A presentation by: Dr. Lori Rockmore, Psy.D., Clinical Director of the Tourette Syndrome Therapeutic Program
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Dr. Rockmore discussed how psychological services can benefit individuals with TS and the treatment options that are available.
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With hand tics which are significantly interfering with the ability to type or write, are there behavioral substitutes or other interventions which can be recommended (other than assistive technology which is already being used but not always practical)?
In response to this question:
Why is Habit Reversal Therapy not recommended for people with ADHD?
It is not necessarily the case that an individual with ADHD would not benefit from Habit Reversal Therapy (HR) and more research would be needed for a definitive answer. I will address the concerns about HR with ADHD and then consider when it might still be indicated.
HR as a treatment requires both persistence and motivation. An individual with ADHD has deficits in both of these areas. With persistence, someone with ADHD is easily distractable and may have difficulties remaining vigilent in doing the HR techniques. With motivation, an individual with ADHD has neurological deficits in long-term planning and immediate gratification needs often overrule delayed gratification. That being the case, a hallmark of ADHD is that a child knows cognitively that they should not do something, but in the moment, do it anyway. Therefore, it may be difficult to resist the urge to tic, even with a competitive response as offered in HR.
Still, every child is different and ADHD should not necessarily rule out HR, though it may be more difficult. As a clinician, I would be more willing to try HR with an ADHD child or adolescent if I felt that they were highly motivated and if I had evidence that they were able, at times, to act contrary to their ADHD. Also, if the ADHD symptoms had been successfully reduced with medication, there would be no reason to think that HR could not be effective.
In response to this question:
With hand tics which are significantly interfering with the ability to type or write, are there behavioral substitutes or other interventions which can be recommended (other than assistive technology which is already being used but not always practical)?
There are two choices here: One, work around the tic. Two, attempt to reduce the tic.
With the first choice, clearly assisted devices could be helpful. Outside of this consideration, it may be necessary to lower the expectations around writing assignments when the tic is causing problems. Ideally, the work could still be completed either orally or at times when the tic is not interfering. Hopefully, parents and teachers would be able to use their knowledge of the child to determine what realistic expectations would be.
In terms of the second option, there are three main avenues to pursue reduce the tic. First, medication could be considered when a tic is disruptive enough that the increase in functioning that would result in reducing the tic outweighs the potential side effects of medication. Second, Habit Reversal is an excellent option in a child who is motivated to reduce their tic. Third, in many children tics have a tendency to wax and wane. If this is known to be the case in this particular child, it might be best to wait and see if the tic decreases or disappears on its own before intervening otherwise (this is especially true when considering medication where it is best to avoid increasing meds every time tics happen to increase due to a natural waxing period).
If these options do not seem adequate, keep in mind that as a parent, sometimes the greatest long term plan is to remain accepting and supportive in whatever challenging situation faces you and your TS child. Hang in there.
This discussion has been closed. Thank you to everyone who participated!
Why is Habit Reversal Therapy not recommended for people with ADHD?
Posted on October 31st, 2008 at 11:58am by diannt