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.