Inside Pediatrics Winter 2015

Behavior Intervention

Good Health

A life-changing approach to helping children overcome the many challenges of tic disorders has families calling its founder “an angel in our lives.” Occupational therapist Jan Rowe, Dr.O.T., O.T.R./L., F.A.O.T.A., is director of the Comprehensive Behavior Intervention for Tics (CBIT) program at Children’s of Alabama, an eight-week, non-drug treatment program that seeks to embed tic strategies or “competing responses” into everyday life. In its first two years, Rowe has seen several hundred new patients from 12 different states, as well as Japan and New Zealand. Her success rate is an impressive 90 percent. The innovative clinic, housed at Children’s and associated with the University of Alabama at Birmingham (UAB,) is part of a consortium of southern universities that already has been recognized by the Tourette Syndrome Association (TSA) as one of just 10 TSA Centers of Excellence. “We all have different strengths, with Children’s being the CBIT program and the services we offer to clients, families, schools and communities,” Rowe said. CBIT consists of three important components: training the child to be more aware of tics, training the child to use “competing” behavior when he or she feels the urge to tic, and making changes to day-to-day activities to help reduce tics. The focus of CBIT is on teaching the child alternate strategies to help manage the tic disorder with discretion and confidence. The initial visit for evaluation generally lasts about two hours. Weekly sessions are 45 to 60 minutes long. Each week, the patient and the parent rate the child’s tic distress on a scale of 1 to 10 with “1” representing minimal distress to “10” indicating horrible, constant distress over the tic. Rowe said she often sees the self rating decrease from a “10” down to a “3” or “4” from one visit to the next.

“Our program is highly dependent on the commitment of the child to adhere to the practice sessions outside of clinic time,” Rowe said. “An occupational therapy practitioner works with each child to promote participation in activities or occupations that are meaningful in his or her daily life. The idea is to develop a competing response for tics, thereby limiting the interruption of tics on the patient’s health, well-being and development.” Two occupational therapists assist Rowe in clinic and while she is on the road training other professionals. To date, she has trained 42 OTs through two-day events that teach participants what CBIT is and how to implement it. She uses case studies, videos and small group practice during the training sessions. Following the training, occupational therapists who seek recognition as a CBIT provider by the Tourette Association of America must be supervised while working with their first two patients. Rowe provides that supervision distantly with her trainees via emails, phone calls or Skype calls after each of the patient’s eight sessions.

Research in Tourette syndrome and tic disorders is another facet of Rowe’s work. “We just completed a pilot study with the Weill Cornell Medical College and recently received approval for a handwriting study,” she said. “I’m also working on a training manual for occupational therapists for the Tourette Association of America, and more publications will be out in the coming year.” Rowe is currently accepting new patients, but she emphasizes that the child needs to be distressed by the tics in order to be a candidate for the program. “If the child is unaware or lacks concern for the tics, he or she will not be motivated to do the weekly work asked of them,” she said. “So we encourage the parents to allow the child to direct the path to the CBIT program.” More information is available at www.childrensal.org/cbit .

The behavior-based CBIT program run by by Jan Rowe, Dr.O.T., O.T.R./L., F.A.O.T.A., involves close and consistent interaction with patients during weekly clinic sessions.

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