Tics Therapists in Toronto, ON

What are tic disorders and Tourette syndrome?

Tics are sudden, repetitive, non-rhythmic movements or vocalizations — motor tics (blinking, head jerking, shoulder shrugging) or vocal tics (throat clearing, sniffing, words or sounds). Tourette syndrome involves both motor and vocal tics lasting more than a year, beginning before age 18. Provisional tic disorder involves tics lasting less than a year. Tic disorders affect approximately 1% of children and often improve significantly or resolve entirely by late adolescence. ADHD and OCD frequently co-occur with tic disorders.

What therapy approaches are most effective for tics?

Comprehensive Behavioural Intervention for Tics (CBIT) has the strongest evidence and is recommended as the first-line treatment before medication for many people. CBIT includes Habit Reversal Training (HRT) — increasing awareness of premonitory urges (the uncomfortable sensation before a tic) and substituting a competing response — combined with functional assessment and psychoeducation. Exposure and Response Prevention (ERP) adapted for tics is also used. CBIT requires a therapist specifically trained in this approach.

What is CBIT and how does it work?

CBIT (Comprehensive Behavioural Intervention for Tics) works by training awareness of the premonitory urge — the internal sensation that precedes a tic — and teaching a competing response (a movement incompatible with the tic) that can be maintained until the urge passes. Over time, practicing the competing response weakens the tic. Functional analysis identifies situations that make tics worse and helps modify those factors. CBIT requires active participation and practice between sessions; results are typically seen within 8–10 sessions.

How does therapy for tics compare to medication?

CBIT and medication (primarily alpha-agonists or antipsychotics) are both effective for tics. Clinical guidelines increasingly recommend CBIT as the first-line approach before medication for mild to moderate tic severity, since it produces lasting change and has no side effects. For severe tics significantly impairing daily life, medication may be used alongside CBIT. The choice between approaches depends on tic severity, the person's motivation and capacity for behavioural practice, access to a trained CBIT therapist, and the presence of co-occurring conditions.

What should families know about tics and treatment?

Tics are involuntary — children and adults with tics cannot simply "stop" when asked, and calling attention to tics typically makes them worse. Reducing stress and anxiety often reduces tic frequency, since tics tend to intensify under stress. Addressing co-occurring ADHD, OCD, or anxiety is often as important as treating the tics themselves. Many children with tic disorders experience significant improvement in adolescence. Education for family members, teachers, and peers about the nature of tics is often an important part of support.