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 Tourettes 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 Tourettes 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. Theres just something about putting a child on medication that many parents dont 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 Tourettes 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 Tourettes Syndrome, the patient needs to have at least two motor tics and a vocal tic that have been present for more than 12 months.
Most of Woods patients are children between eight and 15 years old. I dont 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. Ive sent parents home, telling them, You know what? Dont 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 theyll have what we call a premonitory urge, which is like a sensation that something isnt right, or something just feels uncomfortable, Woods explains. Awareness training also involves noting which settings are more likely to cause tics. Ive had kids who have this happen all the time in math classes but no other classes, and Ive had other kids who did the exact opposite, he says. Theres 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.
Its 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.
Most of the popular medias handling of Tourettes Syndrome focuses on the swearing, which Woods says is grossly inaccurate. They make it sound like Tourettes is the swearing. Like if you dont have that you dont have Tourettes, and thats just so wrong. The estimates are that only twenty percent of those with Tourettes actually have swearing tics.
Another thing Ive noticed in the popular media is many people with swearing tics appear to flaunt that theyre swearing, Woods continues. In reality, kids with Tourettes are often horrified when they do this. They know theyre doing it, they know they dont want to do it, so theyll try to muffle it, change the words, or do a lot of masking things, because they dont like the fact that they say it. Theyll be saying, Im sorry, excuse me, after it comes out.
Although the public still lacks a lot of basic information about Tourettes Syndrome, we have come a long way since the days when Tourettes 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 Tourettes 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 Tourettes, 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 Tourettes Syndrome Association starting to fund some studies that were looking at non-drug treatments, he says. Tourettes Syndrome Association is the national organization for people with Tourettes 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 Tourettes, he says. We dont even attempt to get peoples hopes up with that word. The way we talk about it is, youre basically learning self-management skills. Youve got this [Tourettes], its going to happen at times, its going to have periods where its bad, its going to have periods where its fine. Were going to teach you that when its there, and when you need to, heres how you can control it. And sometimes, when you learn that, it goes away. And sometimes it doesnt 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 Harvards Massachusetts General Hospital. I want us to be there, in terms of treating kids, assessing kids, and understanding kids with Tourettes from a non-drug perspective. And I think were close. We just need more time.