If cognitive-behavioral therapy is not effective for mild to moderate tic disorders, what is the next recommended step?

If cognitive-behavioral therapy is not effective for mild to moderate tic disorders, what is the next recommended step?

• A. Consultation with a pediatric behavioral specialist and consideration of medications
• B. Cutting hair
• C. Long-term anti-streptococcal prophylaxis
• D. Medication with risperidone or clonidine

Answer: (A)

When CBT trials don’t yield meaningful improvement in mild to moderate tic disorders, the next step is to bring in a pediatric behavioral specialist and consider medications. A pediatric behavioral specialist can reassess the diagnosis, optimize behavioral approaches (potentially adjusting or expanding to CBIT), and coordinate with a clinician on pharmacotherapy. Medications such as alpha-2 adrenergic agonists (like clonidine or guanfacine) or antipsychotics (such as risperidone) can reduce tic severity, chosen based on tic burden, comorbid conditions, and side-effect profiles. Other options listed—like hair cutting or long-term anti-streptococcal prophylaxis—aren’t standard treatments for typical tic disorders, so they aren’t appropriate next steps.

When CBT trials don’t yield meaningful improvement in mild to moderate tic disorders, the next step is to bring in a pediatric behavioral specialist and consider medications. A pediatric behavioral specialist can reassess the diagnosis, optimize behavioral approaches (potentially adjusting or expanding to CBIT), and coordinate with a clinician on pharmacotherapy. Medications such as alpha-2 adrenergic agonists (like clonidine or guanfacine) or antipsychotics (such as risperidone) can reduce tic severity, chosen based on tic burden, comorbid conditions, and side-effect profiles. Other options listed—like hair cutting or long-term anti-streptococcal prophylaxis—aren’t standard treatments for typical tic disorders, so they aren’t appropriate next steps.