CBIT for Tourette's and tic disorders: a family guide

Start with what tics are

Tics are repeated movements or sounds that are not simply chosen habits. Some people notice an uncomfortable sensation or urge before a tic; others have difficulty recognizing or describing one. Being able to hold back a tic briefly does not mean a person can reliably stop on demand.

Tourette syndrome is one type of tic disorder. A clinician considers the kinds of tics, their history and other possible explanations. A new movement or sound should not automatically be labeled Tourette's.

Source context: NINDS: Tourette syndrome

The main parts of CBIT

CBIT combines skills and changes to the surrounding situation. The provider works on a tic or difficulty that matters to the person.

• Awareness: learning to recognize the tic and, when possible, the sensations that precede it.
• A competing response: learning an individually selected action that is incompatible with the tic and can be used when appropriate.
• Changes to context: identifying situations or reactions that make tics harder to manage, then adjusting routines or supports.
• Practice and review: learning the skills with support and revisiting what helps in everyday settings.

Source context: CDC: behavioral treatment for tics · Tourette Association of America: CBIT overview

What a course might look like

A commonly studied format uses eight sessions over ten weeks, although actual care can be shorter, longer or adapted. The therapist teaches and reviews practice; they do not simply tell a child to stop ticcing.

Do not invent physical maneuvers, restrain a movement or require breath-holding based on an online example. The competing response needs to be suitable for the specific tic and person. Ask the provider to explain how discomfort, fatigue, communication and learning needs will be addressed.

Source context: Tourette Association of America: CBIT information for patients

A fictional example: less pain during homework

A teenager has a shoulder tic that becomes painful during homework. Their own goal is greater comfort and being able to finish a task, not hiding every tic. A clinician first checks the movement and any pain, then works with the teenager on a suitable plan.

With repeated practice, the tic may become less disruptive. Tics can still fluctuate, and a difficult week does not erase progress. The family also reviews comfort, effort and participation instead of counting every movement.

1. Notice the pattern

   The therapist helps the teenager recognize the tic and any warning sensation, and explores the homework setting.

2. Learn an individualized skill

   The therapist selects and teaches a suitable competing response. This example does not prescribe a movement to copy.

3. Adjust the surroundings

   The team considers comfortable seating, manageable work periods and breaks, based on what helps this teenager.

4. Agree the caregiver's role

   A parent offers a discreet cue only if the teenager wants it and it is part of the plan. They acknowledge practice without policing tics.

Source context: CDC: behavioral treatment for tics · Tourette Association of America: CBIT information for patients

Benefits and limits

Research supports CBIT for reducing tic severity and interference in many children and adults, but benefit varies. It is not a cure for Tourette syndrome, and continuing to have tics does not mean someone failed or did not try hard enough.

Treatment decisions should reflect the person's priorities and how tics affect life. When tics are not causing distress or impairment, education and monitoring may be appropriate. When help is wanted or tics interfere, ask about CBIT and other options with the clinician.

Source context: Tourette Association of America: CBIT overview · American Academy of Neurology: treatment guideline overview · CDC: treatment and support for Tourette syndrome

How families and schools can help

Keep the person involved in decisions. Use reminders only if they are wanted and agreed with the therapist. Avoid punishment, public correction and constant observation of every movement. Therapy should not make home or school feel like a performance test.

Practical supports can include agreed breaks, a comfortable place to work and staff who understand tics. Ask the student what would help and whether they want information shared. Review bullying, pain and barriers to participation alongside any change in tic frequency.

Source context: Tourette Association of America: CBIT information for patients · CDC: treatment and support for Tourette syndrome

Tics, OCD and autistic stimming are different

OCD compulsions often relate to a feared consequence, doubt or a need for things to feel right. Tics may be associated with a bodily urge. These experiences can overlap, and OCD and tic disorders can occur together; the distinction is not always obvious from watching a behavior.

Autistic stimming can support regulation or express enjoyment. Harmless stimming does not need to be eliminated. An autistic person may also have a tic disorder or OCD, but each concern needs its own assessment and goals. CBIT should not become a blanket program to make someone appear less autistic.

Source context: NIMH: OCD signs, symptoms and treatment · NINDS: Tourette syndrome · National Autistic Society: repeated movements and stimming

Questions for a potential provider

Use these original prompts to discuss fit before committing to treatment:

• What training do you have in CBIT, and which ages and needs do you work with?
• How will you assess tics, co-occurring OCD or ADHD, and the person's main priorities?
• What adaptations are available if noticing urges or describing sensations is difficult?
• What will practice involve, what role should caregivers have, and how will we avoid excessive monitoring?
• How will we assess benefit, cost and access, and when would you discuss another approach?

• Compare therapy approaches →
• Explore Tourette's information →
• Explore learning and school supports →