At the Cognitive Behavior Therapy Center of Silicon Valley (Saratoga/San Jose) and Sacramento Valley (Roseville) we offer cognitive behavior therapy (CBT) for children with tic disorders and tourette syndrome. Our approach is practical, goal-oriented, compassionate, and scientifically-based while focusing on your child’s individual needs.
What is a Tic Disorder/Tourette Syndrome in Children?
Tic Disorders and Tourette Syndrome in children are neurological disorders associated with motor or vocal tics that can be embarrassing and disruptive. A tic is a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization. Tics typically begin in childhood, peak in early adolescence and often decrease by adulthood.
Tourette Syndrome is defined as both multiple motor and vocal tics while a Tic Disorder involves motor or vocal tics but not both. For many children with a tic disorder or tourette syndrome, the tics may occur many times a day (usually in bouts), nearly every day or intermittently throughout a period of more than one year, and during this period there was never a tic-free period of more than 3 consecutive months.
The first symptoms in children are usually involuntary movements (tics) of the face, arms, limbs or trunk. These tics are frequent, repetitive and rapid. The most common first symptom is a facial tic (eye blink, nose twitch, grimace), and is replaced or added to by other tics of the neck, trunk, and limbs. Verbal tics (vocalizations) usually occur with the movements. Verbal tics may include grunting, throat clearing, shouting and barking. Despite widespread publicity, the involuntary use of obscene or socially inappropriate words is uncommon in children with tic disorders.
The term “involuntary” can be confusing since most children with tics do have some control over their symptoms. Many children with tic disorders describe an unwanted urge or sensation prior to the tic that is relieved only by performing the tic. Typically, tics increase as a result of tension or stress, and decrease with relaxation or when focusing on an absorbing task. It is common for children with tic disorders to have co-occurring conditions, particularly attention-deficit/hyperactivity disorder (ADHD) and obsessive compulsive disorder (OCD).
Symptoms of Tic Disorders/Tourette Syndrome in Children
Tics may vary in type, frequency and severity; worsen if your child is ill, stressed, anxious, tired or excited; occur during sleep; and may evolve into different tics over time. The types and variety of tics are diverse, and there’s no typical case. While tics may be involuntary, many children experience premonitory urges before the tic comes. Other symptoms such as touching, repetitive thoughts and movements and compulsions can occur. Tics are classified as either:
- Simple tics: sudden, brief and repetitive, involving a limited number of muscle groups
- Complex tics: distinct, coordinated patterns of movements that involve several muscle groups
Common motor and vocal tics in children include:
- Motor tics: eye blinking, touching the nose, head jerking, touching other people, shoulder shrugging, smelling objects, eye darting, obscene gesturing, finger flexing, flapping the arms, sticking the tongue out, or hopping.
- Vocal tics: hiccuping, using different tones of voice, yelling, repeating one’s own words or phrases, throat clearing, repeating others’ words or phrases, barking, or using vulgar, obscene or swear words (less common).
Cognitive Behavioral Model of Tic Disorders/Tourette Syndrome in Children
Tic disorders and tourette syndrome are neurological disorders. Current research indicates that tic disorders may result from the abnormal activity of the brain chemical called dopamine. Other neurotransmitters, such as serotonin, may be involved as well. Recent research shows that behavior therapy can help children learn to tolerate their urges and suppress their tics without rebound effects. In the CBT model, the goal is to increase awareness of premonitory urges so the child with tics can gain some feeling of control by learning to tolerate the discomfort of urges without having to give into the urge as well as learning competing responses to the tic. In addition, managing environmental contingencies and stressors can help reduce the frequency of tics.
Cognitive Behavior Treatment of Tic Disorders/Tourette Syndrome in Children
The two primary evidence-based treatments for tic disorders in children are Habit Reversal and Comprehensive Behavioral Intervention for Tics (CBIT).
- Habit Reversal: Habit reversal has two main parts: awareness training and competing response training. In the awareness training part, your child will learn to identify each tic out loud. In the competing response part, your child will learn to do a new behavior that cannot happen at the same time as the tic. For example, if your child has a tic that involves touching a body part such as head rubbing, a new behavior might be to place his hands on his knees, or to cross her arms so that the tic cannot take place.
- Comprehensive Behavioral Intervention for Tics (CBIT): CBIT teaches children new ways to manage the urge to tic. CBIT includes habit reversal in addition to other strategies, including education about tics and relaxation techniques. In CBIT, your therapist will work with your child to better understand the types of tics your child is having and to understand the situations in which the tics are at their worst. If you are seeking treatment for your child, we will include you (the parent) in the treatment to support your child.
CBIT is based on the following principles:
- Change the situation: We’ll teach your child to be aware of the situations where tics are better or worse. We will develop strategies to change the situation or influence the environment to reduce tics.
- Observe the urge/tic: We will teach your child how to break the tic down into each step. Your child may have an urge before the tic starts, so we will teach your child to watch each step of the urge/tic.
- Tolerate the urge: We will teach your child ways to resist the urge by learning to tolerate the discomfort and stop or delay doing the tic. Your child will learn relaxation skills and other behavioral responses to resist the urges and tics.
- Change the tics: We will make up and practice “competing responses” (a movement that is the opposite of the tic). For example, when your child feels his hand coming up to engage in a tic, he would push it down. When the tics occur, he’ll remind yourself to do the competing responses that he developed in therapy.
How to Get Help for Your Child with Tic Disorders/Tourette Syndrome in Silicon Valley (San Jose/Saratoga) and Sacramento Valley (Roseville)
Your child can get better by learning behavioral skills to manage tics. The skills can be learned with practice, with the help of an experienced therapist, and with the support and encouragement of those close to your child. At the Cognitive Behavior Therapy Center of Silicon Valley, we provide evidence-based treatments for children with Tic Disorders and Tourette Syndrome.
Saratoga: (408) 384-8404
Roseville: (916) 778-0771
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Silicon Valley and Sacramento Valley Communities We Serve
Cognitive Behavior Therapy Center of Silicon Valley offers evidence-based therapy for Anxiety, OCD and Eating Disorders near the following Silicon Valley/San Jose communities:
San Jose Therapy Counseling • Saratoga Therapy Counseling • Los Gatos Therapy Counseling • Monte Sereno Therapy Counseling • Cupertino Therapy Counseling • Campbell Therapy Counseling • Mountain View Therapy Counseling • Los Altos Therapy Counseling • Sunnyvale Therapy Counseling • Santa Clara Therapy Counseling
Cognitive Behavior Therapy Center of Sacramento Valley offers evidence-based therapy for Anxiety, Obsessive Compulsive Disorder (OCD) and Eating Disorders near the following Sacramento Valley and Sierra communities:
Sacramento Therapy Counseling • Roseville Therapy Counseling • Rocklin Therapy Counseling • Granite Bay Therapy Counseling • Lincoln Therapy Counseling • Folsom Therapy Counseling • Citrus Heights Therapy Counseling • El Dorado Hills Therapy Counseling • Loomis Therapy Counseling • Grass Valley Therapy Counseling • Auburn Therapy Counseling