NEW YORK — Tourette's syndrome treatment should be targeted to improve comorbidities rather than on the characteristic vocal and motor tics, Dr. John T. Walkup said at a psychopharmacology update sponsored by the American Academy of Child and Adolescent Psychiatry.
“To enhance outcome, go for the comorbidity; don't go for the tics,” said Dr. Walkup of the department of psychiatry and behavioral sciences at Johns Hopkins University, Baltimore.
“As tics are easy to spot, doctors have a tendency to treat tics first and then stop,” Dr. Walkup said at the meeting. “It's an impulse I would encourage everyone to restrain.”
As tics wax and wane even during treatment, treating physicians can get caught “chasing” tics by upping the dose, and adding or changing meds. Because tics wax and wane, doctors may falsely believe that the medication just delivered was responsible for the improvement, Dr. Walkup said.
Additionally, the comorbidity may not respond to tic-suppressing medications, and a few children with Tourette's will actually develop anxiety or depressive disorders on antipsychotics, Dr. Walkup said.
Tics can present in upward of 25% of school-aged children. Tourette's syndrome is associated with several coexisting conditions, including obsessive-compulsive disorder, attention-deficit hyperactivity disorder (ADHD), anxiety and depressive disorders, and other behavioral problems.
A small percentage of patients have a poor outcome from tics alone, Dr. Walkup said.
Taking a good family and social history is essential to identifying genetic and environmental factors for these conditions.
Children are at risk for specific comorbid conditions at certain ages. As a general rule, ADHD is more likely to occur in children at about ages 5–7 years, whereas anxiety tends to present between 8–10 years, depression between 10–14 years, and the classic version of bipolar disorder from age 14 years and up, Dr. Walkup said.
“If you've got a kid with a history of mild tics and who at age 9 deteriorates in his course, I'd be looking for an anxiety disorder as a potential cause of the deterioration, he said.
Many Tourette's syndrome patients also have behavioral problems, Dr. Walkup said.
Since Tourette's is considered a neurologic disorder, parents inadvertently may back off routine discipline strategies resulting in an increase in behavior problems, he explained.
Dr. Walkup recommends parent training for child behavioral problems, including emotional outbursts.
Data are expected at the end of 2007 from two large National Institutes of Health-funded studies evaluating behavioral strategies for tic suppression in children with Tourette's, he said.