Tourette Syndrome and Obsessive Compulsive Disorder (OCD)
Written By: Jan Rowe, Dr. OT, OTR/L, FAOTA
I see many patients each week who have TS and OCD. Most present to my clinic because of their tics but the truth is, the OCD may be a bigger hurdle for them to overcome. Families haven’t always thought about the ‘co-morbidities’ when they seek CBIT (comprehensive behavioral intervention for tics) treatment. In the first session I try to make clear the tics are really the easiest part of the scenario. Those of us who provided CBIT can teach children how to manage or minimize their tics. The tics will decrease and become less noticeable but the OCD will still be there. Like anxiety and ADD the OCD will always be a bigger struggle in the balancing act of school, play, home life, and eventually adulthood.
CBIT is based in cognitive behavioral therapy and can have a positive effect on OCD if the child and family are willing to do the necessary work. Depending on the age of the child they may think of their OCD as ‘mental tics’. This language is supported in some scientific literature as well. If a child is willing to confront their obsessional thinking or compulsive acts, agree to an acceptable and comfortable replacement and work on this daily; their OCD can be substantially changed. They also learn that having OCD does not have to mean obsessions or compulsions control them. They can learn that their OCD can work for them. That said, some children may also need medication in combination with their new found strategies for best results.
I am by no means an expert in OCD but have had success treating OCD along with TS in the CBIT clinic. This has become an important part of my clinic because the OCD, like tics can disrupt everyday activities of children. Occupational therapists call these activities ‘occupations’. Occupations are things we all do which are ‘meaningful and purposeful’. When a child is so focused on their thoughts or compulsions and miss important information in class, opt out of community activities or extracurricular activities we need to address it. Here’s an example of OCD interrupting a child’s school experience.
A few years ago a 14 year old male patient presented with TS and OCD. The OCD was not known at the time of the evaluation. Through the evaluation he described many of his tics in a way which raised suspicion about OCD. He disclosed that one of his ‘mental tics’ was having to spend the last 10 minutes of every class obsessing about how he could get down the hallway, between classes without touching or being touched by peers. If you think about what happens in the last 5-10 minutes of class teachers tend to convey important information- reminders of projects, tests, homework to be done, etc. This young man heard none of it. As a result he was delinquent on assignments, missed important due dates and was often unprepared for the next day of class. Once we started making head way on his tics through CBIT we shifted our attention to dealing with his OCD (session 4 or 8). In addition, I assisted his parents and the school to develop a 504 plan for accommodations within the school environment, addressing his TS and OCD.
The comprehensive behavioral intervention can and does work well for this group of children who present with TS and OCD. I find a healthy amount of ‘distress’ over the tics and OCD is a good thing when seeking out CBIT programs. Keep in mind your child may need to work with a specialist to address their OCD.
For additional information or resource material:
- “Freeing your child from OCD” Tamar Chansky
- “Talking Back to OCD” J. March and C. Benton
For more information regarding CBIT and the UAB program, explore the link on the Center of Excellence Page.