Case Study: Sam's Vocal and Motor Tics

Sam and his parents both decide for Sam to receive treatment in order to reduce his vocal and motor tics. After discussion with their paediatric neurologist, Sam was referred for Habit Reversal Treatment. Treatment with Sam was implemented during 60-minute sessions during a course of 20 weeks.

Phase I: Awareness Training

The first part of the treatment is to increase Sam’s awareness of his tics. The therapist assists him in identifying, describing and producing on demand the dominant vocal and motor tics. The therapist also employs response detection by signalling Sam each time he displays a specific tic. Sam and the therapist also record tic frequency during randomly selected 5-minute periods.

Phase II: Self-Monitoring

The next phase focuses on Sam’s detection of tics outside of therapy sessions. Sam is asked to self-record tic frequency during designated periods of the day in which the therapist then reviews with Sam during sessions, enabling them to isolate situations and conditions that were associated with increased tic frequency.

Phase III: Relaxation Training

At this phase, the therapist teaches Sam progressive muscle relaxation, deep breathing and calming self-statements. In addition, he practises stretching exercises which, combined with relaxation, appear to calm Sam both within and outside of therapy sessions.

Phase IV: Competing Response Training

The final phase consists of teaching Sam to perform behaviours that compete with the habit of his tics. As he primarily exhibited vocal tics, the behaviour was slow, deep breathing through his nostrils to lessen the tics. Sam was also taught to slow down his rate of speaking so that palilalia and echolalia will occur less frequently. For Sam’s motor tics, the competing response was rhythmic, controlled eye blinking on a 2-second schedule. He also discovered that neck stretching exercises helped with his head jerking and facial grimacing. Sam reported that he could rehearse those movements on a cue-controlled basis and gain additional control over his motor tics.

Sam showed significant improvement after the relaxation training and not only has the frequency of Sam’s tics lessened but his mood was markedly improved over the course of his treatment and his self-esteem seems to have elevated.

Sam will be observed over the next few years and it is likely that his symptoms will reach its severity by age 10-12 however it will eventually decline after that and possibly subside altogether as he goes into adulthood.

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