Controlling behavior of children with tourette and tic disorders

New Haven, Conn.--A program to train parents how to manage the disruptive behavior of children with Tourette syndrome (TS) and tic disorders works well, according to a pilot study conducted by Yale School of Nursing and the Yale Child Study Center.

"A new approach is needed because the relationship between tics and disruptive behavior is unclear and this can be confusing for parents and teachers," said the lead author, Lawrence Scahill, professor at Yale School of Nursing and the Yale Child Study Center. "Tics are involuntary, but not all of the disruptive behavior seen in children with TS is involuntary. This can lead to uncertainty about what behaviors to accept and what behaviors to limit."

TS is a neurological disorder that begins in childhood and is defined by an enduring pattern of motor and phonic tics. Children with only motor or only phonic tics are diagnosed with chronic tic disorder. The current primary treatment is medication to control tics or to treat the commonly associated conditions of attention deficit hyperactivity disorder or obsessive-compulsive disorder.

This is the first study to use Parent Management Training (PMT) for children with TS. Of the 24 children in the study, 18 had TS and six had chronic tic disorder. The children were ages six to 12.

The 10-week program included positive reinforcement for appropriate behavior, communicating directions effectively, and being consistent with consequences for disruptive behaviors. Parenting skills were taught through modeling, role-play, and corrective feedback provided by a therapist. Half of the children were randomly assigned to PMT and were allowed to continue with ongoing treatments such as medication or psychotherapy. The other half of the subjects continued with only their original treatment.

The results showed PMT was successful in controlling moderate to severe levels of oppositional behavior. As rated by the parents, there was a 51 percent decline in disruptive behavior in the PMT group and a 19 percent decrease in the control group. Without knowing ahead of time which treatment the children received, the clinicians rated 64 percent of the children in the PMT group as much improved or very improved compared to 17 percent of the children in the control group.

Journal Child Neurology 21: 650-656 (August 2006)