Good article on therapy for Tourettes. Article is below, as links disappear.
Behavioral Therapy Offered at Duke Clinic Helps Boy Gain Control Over Tourette's Syndrome
05-07-2007 3:04 PM
CARY, N.C. (Associated Press) -- Thanks to new behavioral therapy at a Duke University Medical Center clinic, 9-year-old Rick Shocket is doing what seemed impossible for him a year ago: gain control over Tourette's syndrome, a brain disorder that causes repetitive movements and sounds.
The illness made it difficult for him to cross a room. A myriad of tics he's battled include sniffs, coughs, yips, fidgets and twitches. Rick felt compelled to do a deep knee bend with nearly every step, leaving him exhausted by the end of the day.
"Every time I went anywhere it was like, squat, squat, squat," he said. "I could never get anywhere."
Since starting behavioral therapy at Duke last year, he can recognize the warning signs that precede the tics then resist the urge to perform them. The therapy also has enabled him to stop many of the prescription medications he took.
The therapy goes against years of thought on Tourette's syndrome, which has held that the tics are involuntary and that it's best for those with the illness to simply ignore them.
The habit-reversal training offered at Duke teaches the exact opposite, instructing patients to stay hyper-aware of tics so they can anticipate and suppress them.
Doctors believe Tourette's affects one in 100 people, a change from past thinking that considered it a rare disorder occurring in no more than five of every 10,000 people. The new view stems from physicians being more likely to recognize even mild cases.
They also no longer view it as a mental illness but as an inherited neurological condition, which occurs in boys up to four times more often than in girls. Symptoms usually appear when they're between the ages of 7 and 10.
"There's a big severity spectrum," said Dr. Jarrett Barnhill, a specialist in tic disorders and director of the Developmental Neuropharmacology Clinic at UNC Hospitals in Chapel Hill. "There are kids who meet the diagnostic criteria for tics, but if you weren't looking for them, you might not think anything of it."
As a young child, the doctor told Rick's mother that his tics were common and that he'd grow out of his idiosyncrasies that included hard sniffing and hitching up his trousers and kicking out one leg.
When he was 7, she began paying closer attention to his idiosyncrasies after watching a documentary on the disorder. Around that time, Rick asked for help.
"Mom, I need help. I'm having a problem with some noises," Clare Shocket remembers him saying.
The went to see Barnhill, who specializes in tic disorders. Tourette's was confirmed, and Rick was also diagnosed with anxiety, attention-deficit problems and obsessive-compulsive disorder. Medications led to side effects including drowsiness and weight gain.
That led his parents to seek an alternative in cognitive behavioral therapy.
Dr. John March, chief of adolescent and child psychiatry at Duke Hospital and a national leader in the use of cognitive behavioral therapy with children, had Rick identify the tics he most wanted to control. Rick named the squat, squeaks, coughs, and tics that caused him to jerk his neck and look away from people mid-conversation.
Rick was told to concentrate on the feelings or sensations that occur right before a tic, which can be much like a building tension or feeling of intense discomfort.
He then developed a competing action or response to counter the tic. Slow breathing was done to block squeaking and coughing. He locked his knees to counter an approaching squat.
"There's this feeling like, 'You've got to do this, you've got to do this,' " Rick said in describing how he uses the approach. "But then you say, 'OK, I need to do this. But not right now. Maybe later.' "
"He hasn't squatted since September," said Clare Shocket, who says she would have tried behavioral therapy before drugs if she had known it was an option. "I've tried to figure out why more people don't rush out and do this."
Still, behavioral therapy is not a cure for Tourette's, which is considered a lifelong disorder.
But it has given Rick and his family hope.
"It appears to be something that's not the end of the world," Abe Shocket said. "The tics come and go. Every month that goes by, it seems more likely that he'll be able to have a normal life."
___
Information from: The News & Observer,
http://www.newsobserver.com
Therapy for Tourettes - Article
Linear Mode
