General Comments | Specific Interventions
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