There is no cure for<unk> 's. There is no single most effective medication, and no one medication effectively treats all symptoms. Most medications prescribed for tics have not been approved for that use, and no medication is without the risk of significant adverse effects. Treatment is focused on identifying the most troubling or impairing symptoms and helping the individual manage them. Because comorbid conditions are often a larger source of impairment than tics, they are a priority in treatment. The management of<unk> 's is individualized and involves shared decision-making between the clinician, patient, family and caregivers. Practice guidelines for the treatment of tics were published by the American Academy of Neurology in 2019. Education, reassurance and psychobehavioral therapy are often sufficient for the majority of cases. In particular, psychoeducation targeting the patient and their family and surrounding community is a key management strategy. Watchful waiting "is an acceptable approach" for those who are not functionally impaired. Symptom management may include behavioral, psychological and pharmacological therapies. Pharmacological intervention is reserved for more severe symptoms, while psychotherapy or cognitive behavioral therapy (CBT) may ameliorate depression and social isolation, and improve family support. The decision to use behavioral or pharmacological treatment is "usually made after the educational and supportive interventions have been in place for a period of months, and it is clear that the tic symptoms are persistently severe and are themselves a source of impairment in terms of self-esteem, relationships with the family or peers, or school performance". Psychoeducation and social support Knowledge, education and understanding are uppermost in management plans for tic disorders, and psychoeducation is the first step. A child's parents are typically the first to notice their tics; they may feel worried, imagine that they are somehow responsible, or feel burdened by misinformation about<unk> 's. Effectively educating parents about the diagnosis and providing social support can ease their anxiety. This support can also lower the chance that their child will be unnecessarily medicated or experience an exacerbation of tics due to their parents' emotional state. People with<unk> 's may suffer socially if their tics are viewed as "bizarre". If a child has disabling tics, or tics that interfere with social or academic functioning, supportive psychotherapy or school accommodations can be helpful. Even children with milder tics may be angry, depressed or have low self-esteem as a result of increased teasing, bullying, rejection by peers or social stigmatization, and this can lead to social withdrawal. Some children feel empowered by presenting a peer awareness program to their classmates. It can be helpful to educate teachers and school staff about typical tics, how they fluctuate during the day, how they impact the child, and how to distinguish tics from naughty behavior. By learning to identify tics, adults can refrain from asking or expecting a child to stop ticcing, because "tic suppression can be exhausting, unpleasant, and attention-demanding and can result in a subsequent rebound bout of tics". Adults with<unk>  may withdraw socially to avoid stigmatization and discrimination because of their tics. Depending on their country's healthcare system, they may receive social services or help from support groups. Behavioral Behavioral therapies using habit reversal training (HRT) and exposure and response prevention (ERP) are first-line interventions in the management of<unk> , and have been shown to be effective. Because tics are somewhat suppressible, when people with<unk>  are aware of the premonitory urge that precedes a tic, they can be trained to develop a response to the urge that competes with the tic. Comprehensive behavioral intervention for tics (CBIT) is based on HRT, the best researched behavioral therapy for tics.<unk>  experts debate whether increasing a child's awareness of tics with HRT/CBIT (as opposed to ignoring tics) can lead to more tics later in life. When disruptive behaviors related to comorbid conditions exist, anger control training and parent management training can be effective. CBT is a useful treatment when OCD is present. Relaxation techniques, such as exercise, yoga and meditation may be useful in relieving the stress that can aggravate tics. Beyond HRT, the majority of behavioral interventions for<unk> 's (for example, relaxation training and biofeedback) have not been systematically evaluated and are not empirically supported. Medication Clonidine is one of the medications typically tried first when medication is needed for<unk> 's. It is available as a pill or a transdermal (skin) patch. Children with tics typically present when their tics are most severe, but because the condition waxes and wanes, medication is not started immediately or changed often. Tics may subside with education, reassurance and a supportive environment. When medication is used, the goal is not to eliminate symptoms. Instead, the lowest dose that manages symptoms without adverse effects is used, because adverse effects may be more disturbing than the symptoms being treated with medication. The classes of medication with proven efficacy in treating tics—typical and atypical neuroleptics—can have long-term and short-term adverse effects. Some antihypertensive agents are also used to treat tics; studies show variable efficacy but a lower side effect profile than the neuroleptics. The antihypertensives clonidine and guanfacine are typically tried first in children; they can also help with ADHD symptoms, but there is less evidence that they are effective for adults. The neuroleptics risperidone and aripiprazole are tried when antihypertensives are not effective, and are generally tried first for adults. Because of lower side effects, aripiprazole is preferred over other antipsychotics. The most effective medication for tics is haloperidol, but it has a higher risk of side effects. Methylphenidate can be used to treat ADHD that co-occurs with tics, and can be used in combination with clonidine. Selective serotonin reuptake inhibitors are used to manage anxiety and OCD. Other Complementary and alternative medicine approaches, such as dietary modification, neurofeedback and allergy testing and control have popular appeal, but they have no proven benefit in the management of<unk> . Despite this lack of evidence, up to two-thirds of parents, caregivers and individuals with<unk>  use dietary approaches and alternative treatments and do not always inform their physicians. There is low confidence that tics are reduced with tetrahydrocannabinol, and insufficient evidence for other cannabis-based medications in the treatment of<unk> 's. There is no good evidence supporting the use of acupuncture or transcranial magnetic stimulation; neither is there evidence supporting intravenous immunoglobulin, plasma exchange, or antibiotics for the treatment of PANDAS. Deep brain stimulation (DBS) has become a valid option for individuals with severe symptoms that do not respond to conventional therapy and management, although it is an experimental treatment. Selecting candidates who may benefit from DBS is challenging, and the appropriate lower age range for surgery is unclear; it is potentially useful in less than 3% of individuals. The ideal brain location to target has not been identified as of 2019. Pregnancy A quarter of women report that their tics increase before menstruation; however, studies have not shown consistent evidence of a change in frequency or severity of tics related to pregnancy or hormonal levels. Overall, symptoms in women respond better to haloperidol than they do for men. Most women find they can withdraw from medication during pregnancy without much trouble. When needed, medications are used at the lowest doses possible. During pregnancy, neuroleptic medications are avoided when possible because of the risk of pregnancy complications. When needed, olanzapine, risperidone and quetiapine are most often used as they have not been shown to cause fetal abnormalities. One report found that haloperidol could be used during pregnancy, to minimize the side effects in the mother, including low blood pressure, and anticholinergic effects, although it may cross the placenta. If severe tics might interfere with administration of local anesthesia, other anesthesia options are considered. Neuroleptics in low doses may not affect the breastfed infant, but most medications are avoided. Clonidine and amphetamines may be present in breast milk.
Tourette syndrome
Lesch–Nyhan syndrome
Conduct disorder
Tardive dyskinesia  Tardive dyskinesia  1
Autism spectrum
High-functioning autism
Oppositional defiant disorder
Klismaphilia