Treatment of Chronic Vocal Tic Disorder:


A Case Study Using Auditory and Visual Stimulation


by Ruth Olmstead, M.A., Psychological Resident

Dr. Mitch Spero, Supervisor

Licensed Psychologist / FL #PY0004098


This case study examined the effects of auditory and visual stimulation (AVS) treatment intervention for Chronic Vocal Disorder, as measured by Parent Reports. The patient was a 9-year-old boy who was diagnosed with 307.22 Chronic Vocal Tic Disorder. According to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) characteristics of Chronic Vocal Tic Disorder include:

* Single or multiple vocal tics (i.e., sudden, rapid, recurrent, nonrhythmic, stereotyped vocalizations), which have been present at some time during the illness.

* The tics which occur many times during the day nearly every day or intermittently throughout a period of more than one year, and during this time there was never a tic-free period of more than three consecutive months.

* The disturbance causes marked distress or significant impairment in social, occupational or other important areas of functioning.

* Onset is prior to age eight.

* The disorder is not due to direct physiological effects of a substance or general medical condition.

* Criteria is not met for Tourette’s Disorder. The patient was referred by his parents, a physician and homemaker, for his uncontrolled ” vocalizations.”

His vocal tics consisted of sounds such as clicks, grunts, yelps, snorts, and coughs. His parents reported that since their son was about four years of age he has made unusual sounds, but that during the past few years his teachers have been commenting that he makes “disturbing” sounds approximately three or four times a day in class.

The patient reports that most of his vocalizations typically occur after he completes his homework (when he believes “he is bored”) and just prior to falling asleep. Both parents also noted that their son made the most prolific vocalizations at night when he was preparing for bed, which would last for approximately 20 minutes before falling asleep. AVS was used at 13 Hz for a duration of 20 minutes for five sessions. Sessions took place weekly for the first three sessions. After a three-week break, an additional session was administered. Results were measured by weekly Parent Reports, a survey consisting of 20 questions regarding change in a number of areas such as behavior, sleep patterns, affect, and vocalizations. After the initial session the patient’s father reported that he heard no vocalizations that evening, though he did report hearing vocalizations several days later in the week prior to his son’s bedtime.

The Parent Report after the second session indicated a significant decrease in the patient’s vocalizations. The Report after the third session demonstrated the most significant change, with only one or two reported vocalizations occurring in a three-week period. No vocalizations were reported at home by either parent or the child after the fourth session, however, the patient’s teacher did report some infrequent vocalizations approximately three times a week, though very short in duration.

To date, a significant reduction in vocalizations has been sustained for approximately six months, though it is not yet known if future stressors may induce an increase or recurrence of symptoms.

According to the Child/Adolescent Intake Form and Clinical Interview with the patient’s mother, the patient was born prematurely at 34 weeks, and the Pre-Labor use of the drug Albuterol was reported. All developmental milestones were reportedly met within normal range.

Medical history is otherwise unremarkable. The patient is reported to be an outstanding student, and exhibits no cognitive, behavioral, or learning difficulties, and is not taking any medications.

It should be considered that this was an informal experimental trial of a non-drug treatment intervention for Vocal Tic Disorder and no quantitative measures were taken with the exception of Parent Reports and Teacher Reports. This case study, though valid only qualitatively, may lend efficacy to utilizing AVS as a possible intervention for this type of disorder, and replication of the present study with larger number of such patients is necessary before advancing such studies.

Reference American Psychological Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC:

Copyright Ruth Olmstead, Ft. Lauderdale, FL 2001 , AVS Journal, Summer 2001 Edition.