Training parents of children with Tourette’s syndrome to recognize disruptive behavior and teaching them to use positive, consistent reinforcement decreases behavioral problems, a recent Yale School of Nursing and Center for Child Study publication shows.
Tourette’s syndrome, a disorder characterized by involuntary motor and phonic tics, is an inherited neurological condition whose causes are not well understood. Symptoms can be treated with medication and other therapies, but children with Tourette’s often exhibit disruptive behavior, such as defiance or tantrums, which may or may not be involuntary, said Lawrence Scahill, a professor at the School of Nursing and the lead author of the study.
The focus in treating Tourette’s syndrome has traditionally been on the tics themselves, not on dealing with the accompanying behavioral issues.
“The issue of whether or not “tics are to blame” for disruptive behavior is complicated and not fully understood by researchers,” co-author Denis Sukhodolsky said in an e-mail.
With the larger goal of learning more about these behaviors, the purpose of the School of Nursing study was to investigate whether disruptive behavior in children with Tourette’s could be dealt with using the same Parent Management Training used with other disorders, such as ADD or ADHD.
“Parent training has been around for a long time for children who don’t have tic disorders,” Scahill said. “It’s one of the best interventions in child mental health.”
Parents of children whose symptoms resemble behavioral problems often have difficulty discerning whether they should deal with tantrums as they would with another child or if special consideration is needed, he added.
The study applied PMT to the Tourette’s issue by randomly dividing 24 subjects diagnosed with TS or chronic tic disorder into two groups. Twelve subjects’ parents attended a 10-session training course in which they were taught to be consistent in their reactions to outbursts and clear in explaining consequences, as well as using positive rather than negative reinforcement. The remaining 12 subjects’ parents did not receive training, while both groups continued any medication or therapy they had been receiving.
Positive reinforcement is particularly important in PMT said study co-author Karen Bearss of the Center for Child Study, via e-mail.
“This can take the form of a ‘special time’ where the parent and child participate in a mutually enjoyable activity,” she said. “This also can mean attending to and rewarding specific appropriate behaviors.”
To assess the results, the parents themselves kept track of how many tantrums or other disturbances occurred during the 10-week period. Scahill said it was true that due their personal involvement in the case, parents might not be completely unbiased in their reporting.
“That’s something we never fully get away from in these studies,” he said, but added that repeated follow-ups and consultations with clinicians who didn’t know if the children had received PMT or not were used to reduce bias in the results.
The results indicated that PMT could be effective in reducing severe behavioral problems in children with Tourette’s. PMT parents reported 32 percent fewer disruptive incidents than non-PMT parents, and clinicians conducting blind interviews with parents reported a 47 percent difference between PMT and non-PMT groups in disruptive incidents.
Scahill said the next step is to conduct larger clinical trials with longer follow-up periods, which will clarify results. Additionally, he said an important element to remedying behavioral problems is to teach parents that they will have to learn things that other parents do not. They often have their confidence shaken by outbursts, Scahill said.
“One of the biggest things is telling parents that they’re not to blame,” he said.