Comparison of Habit Reversal Training vs. Habit Reversal Training with Adjunctive Pharmacotherapy in Adolescents with Tic Disorders

Grant Type
Grant Year
Institution Location
Institution Organization Name
Massachusetts General Hospital
Investigators Name
Steingard, Ron, MD

There has been much interest in the role of behavioral therapy in the treatment of tic disorders. However, problems have been encountered with treatment compliance and long-term maintenance of response with behavioral interventions. In the treatment of Obsessive Compulsive Disorder (OCD) concomitant use of medications has improved compliance and response to behavioral interventions. We propose a study to compare the treatment of tic disorders in adolescent patients using habit reversal training alone versus habit reversal training augmented with pharmacotherapy. We anticipate a positive response in both groups, but speculate that the combined treatment (habit reversal training and pharmacotherapy) will result in better treatment compliance and improved response. Behavioral treatment will consist of habit reversal training which has been reported to be highly effective in the treatment of tic disorders. All patients will receive behavioral therapy, however, one half of the patients will also receive clonazepam, an agent with demonstrated efficacy in the treatment of tic disorders, while the other patients will receive placebo. Unlike haloperidol and pimozide, clonazepam does not carry a risk of extrapyramidal side effects or tardive dyskinesia. In addition to reducing tic frequency, clonazepam is an effective antianxiety agent. Therefore, we speculate that clonazepam may act to augment habit reversal by enhancing the relaxation component of this therapy technique. Treatment response will be assessed frequently during the active phase of treatment. In an attempt to compare long term response, treatment responders will be maintained on study treatment for a full year and assessed at regular intervals during this phase of the study. Ron Steingard, M.D. Massachusetts General Hospital, Boston, MA Award $25,000 Tourette Association of America Inc. – Research Grant Award 1991