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CNNH BLOG: Behavior Therapy for Children with Tourette Disorder
Date Posted: June 18, 2010
FROM THE DESK OF MARK MINTZ, MD…
Just published results from a larger NIMH-sponsored study indicate using a comprehensive behavioral intervention based on Habit Reversal (HR) for Tourette Disorder/Tics results in positive outcomes. This study validates several previously published smaller studies. The authors point out that the magnitude of the positive response to HR is comparable to the results of studies using neuroleptics. Even in those subjects that did not benefit, there was an absence of tic worsening with behavioral interventions. The authors discuss that there may need to be a reconceptualization of Tourette Disorder as not just a neurotransmitter disorder potentially treatable with dopamine-blocking agents (and their attendant side effects), but a more complex motor disorder of cortical and basal ganglia circuits that can lead to habit formation, and thus, may respond to behavioral interventions in some patients, but may necessitate medications in others. However, this study provides substantial support for behavioral interventions, particularly Habit Reversal, expanding available treatment options for patients, and providing an avenue for patients and families to take an active role in treatment.
Piacentini J, et al. JAMA. 2010; 303(19):1929-1937.
However, not to get fully away from the neurotransmitter aspects of Tourette Disorder, as a report from the New England Journal of Medicine links the role of histaminergic neurotransmission as a potential mechanism for mediating tics in one family.