Cognitive Behavioural Therapy for Children with Tourette Syndrome

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Cognitive Behavioural Therapy for Children with
Tourette Syndrome

• Dr. Patricia Byrne,
• TSAI, 28th November, 2009.

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Overview

• What is Cognitive Behavioural Therapy (CBT)?
• How can CBT be helpful for children with Tourette
  Syndrome (TS)?
• Who does it help?
• How is it done?

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What is Cognitive Behavioural Therapy (CBT)?
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How can CBT help in TS?
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Goal of CBT in TS

• Goal is not to cure tics,
• but
• to increase the young persons ability
• to manage tics in his / her
• day to day life.

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Who is it for?

• The first line of intervention for all is
  learning about tics TS, and learning to accept
  tics.
• Behavioural interventions are used to support
  children and adolescents whose tics are causing
  ongoing distress, and who want to learn skills to
  manage them.
• Behavioural interventions can be used alongside
  or as alternative to medication, depending on
  child and family choice.
• Programmes developed for children aged 9.

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How is this Done?

• CBT supports children and their families by
• Helping them learn and understand TS
• General Psycho-education
• Helping them learn and understand how TS is
  affecting their lives.
• TS, me and my Family
• Provide them with skills to manage tics
• The right skills, at the right time,
• for the right people.

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Skills to manage Tics

• Support Self-Esteem - Learn to accept that tics
  are just a part of your life, but do not make you
  who you are..
• Functional Analysis - Learn your triggers, you
  may be able to reduce or avoid some troublesome
  tics.
• Relaxation skills.
• Habit Reversal
• learning to notice when a troublesome tic is
  building (premonitory urges).
• - learning to prevent the tic occurring by
  doing the opposite.

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Know your Triggers (functional analysis)

• Certain things can increase frequency or severity
  of tics (but are not the cause) e.g.
• Stress or worry
• Lack of sleep
• Particular Situations
• Being told not to tic
• Others attention to tics
• Negative - giving out, teasing, disapproving,
• Rewarding tics getting out of tests, getting
  extra toys or attention

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Knowledge is Power

• Parent and child spend time noticing what tics
  occur and when
• Recording what was happening before i.e.
  possible triggers,
• Record what happened after - i.e. consequences of
  tic,
• Come up with a plan together to reduce triggers
  and reinforcing consequences

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An example

• Bill is 12. He has a throat clearing tic, and
  shrugs his shoulders. Its worse when he is
  tired. As soon he goes into watch telly his
  brother John (14) tells him not to be doing his
  weird stuff. Bill tries but the more he thinks
  about it the harder it gets not to tic.
• John shouts at him. Mam comes in, gives out to
  John, and sends John to his room. John goes
  saying its not fair you always blame me. Mam
  feels upset, and Bill feels bad. He worries -
  will his tics stop him watching the Irish
  football game next week with Dad and John?

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Figuring out what happened..

• Triggers
• Bill was tired,
• John does not understand about TS,
• Bill being told not to tic which made it
  harder!
• Consequences
• John shouted at Bill
• Mam gave out
• John felt confused and blamed,
• Bills feeling worried about watching the
  football match next week.
• Everyone felt upset.

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Working out a family plan

• Bill is going to go to bed early in days prior to
  big match.
• To sit down as a family to learn about TS
  together.
• To listen to everyone about how TS affects them
  (particularly siblings), encourage support.
• Explaining to John telling Bill not to tic makes
  it more likely to happen, while ignoring tics
  helps reduce tics.
• Mam staying calm, reminding John about tic
  triggers, praise him for supporting Bill.
• Bill taking tic breaks during breaks on
  telly.

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Relaxation Skills
Relaxation helps reduce triggers such as stress
and worry, and reduces muscle tension.
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Habit Reversal (doing the opposite)

• Most people with TS can notice when a tic is
  building this is known as a premonitory urge
  (pressure, tickling feeling, like a sneeze coming
  on)
• This feeling is relieved by doing the tic, which
  then reinforces the tic.

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• If you use the same muscles involved in the tic
  (e.g. shoulder shrug), to do the opposite, this
  prevents the tic occurring.
• Over time this helps reduce the tic, breaks the
  reinforcing cycle, helps the young person feel
  more in control and may replace a tic with a less
  noticeable or embarrassing action.

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Habit Reversal

• Awareness training noticing your urge to tic
  early on.
• Competing responses using the muscles to do the
  opposite (motor tics)
• Vocal tics Diaphragmatic breathing (deep
  breathing - right down to the belly!)

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Putting it all together

• Learn about TS
• Learn to live with and accept TS
• Learn about how TS affect you
• Reduce triggers and reinforcers
• Relax
• If needed, learn to do the opposite
• Goal is to learn to control TS, and not let it
  control you.

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Resources ?

• Treatments that Work series, Managing Tourette
  Syndrome a behavioural intervention. D.
  Woods, 2008. (Professional support workbooks
  for adults and children)
• Coping with Tourette Syndrome a workbook for
  Kids with Tic Disorders, Sandra Buffolano, 2008.
  (Parents and families guide)

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• Questions?
• Many thanks.