Medication is currently the primary option for most children and adolescents requiring treatment for Tourette Syndrome (TS) and chronic tics (CMT). Although medication can reduce tics in most youngsters, potentially serious side effects, a limited knowledge about long term use, and a poor or only partial treatment response for many children indicate a great need for non-medical treatments, such as behavior therapy. In spite of this need, behavior therapy for children with chronic tics remains poorly studied. The treatment of chronic tics in children is often complicated by other factors such as coexisting behavioral and emotional problems. Also, tic expression can be very sensitive to environmental factors, e.g. worsening in stressful situations. Unfortunately, there is little information available about the impact of these other factors on treatment effectiveness. This study will compare two forms of behavior therapy for chronic tics, and also examine the impact of other problem behaviors and stressors on treatment outcome. It is our hope that the direct comparison of these two behavioral treatments will provide impor¬tant information that can be used to develop more effective treatment approaches for children with chronic tics. In addition, the identification of specific predictors of treatment outcome will assist us in our efforts to develop individualized treatment programs for different children based on their specific symptom patterns and circumstances. A total of 30 children and adolescents with chronic tic disorder will be randomized to receive either Habit Reversal Training (HRT) or Awareness Training (AT). In HRT, patients are taught to self-monitor their tics, and then engage in an incompatible physical response each time they feel the need to tic. For example, for an eyeblinking tic, one might be encouraged to raise the eyelid and hold it open every time the urge to blink occurs. Motivational exercises are in¬cluded in HRT to help children adhere to the technique. In AT, children are taught to recognize their urges to tic, then systematically record them and their actual tic behaviors. In therapy sessions, children are rewarded for completing the ratings that are reviewed with the therapist. Both HRT and AT will be 8 weeks in length. Several measures will be used to rate improvement at the middle and end of treatment, and at 3- and 6-month follow-up visits. Also, ratings of other behavior and emotional symptoms and environmental stress will be collected to assess how these problems affect the efficacy of the two treatments. While we suspect that HT may result in slightly greater and longer-lasting symptom reduction than AT, younger or poorly motivated children, or those coping with other behavior problems may find it difficult. In contrast, AT is easier to teach and use. As a result, AT may prove more acceptable with increased compliance by younger patients. In either case, our goal is to establish that one or both of these treatments can be useful additions to medication treatment, or perhaps, in certain cases, as effective treatments on their own. John Piacentini, Ph.D. James T. McCracken, M.D. Courtney Jacobs, Ph.D., University of California Los Angeles, CA Award: $36,853 Tourette Association of America Inc. – Research Grant Award 1997