then allows them to implement behavioral strategies to reduce tic severity.”

The behavioral therapies in this research are:

• Habit reversal training, which helps patients become more aware of their tics and teaches them strategies to replace tic behaviors with alternative actions, like subtly squinting your eyes to counter eye-widening tics.
• Comprehensive behavioral intervention for tics, which builds on the foundation of habit reversal training by incorporating interventions and relaxation techniques, such as deep breathing and progressive muscle relaxation, to manage factors that can trigger tics.
• Exposure with response prevention, which focuses on helping patients experience the urge to tic without acting on it through gradual exposure. It aims to disrupt the pattern of premonitory urges (the sensations that typically precede tics) and reduce the need to perform a tic.

Dr. Jonathan Muniz, MD, a co-author of the publication, explained that these therapies are proven effective for children, teenagers, and adults with TS.

“These behavioral therapies are really straightforward approaches that patients of all ages can benefit from,” said Muniz. “It’s a practical solution to reducing tics that patients can easily incorporate into their everyday lives.”

Despite the success of these therapies, access to care remains a significant challenge for many families. It is estimated that only 25% of children with Tourette syndrome receive behavioral therapy due to the limited availability of trained providers. To address this, Kennedy Krieger Institute is working to expand access to these therapies through online platforms and telehealth services.

“We want to bridge the gap in accessing care and ensure that all patients, especially those in rural areas or who may struggle to access in-person care, can benefit from these effective treatments,” said Dr. Katato.

While behavior therapy serves as the frontline treatment, the research team is now investigating other ways to help patients with TS. This includes enhancing behavior therapy with medications like d-cycloserine or brain stimulation techniques—which may boost the effectiveness of behavioral therapy treatment outcomes. Additional investigations by the research team include how mindfulness may also benefit patients with TS and have secondary benefits for co-occurring conditions and improve quality of life.

“Our goal is to help the whole person, not just reduce the tics,” said Dr. Muniz. “Many patients with Tourette syndrome face additional challenges like anxiety, ADHD, and OCD, and we want to provide treatments that address all aspects of their well-being.”

More information: Hala Katato et al, Evidence-Based Behavior Therapy for Tourette Syndrome, Psychiatric Clinics of North America (2024). DOI: 10.1016/j.psc.2024.08.007

Provided by Kennedy Krieger Institute