Assessment and Treatment of Tourette Syndrome

As an expat or someone living far awayfrom a specialist centre for neurobehavioral disorders, you’ll know how hard it is to find English-speaking psychologists.

We are experienced UK qualified psychologists providing online assessment and diagnosis of Tourette’s and Tic Disorder using internationally recognised, reliable tools.

Our therapy uses proven methods such as Habit Reversal Therapy(HRT), Behavioural Therapy, Exposure and Response Prevention (ERP) and Comprehensive Behavioural Intervention for Tics (CBITs).We will help you to manage your tics better, and live a more fulfilling life at work or at home.

If you are self-conscious about your tics or have other emotional issues,we will also use Cognitive Behavioural Therapy (CBT),Mindfulness-Based Cognitive Therapy (MBCT) and Compassion Focused Therapy to help you feel better and more confident.

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What does a diagnostic assessment for Tourette Syndrome or Tic Disorder look like?

We useguidelineslike theEuropean Society for the Study of Tourette Syndrome (ESSTS) (2011)to inform our diagnostic assessments and therapy.

When wemeet a young personor adultwith suspectedTourette Syndrome (TS)or Tic Disorder we gatherinformation about the symptoms from various sources.Ideally,we like to get theperspective ofthe patient as well asa family member,orothers significant in their life (‘informants’).The reason we like to speak to someone who knew the patient in childhood (in the case of an adult) or the parents (in the case of achild) is because TSis a ‘neurodevelopmental’ condition,which meansthe symptoms started in childhood.This is whyweask for school reports if they are available, and/ortalk with the parents or carers.Withadultsit can be reallyhelpfulfor us tospeakwith the patient’spartner orafriend who knows them well. Ifthe patient isn’t able to identify a suitable person for us to talk tolive by video call or telephone, then wecanemailthemandask them to complete somequestionnaires instead.

The assessment process is conducted by one ofthe team.We charge a fixed fee (contactusfor details) for the assessment and diagnosis which comprises the elements below:

1. We collect some information from the patient and those close to them before we meet. These questionnaires can be returned by email.

2. Ideally, a short piece of video footage will be collected by a parent or other informant (with patient's permission) lasting 5 to 15 minutes of the full range of the patient's tics

3. When these sources of information have been collected, we will meet the patient in a video call (or in some cases in person). This is called a Clinical Interview and it usually lasts about 60 minutes. If we are assessing a child or young person, we will invite the parents to be present for at least part of the meeting.

4. Either in this meeting, or a second one, we will conduct a Structured Diagnostic Interview which lasts one to two hours. Ideally this includes an informant.

5. In our last meeting we will feedback the results (approx 50 minutes) and provide a written report. Further amendments may be made after the meeting before it is finalised.

6. We will send the final report to the patient and any other health professionals involved (with written consent).

Please note:when there aremultiple complex difficulties then further assessment sessions and/or liaison with other professionals or informants may be recommended.If there isAutistic Spectrum Disorder,ADHD, or a mental health problemlikeOCDsuspectedthen thesecanbeinvestigated separatelyfor an additional fee. If medication is something the patient would like to explore, we can make a referraltoa Consultant Psychiatrist who is able to prescribe medication for TS.

What does therapy for Tourette Syndrome look like?

We offera type of CBT calledComprehensiveBehavioralIntervention forTourettesSyndrome (CBITS). Thisis a well-proven psychological therapydeveloped by Prof Doug Woods, aclinical psychologistfrom America. 

After the assessment has been completed therapy will typically consist of 8 meetings where we address your tics one by one. More information about how clinical psychologists work with Tics/Tourettes is available in this leaflet written by Alesia with Dr Tara Murphy (insert hyperlink).What we are aiming to do is to helpyou manage the tics so youfeelmore in control and lessbothered by them.

1. The first thing we do in therapy is to conduct a 'functional assessment'. Here we analyse your environment or social context which makes the tics worse. We then try to change those triggers with a 'function-based intervention'. We list all the tics that bother you the most, and put them in hierarchy, with the ones that distress you most at the top.

2. The next thing we do is called Habit Reversal Therapy (HRT). We pick one of your tics, and teach you how to sport when it is going to occur by scanning your body to see if there is a 'premonitory urge' or 'tic signal'. After this tic awareness training we then help you create a 'tic blocker' or competing response (CR). This is something you can do instead of the tic until the urge to tic dies down / doesn't bother you anymore. The CR has to meet certain criteria to be effective, such as something that looks natural which wouldn't be noticed by others.

3. When you feel that the first tic has been dealt with sufficiently, we then create new CRs for each tic on your hierarchy. You'll need to practice each CR for several days at home until you have retrained your brain to block the tics.

4. We may also use some relaxation and CBT strategies as we progress through therapy, as stress often makes tics worse.

Aftertheinitial 8 sessionswe hope you will feel more confident managingyour tics.You will be offeredthree 'booster' sessions once a month tohelp you maintain your progress andsupport you asapplythe strategies independentlytoyour everyday life.

If you would like to see whatCBITsand HRT looks like live, you can watchProf Doug Woods demonstrate the techniques in this video. There is another great video withDrTara Murphy 'Rupert shares his experience of CBIT therapy withTourettesAction'.

Some people have a lot oftics andtheyfindthe CR too complicatedand want something simpler. This is whereExposure and Response Preventioncan behelpful.Wedon’t have as many scientific studies on this type of treatmentyetand that is why we don’t recommend it first.However,lots of people find itmore straightforward andjust as, if not more,effective for them.

Where do you see people?

We specialise in helping people online by videoconference call so our patients can be located anywhere in the world. We also may be able to meet in person, either in theUK ,or elsewhere in Europe. If you require us to come to you, please contact us for details. Many of our clients are English speaking expats who are unable to access diagnostic and treatment options in their host country.

Useful materials for clients

ProfDougWoodshas written one of the most important CBT manuals currently used in this field 'Managing Tourette Syndrome: a behavioural intervention for children and adults'.

DrTaraMurphyhas written a really useful book about TS in general. It looks at the biology, medication issues as well as psychological therapies for the disorder 'Tic disorders: a guide for parents and professionals' .

 A great book for children and young people is Nix Your Tics by Dr Duncan Mckinlay. Unfortunately, you cannot buy a hard copy at the moment and only aKindle versionis available.

References

  • ESSTS, (2011). European clinical guidelines for Tourette Syndrome and other tic disorders. Part 1: assessment. European Child and Adolsecent Psychiatry, 20, 155-171.