Tics or Tourette Syndrome – Primary Care, Outpatient Specialty Care and Emergency Department – Treatment Considerations

Tics or Tourette Syndrome – Primary Care, Outpatient Specialty Care and Emergency Department

Treatment Considerations

Prognosis Considerations
  • Provisional tics (< 1 yr) are highly likely to completely resolve on their own
  • Chronic tics (≥ 1 yr) are less likely to resolve in childhood and more likely to have co-occurring conditions that require management
Management Strategies
  • Only treat tics that are bothersome to the child, disruptive to learning or functioning, dangerous or painful
  • Before treating tics, consider treating behavioral comorbidities
Considerations for Managing Comorbidities
  • Treat most impairing symptom first
  • Stimulants may be used to treat ADHD in children with tics
    • Stimulants do not affect tics in most children, but may cause some to have an increase in tics
    • Stimulants generally do not need to be stopped in children with ADHD who develop tics
    • ADHD Clinical Pathway
  • Consider SSRI for children with anxiety/OCD as it may also improve tics
Referral to Comprehensive Behavioral Intervention for Tics (CBIT)
  • CBIT is a structured therapy that helps children manage tics by building awareness, teaching alternative behaviors, and reducing triggers
    • Treatment usually involves 8 sessions over about 10 wks with options for booster sessions to address new or recurring tics
  • Considerations for referral to CHOP CBIT
    • ≥ 7 yrs old
    • Child and family aware of referral and interested in treatment
    • Child is motivated to treat tics, not just the parent
    • Behavioral health concerns should be addressed separately from CBIT
  • Tourette Association of America Provider List   and Tic Helper   for non-CHOP CBIT providers