Relapse Prevention Strategies and Guidance on Refractory Cases

Abstract Following an appropriate course of evidence-based treatment for tics, whether psychosocial or pharmaceutical in nature, clinicians face difficult decisions about next steps. Therefore this chapter focuses on the challenges that relate to end of the treatment decisions. First, an overview is provided regarding information important to this process. Second, guidance is provided on end-of-treatment decisions as they relate to youth who have not demonstrated an adequate treatment response and/or those who continue to have impairing symptoms despite initial response. This includes discussions around strategy variation, identifying, and addressing factors associated with poor adherence, medication side effects, problematic comorbid symptoms, severity of tics, alternative conceptualizations, and alternative treatment options. Third, relapse prevention strategies are presented including how they relate to maintaining behavior management gains, medication management postresponse, and maintaining quality-of-life gains. Finally, conclusions and areas of continued research are presented.