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The cornerstone of treatment is observation. Clinicians, patients, parents, and teachers benefit from knowing what symptoms are present and how they change over time and with different circumstances (Himle et al. 2006), how much a child struggles with his or her symptoms, and what strategies he or she uses to reduce them. Observing can be as simple as a log or diary of the most prominent tics, when they change, and what efforts the child has made to contain them. A more rigorous behavioral approach, called Self-Monitoring, relies on detailed observations at specific periods (Azrin and Peterson 1988). Observation alone can have a potent effect on reducing symptoms by raising awareness and increasing helpful coping responses. However, in unusual circumstances, observation can "backfire"—i.e., increase tics—by reminding the patient about symptoms or by expanding parental anxiety, increasing scrutiny, and leading the patient to feel greater pressure to contain and monitor his symptoms.

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Table Reference Number
TABLE 27–5. Pharmacological treatment of tic disorders: agents that have randomized, placebo-controlled trials

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