At least 138,000 children in the United States are estimated to have Tourette’s syndrome, a condition which causes urges that lead to repeated involuntary movements (motor tics) and sounds (phonic tics). For decades, research suggested pharmaceutical therapies were the only effective treatments for tics, but clinical psychologist Dr. Geoffrey Wiegand is having success using a new, innovative behavior intervention to treat tics. Wiegand is also offering highly effective behavior therapy to children with Obsessive Compulsive Disorder (OCD) to help them manage their worries and compulsions.
Jules Brown appeared to be a happy, healthy child until she was 5 years old, when her parents began noticing odd behaviors. She was constantly changing her clothes out of fear of being dirty and would wash her hands until they bled. It took the family hours to leave the house because Jules was terrified she would have an “accident” and would insist on visiting the bathroom repeatedly. At school, she spent many days in the nurse’s office, afraid of various illnesses or injuries that she did not have.
“As her mom, I wanted to protect her, so we were constantly doing anything we could to reassure her,” Christie Brown said. “But the impulsive behaviors just got worse.”
Over the next two years, Jules’s anxiety increased. She began having night terrors in which she would dream about her family members being killed and soon was hardly sleeping. One night, when Jules was 7 years old, she began crying hysterically as her mom tucked her in to bed. She told her parents “I can’t take it anymore” and begged them to kill her. While her parents tried to soothe her through the night, Jules picked out a place in the back yard where she wanted to be buried.
“It was terrifying,” her dad Charles Brown said. “We didn’t understand what was going on.”
Tyler DeBrock’s parents first noticed his eye twitching when he was 2 years old. Over the next few years, other twitches and loud, interruptive noises developed. While they thought Tyler’s behavior was strange, he hardly seemed to notice. But the movements and noises grew worse.
“He started cycling through a variety of tics including blinking, hand movements and throat clearing,” Tyler’s mom, Lisa DeBrock, said. “He started shaking his head so violently we feared he might hurt himself. “We didn’t know if it was best to talk with Tyler or ignore the tics and hope they would go away on their own.”
By age 11, Tyler had grown self-conscious of his impulsive behavior.
“I would interrupt class with my verbal tics or be the only one making loud noises during a wedding,” Tyler said. “I couldn’t control myself. I just wanted the tics to stop.”
Help for Jules and Tyler
Jules was diagnosed with severe OCD and Tyler had mild OCD and Tourette’s, but both patients’ lives changed dramatically when they started treatment with Wiegand.
To treat both patients’ OCD, Wiegand prescribed cognitive behavior therapy, also known as “exposure.” He set rules that challenge the patients to act against their urges. Tyler always wanted things to be perfect, neat and symmetrical, so he was instructed to leave one intentional mistake on his math homework and color pictures outside of the lines. He was also terrified of bugs, so he was told to hold spiders in a tissue for a few seconds before killing them. Wiegand tried to counteract Jules’ obsession with cleanliness by challenging her to only wash her hands three times a day and even rub her hands on the floor of public places.
Putting her daughter in uncomfortable situations was difficult for Christie Brown, but her trust in Wiegand’s treatment paid off. Jules’ anxiety decreased and she was soon able to leave her home more easily. Once she completed her treatment, Jules was confident enough to try adventurous activities like zip lining, repelled down a building, flying in a helicopter and indoor skydiving.
“Everything changed once she started seeing Dr. Wiegand,” Christie Brown said. “She became this fearless, happy kid. As a mom, your instincts tell you to give your child whatever they want, but forcing her to be strong was the best thing we ever did for Jules.”
Tyler’s OCD improved as well, so Wiegand began treating his Tourette’s with Comprehensive Behavioral Intervention for Tics (CBIT), a four to six month behavioral intervention program designed to extinguish unwanted impulses and tics by teaching patients to recognize problematic urges and counteract them.
Each time Tyler felt a tic coming on – like flicking his wrist – he would instead use that body part to do something else – like pressing his palms together. Over time, the tics occurred less and less.
“It was hard to do, but it was cool to see that I could improve myself,” Tyler said. “I know that I will continue to have tics come up in the future, but I feel confident that I can handle any that come my way.”
Although some patients are helped by a combination of pharmaceutical and behavior therapies, Tyler’s parents were impressed by how much their son’s behavior changed without using medication.
“Words cannot describe Tyler’s transformation over the past year,” Lisa DeBrock said. “This treatment has given him the ability to be a normal 11-year-old boy who plays soccer, runs, skis, bikes, hikes and hangs out with his friends. We know Tyler still has a rough road ahead of him but we feel empowered as a family to conquer these tics together.”
Despite the effectiveness of these behavior therapies, parents often struggle to find providers with the expertise to offer them. To make these treatments readily available, Wiegand will start a clinic this fall at Seattle Children’s to train mental health providers in the behavioral treatment of OCD and Tic Disorders.
“Tourette’s and OCD are chronic, but this intervention effectively teaches kids skills they can use throughout their lives to control those conditions,” Wiegand said. “When they finish treatment they have conquered their fears and are ready to take on the world.”
If your child needs treatment for OCD or Tourette’s please contact your primary care physician or Seattle Children’s Psychiatry and Behavioral Medicine Team.