The thirteen-year-old boy sitting in his living room suddenly stops the video game he was playing, tenses his muscles, and stares straight ahead. As the hero on the video screen is attacked by monsters, the boy concentrates on holding his muscles tight while mentally counting to sixty. After a minute has passed, he slowly relaxes, breathes deep, and resumes his game, maneuvering the hero out of his predicament to live to fight another day. The teenager has just used a behavior therapy treatment called Habit Reversal to conquer a tic associated with his Tourette’s Syndrome. In lab space converted into a clinic in the basement of Garland Hall, Douglas Woods does behavior therapy with children afflicted by all kinds of tics. A UWM associate professor in psychology, Woods first opened the Tic Disorders Specialty Clinic and the Trichotillomania/Body Focused Repetitive Behavior Specialty Clinic in January 2000 and now sees up to two to three patients a month. Kids come from across the state and places as far away as California and Pennsylvania for a chance to conquer their own monsters. The interest in Woods’ clinic stems from its unique approach. While the majority of those suffering from Tourette’s Syndrome are given medicine to help assuage the tics, Woods concentrates on behavior modification. So far his type of treatment, Habit Reversal, has shown results equally as effective as the most successful medicine, Haloperidol. This non-pharmacological approach is attractive to many parents who would rather not use medicine to treat their children. “There’s just something about putting a child on medication that many parents don’t want to do, and I understand that,” sympathizes Woods, who is himself a parent. Woods treats children with chronic motor and vocal tics, and the more complex Tourette’s Syndrome. Motor tics can be described as rapid, repetitive muscle movements, such as rapid eye blinking or head jerking. Vocal tics, sometimes called phonic tics, are phrases or sounds such as grunting, sniffing, barking, throat clearing, and rarely, swearing. For the disorder to be considered Tourette’s Syndrome, the patient needs to have at least two motor tics and a vocal tic that have been present for more than 12 months. Pete Amland Doug Woods observes students practicing a therapy session. Some people claim that transient tic disorder (tics that last less than 12 months) happens in 25 percent of the population. “That just means that when we are kids we have lots of little habits that can be classified as tics,” Woods says. Chronic tics, those that plague people for more than a year, may affect one to three percent of the population. And for Tourette’s, the most conservative estimate is that .04 to .05 percent of the population, or 4 to 5 in 10,000, suffer from the illness. Most of Woods’ patients are children between eight and 15 years old. “I don’t typically see kids under the age of six, because a lot of times the tics will just go away,” he says. “Sometimes parents can do more damage by making a big deal of it in really young kids. I’ve sent parents home, telling them, ‘You know what? Don’t worry about it for now.’ “ The kids are brought into the clinic upon referral from neurologists or psychiatrists who have already diagnosed them. All the kids undergo an assessment to see how the tics are affecting their lives and what the associated problems are. Then they receive a report that details what they can expect in the form of treatment. At that point the children and their families decide whether they want to go forward with Woods’ Habit Reversal program. Habit Reversal involves three steps: awareness training, competing response training, and social support. Step one, awareness training, is teaching the child to pay attention to the sensations and behaviors that lead up to the tics. “Sometimes they’ll have what we call a premonitory urge, which is like a sensation that something isn’t right, or something just feels uncomfortable,” Woods explains. Awareness training also involves noting which settings are more likely to cause tics. “I’ve had kids who have this happen all the time in math classes but no other classes, and I’ve had other kids who did the exact opposite,” he says. “There’s definitely a reactivity to the environment.” The second step is to teach them a competing response. For example, if the child has a neckjerking tic and he has learned through awareness training that when his chin starts to go down he is about to have a tic, he will use the competing response, such as tensing the muscles of his neck for sixty seconds. If at the end of one minute the feeling is gone, he can relax. If not, he holds his muscles until the sensation disappears. “The competing response is really just a behavior that you do that prevents, physically, the tic from happening,” Woods says. The third step is social support. The parents participate in the Habit Reversal procedure by praising and rewarding their child for doing the competing response correctly or reminding him to use it if he starts to tic without the competing response. “It’s a very simple procedure we practice over and over again across a number of sessions with different tics that they have, because kids will come in with four or five tics, and we have to do a different type of behavior for each tic,” Woods says. Woods’ non-pharmacological approach is attractive to many parents who would rather not use medicine to treat their children. Woods didn’t originally plan for Tourette’s to be the focus of his career. “I kind of stumbled into it,” he admits. While earning his master’s degree in clinical psychology at North Dakota State University, he intended to study a treatment for stuttering. But when the state speech board heard about his plans, they threatened to sue the university for impinging on their territory. Because the same treatment had been used on tics, Woods changed his project to avoid a lawsuit. At that time, he says, “I knew nothing about Tourette’s Syndrome. I started working with these kids who had tics and it was just fascinating for me.” When he left North Dakota to earn his Ph.D. at Western Michigan University, he says, “I kept doing a little bit of the work, and people there would find out that I was doing it and wanted me to work with their kids, and I couldn’t get away from it after I started.” Most of the popular media’s handling of Tourette’s Syndrome focuses on the swearing, which Woods says is grossly inaccurate. “They make it sound like Tourette’s is the swearing. Like if you don’t have that you don’t have Tourette’s, and that’s just so wrong. The estimates are that only twenty percent of those with Tourette’s actually have swearing tics.” “Another thing I’ve noticed in the popular media is many people with swearing tics appear to flaunt that they’re swearing,” Woods continues. “In reality, kids with Tourette’s are often horrified when they do this. They know they’re doing it, they know they don’t want to do it, so they’ll try to muffle it, change the words, or do a lot of masking things, because they don’t like the fact that they say it. They’ll be saying, ‘I’m sorry, excuse me,’ after it comes out.” Although the public still lacks a lot of basic information about Tourette’s Syndrome, we have come a long way since the days when Tourette’s sufferers were considered satanically possessed. In the early 1900s Freudian theories took hold, with the belief that if patients could discover the root causes of their psychiatric problems, the tics would disappear. Unfortunately, patients spent years in psychoanalysis without any change. Then in the 1950s there was a drug revolution in psychiatry. When Haloperidol was discovered to have a tic-reducing effect, the neurologists and psychiatrists who had watched their patients not get any better decided that Tourette’s was a completely biological illness and that it should be treated completely with medicine. In the ‘70s and ‘80s, behavior therapy seemed to have an effect on Tourette’s, but the practitioners who had watched psychoanalysis fail were hesitant to go back to treating the illness without medicine. But behavior therapy, such as the treatment that Woods prac- tices, has seen some growing acceptance in the past five years or so. “What lent the most credence was the Tourette’s Syndrome Association starting to fund some studies that were looking at non-drug treatments,” he says. “Tourette’s Syndrome Association is the national organization for people with Tourette’s Syndrome. And when they put their stamp on something, people start to listen a bit more.” Although being treated at Woods’ clinic can bring remarkable change and enormous relief to sufferers, “We never ever talk about a cure with Tourette’s,” he says. “We don’t even attempt to get peoples’ hopes up with that word. The way we talk about it is, you’re basically learning self-management skills. You’ve got this [Tourette’s], it’s going to happen at times, it’s going to have periods where it’s bad, it’s going to have periods where it’s fine. We’re going to teach you that when it’s there, and when you need to, here’s how you can control it. And sometimes, when you learn that, it goes away. And sometimes it doesn’t come back. But when it does, this is how you handle it.” Woods sees a bright future for the clinic and the kids he treats. He is now doing collaborative research projects with other major clinics nationwide that offer non-drug procedures, including the Yale Child Study Center, the UCLA Neuropsychiatric Institute, and Harvard’s Massachusetts General Hospital. “I want us to be there, in terms of treating kids, assessing kids, and understanding kids with Tourette’s from a non-drug perspective. And I think we’re close. We just need more time.”