CBIT for Tics and Tourette’s
A proven, medication-free approach to reducing tics in children and teens.
For Tics
A proven, medication-free approach to reducing tics
Comprehensive Behavioral Intervention for Tics (CBIT) is a structured behavioral treatment for Tourette's and persistent tic disorders. It gives children practical tools to reduce how often tics happen and how much they interfere with daily life, and it's recommended as a first-line option by the American Academy of Neurology.
How it works
Working with the urge, not against the child
Many tics are preceded by an uncomfortable feeling or urge, like an itch that needs scratching. Doing the tic relieves the urge briefly, which reinforces the tic over time.
CBIT teaches children to notice that urge early and respond differently. It doesn't ask kids to simply "stop" their tics, and it isn't about blame. Instead, it gives them skills and adjusts the environment so tics become less frequent and less disruptive.
- Psychoeducation. We explain what tics are and aren't, reduce stigma, and set goals together.
- Awareness training. Kids learn to notice each tic and the warning urge that comes right before it.
- Competing response training. For each target tic, your child practices a subtle, easy movement that makes the tic hard to perform, held until the urge passes.
- Functional intervention. We look at where and when tics get worse (for example, during homework, screen time, or stress) and change those situations to help.
- Relaxation and rewards. Breathing and relaxation reduce stress, and a reward plan keeps practice motivating.
Who it helps
- Tourette's disorder
- Persistent (chronic) motor or vocal tics
- Tics that occur alongside anxiety or OCD
- Kids who feel self-conscious about their tics
- Families looking for a non-medication option
- Children whose tics interfere with school or friendships
What sessions look like
CBIT follows a clear structure, typically about 10-15 sessions. We usually work on one or two tics at a time, starting with the ones that bother your child most.
Each session includes reviewing practice, learning or refining a competing response, and adjusting the plan. Daily home practice, even a few minutes, is an important part of CBIT.
Because many children with tics also experience anxiety or OCD, we can address these together in one coordinated plan.
Tailored to your child
How we adapt it by age
Ages 6 to 8
Simplified awareness games, lots of parent coaching, and reward charts. Parents play a big role in daily practice.
Ages 9 to 12
The age range most studied in CBIT research. Kids learn to track tics and practice competing responses with increasing independence.
Teens
Teens lead goal-setting and practice, with attention to school, social situations, and privacy.
The parent's role: You'll learn how to support practice without commenting on or drawing attention to tics, how to praise effort, and how to reduce triggers at home. With your permission, we can also share strategies with your child's school.
The evidence
What the research says
CBIT is one of the best-studied behavioral treatments for tics. Large randomized trials show meaningful tic reduction in children, and national guidelines recommend it as an initial treatment option.
of children improved much or very much with CBIT, compared with supportive therapy and education, in a trial of 126 children ages 9 to 17.
Piacentini et al., 2010 [1]of children who responded to CBIT were still benefiting 6 months after treatment ended.
Piacentini et al., 2010 [1]The American Academy of Neurology advises clinicians to offer CBIT as an initial treatment option relative to medication.
Pringsheim et al., 2019 [2]- In the landmark JAMA trial of 126 children and teens with Tourette's or chronic tic disorder, CBIT led to significantly greater reductions in tic severity than supportive therapy after 8 sessions over 10 weeks[1].
- The 2019 American Academy of Neurology guideline states that for people with tics who have access to CBIT, clinicians should offer CBIT as an initial treatment option relative to medication[2].
- CBIT has little to no side effects, which makes it an attractive first step for many families[2].
- The CDC describes CBIT as an effective behavioral treatment that helps people manage tics[3].
Research results describe averages across groups of children. Every child is different, and we track your child's progress with standardized measures throughout treatment.
Common questions
Will CBIT make tics go away completely?
CBIT usually reduces how often tics occur and how much they bother your child, rather than eliminating them entirely. Many children also feel more in control and less self-conscious.
Does holding back tics make them worse later?
This is a common worry. Research has not found that CBIT causes a "rebound" of tics or new tics to replace old ones.
Is CBIT only for Tourette's?
No. CBIT is also used for persistent motor or vocal tic disorders.
Can we do CBIT and treat anxiety or OCD at the same time?
Yes. Tics often occur alongside anxiety and OCD. We'll build one coordinated plan and decide together what to focus on first.
References
- Piacentini, J., Woods, D. W., Scahill, L., et al. (2010). Behavior therapy for children with Tourette disorder: A randomized controlled trial. JAMA, 303(19), 1929–1937. View study
- Pringsheim, T., Okun, M. S., Müller-Vahl, K., et al. (2019). Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology, 92(19), 896–906. View guideline
- Centers for Disease Control and Prevention. Behavioral treatment for tics that works. View article