Treatments for Tourette's Syndrome

Tourette's syndrome is an organic disorder related to abnormalities in the basal ganglia and can be regulated through drugs that are dopamine antagonists. In addition to (or instead of) drug treatments, several behavioral treatments are also employed to treat this disorder.

Peterson and Azrin published a review of the effectiveness of available drug and behavioral treatments, noting that three drugs have been used in the treatment of Tourette's syndrome: haloperidol (the most common drug of choice), pimozide, and clonidine. While haloperidol and pimozide have been demonstrated to produce between a 34 percent and 67 percent reduction in tics, clonidine only produces about a 10 percent reduction in motor tics and may increase vocal tics. Behavioral treatments for Tourette's syndrome include: massed negative practice (having the patient perform the tic rapidly and intensely for extended periods in order to produce reactive inhibition), contingency management (attempting to modify tic frequency through either positive reinforcement or punishment), relaxation techniques focusing on the muscles associated with a tic, self-monitoring of tic frequency and intensity, and habit reversal (training competing muscular responses). Habit reversal seems to be the most effective technique, with studies reporting up to a 90 percent reduction in motor tic frequency. The other behavioral techniques tend to produce reductions of up to 50 percent, but these reductions may be temporary.

Drugs are often the treatment of choice because they have the advantage of taking less time to produce an improvement. A major disadvantage of drug treatments, however, is that the drugs produce adverse side effects in between 50 percent to 85 percent of the patients, often resulting in the discontinuation of drug use. Although behavioral treatments are more difficult to use and are more time consuming, they can be effective without the problem of side effects associated with drugs. These conclusions should be evaluated in light of some difficulties associated with studying the effectiveness of therapies for Tourette's syndrome. Specifically, studies vary in how they assess treatment outcome, are based on small samples, or fail to do adequate follow-up evaluations. Although some studies (particularly those using behavioral treatments) use objective frequency counts of motor and vocal tics, many studies simply rely on subjective ratings of frequency, intensity, and severity.

Peterson, A. L., & Azrin, N. H. (1993). Behavioral and pharmacological treatments for Tourette syndrome: A review. Applied & Preventive Psychology, 2, 231-242.

Reprinted from Whitford, F. W. (1995). Instructor's resource manual for Psychology: Principles and applications by S. Worchel & W. Shebilske. Englewood Cliffs, NJ: Prentice Hall.