Navigating the complexities of Tourette’s Syndrome and tic disorders in children can be overwhelming for families. In Mississippi, a beacon of hope has emerged with the establishment of the state’s first dedicated Tourette’s clinic. This pioneering clinic, a collaborative effort between clinical psychologist Dr. Monica Sutton and pediatric neurologist Dr. Tarif Bakdash, offers a comprehensive approach to diagnosis, treatment, and support for children and adolescents affected by these conditions.
Recognizing a significant unmet need in Mississippi, both Dr. Sutton and Dr. Bakdash, based at the University of Mississippi Medical Center, frequently found themselves referring patients to each other. Dr. Sutton, with her expertise in child psychology, and Dr. Bakdash, specializing in pediatric neurology, understood that optimal care required a dual approach, addressing both the neurological and psychological aspects of tic disorders. This realization sparked the idea for a joint clinic.
“I was referring so many patients to him, and he was referring so many patients to me, that we decided to offer a clinic together,” explained Dr. Sutton. Launched in March, the Tourette’s clinic operates every Thursday at the CAY Clinic, located within Select Specialty Hospital in Jackson, providing a much-needed resource for families across Mississippi.
Dr. Bakdash emphasizes the clinic’s unique position, stating, “This is the only Tourette’s clinic available in Mississippi.” This distinction underscores the clinic’s vital role in providing specialized care for Tourette’s Syndrome and its common co-occurring conditions, known as comorbidities. These comorbidities can include Obsessive-Compulsive Disorder (OCD), Attention Deficit Hyperactivity Disorder (ADHD), mood disorders, and various anxiety disorders. The clinic’s integrated approach ensures that these related conditions are also addressed, offering holistic care for each patient.
Tourette’s Syndrome is clinically defined by the presence of at least two motor tics and one vocal tic for a minimum of one year. These tics can manifest in a wide range of ways. Dr. Sutton illustrates, “It could be clearing the throat over and over. We have some who hum and some who curse involuntarily.” The severity of Tourette’s varies significantly. The National Institutes of Health estimates that approximately 200,000 Americans experience the most severe form of Tourette’s, while a much larger number, possibly as many as one in 100, live with milder symptoms. It’s also important to note that tic severity can fluctuate, often worsening during periods of stress or excitement and lessening during calm, focused activities.
Dr. Bakdash explains the neurological basis of tics, pointing to “a deficit in a brain circuit that connects deeper parts of the brain, basal ganglia and the thalamus, to the front of the brain.” This neurological understanding is crucial for developing effective treatment strategies.
Effective management of Tourette’s and tic disorders typically involves collaboration between pediatric neurologists and child psychologists. Dr. Bakdash notes that while most cases benefit significantly from behavioral therapy, a multidisciplinary approach is often the most effective.
The impact of tics on a child’s life can be profound. Persistent throat clearing, involuntary movements or vocalizations, blinking, or even blurting out unintended words can lead to significant challenges. Children may face unwanted attention, stares, and social difficulties, particularly in school settings.
Dr. Sutton points out that Tourette’s is frequently diagnosed around the time a child starts school, at approximately age 6. “They often have trouble in school and have problems with their peers. Sometimes they are made fun of by classmates or are punished for disruptions in class.” The statistics are concerning, with Dr. Bakdash reporting, “About 50 percent of children with Tourette’s are bullied.”
At the new Tourette’s clinic, patients and their families gain valuable knowledge about the neurological origins of tics, available medications if necessary, and evidence-based behavioral strategies. Dr. Sutton emphasizes a tailored approach, stating, “Sometimes, we determine that the tics are severe enough that medical and behavioral therapies are warranted.”
Cognitive Behavioral Intervention for Tics (CBIT) is a cornerstone of the clinic’s treatment program. This structured eight-week program, involving both patients and their families, empowers them with tools and techniques to manage tics. Weekly sessions focus on building tic awareness, identifying triggers, and understanding situations that exacerbate tics.
One key CBIT strategy involves teaching patients competing responses to counteract tics. Dr. Sutton provides an example: “For example, if a patient’s tic is coughing, we teach them to breathe in through the mouth and out through the nose. You can’t do that and cough.” This technique gives children a tangible way to gain control over their tics.
Parental involvement is crucial to the success of CBIT. Dr. Sutton stresses, “We have to have the parents’ buy-in. They are the ones who will monitor the child and help implement the CBIT strategies. Parental involvement is critical for CBIT to work.” The clinic recognizes the family as an integral part of the treatment process, providing support and guidance to parents as well as children.
Beyond tic management, Dr. Sutton also addresses the emotional impact of Tourette’s, helping patients and families cope with the social and emotional challenges, including diminished self-esteem resulting from peer teasing and bullying. “By the time they get to me,” Dr. Sutton shares, “they can feel defeated.” The clinic provides a supportive environment to rebuild confidence and resilience.
Dr. Sutton encourages parents to seek consultation if tics are interfering with their child’s daily life. “They should seek treatment if their children are being bullied in school, are distracting others in the classroom or can’t participate in activities such as playing sports or going to church because of their tics.” Early intervention can significantly improve a child’s quality of life and long-term well-being.
The clinic also addresses co-occurring learning disorders or anxiety, often treating these conditions first to optimize a child’s ability to engage in CBIT strategies. Dr. Bakdash adds that while medication can play a role in treating Tourette’s, a combination of CBIT and medication often yields the best outcomes.
Reassuringly, Dr. Bakdash notes that “About a third of Tourette’s patients outgrow their tics,” and another third experience significant improvement as they transition into adulthood. However, “About 30 percent of patients continue to have Tourette’s symptoms from childhood during their adult years.” The clinic provides realistic expectations and long-term support.
Dr. Sutton concludes on a hopeful note, “We don’t want to give parents false hope, but in many cases, we see a significant decrease in tics, and as children grow up, some tics may go away. The reality is, though, that they can come back, but if they do, the patient will have the tools to control the tics again.” The Mississippi Tourette’s Clinic offers not just diagnosis and treatment, but also empowerment and lasting strategies for children and families facing the challenges of tic disorders.
