HALDOL IN THE TREATMENT OF CHILDREN WITH TICS AND

STUTTERERS--AND AN INCIDENTAL FINDIN(F

BY FER]~ANDO TAPIA, M.D. ~

Chemically Ha]dol is the prototype of the butyrophenones series of neuroleptic compounds. The pharmacology of Hatdol has been exten,sively described by Jans,sen. ~ This drug became available i~ 1960, and millions of doses have since been adminis tered--par t ic- u lar ly in psychiatry, but also in anesthesiology and in obstetrics.

Following the success of Haldol with Touret te 's disease, 1 .~ s,ome indication for t rying the drug on patients with "plain" tics (habit spasms) certainly existed. The predominance of male ticquers (3: j) ,s of males with speech disorders (3:1), ~~ and the well-known predominance of male ,stutterers among whom left-handers are in grea ter prevalence than in the general population, led to consider- ation of a tr ial of t ta ldol on children who stut ter as well as on ticquers. Fur thermore , the author 's pilot study 11 on girls with con- ditions more commonly seen in boys turned up five female ticquers, three of whom were left-handed. This interdependence of male co,nditions and frequency of left-handedness seemed suffici.ently inter twined to strengthen the indications for t rying Haldol.

Recently P. It. Conne]], et al. 3 reported modest success using Haldol with adolescent ticquers. In their r igidly controlled study of four adolescents, they were able to establish a significan,t reduc- tion of tics through use of the drug. That study was a culmination of previ~ous drug .attempts, as well as the use of psychotherapy and behavior therapy, all with equivocal success.

Tranquilizers have been used with some modest benefits in the ease of stutterers. Thioridazine was considered a helpful adjunct to speech therapy by R. Goldman. ~ A few years earl ier Hackett , et al., 6 reported success with chlorpromazine, and Meffert 9 with reserpine.

The present paper i.s a pre l iminary report on the use of Haldol on, a series of children with tics, and a group of stutterers. To date ]2 stut terers and 6 ticquers have been placed on what may be

'~From the University of Missouri School of Medicine, this paper was submitted to the Q~ARTEr~LY on ffuly 22, 1969. I ts appearance in abstract form in another journal was neither authorized nor condoned by the author.

~~The author wishes to acknowledge research support for this investigation from MeN'ell Laboratories.

~4~ TREAT1VIEIqT OF CHLDIREN WITH TICS~ AND STUTTERERS

considered adequate doses of Haldol. As control we have sub- stituted placebos in the instances of apparent success, thus having the patients serve as their own eoa~trols. The dosages have ranged from 1.0 rag. to 2.5 rag. per day and were usually arrived at by slight reduction of dosage after reaching a point of dr owsine.ss. The results so far have been different for the two entities.

STUTTERERS

Of the 12 stutterers 6 reported improvement, but only 2 were noted to be better when their speech hesitations and reading prob- lems were analyzed by actual count of "sticks" and hesitations. Both of the definitely improved patients (a 12-year-old girl and an 8-year-old girl) relapsed when the placebo was surreptitiously substituted. At this point it would seem that some stutterers (2 of 12 in our study) do improve with Haldol. However, our evatua- tion could not uncover any distinguishing features which might explain the success with the two girls. We could not confirm Gat- tuso's 4 findings of greater success with Haldol in the younger (5-8) group vs. the older (10d2) group of stutterers.

TICQUERS The results with the ticquers were more dramatic. Of the six

ticquers (ages 9 to 17) receiving the drug, five showed definite im- provement-i.e., a 50-90% reductio~ of ties from the pre-treatment computation of the rate of both gross and minor tic movements for a five-minute span. The reduction of tics came about rapidly and was sustained as long as the drug was administered. Two pa- tients, i~ fact, were able to go off the drug ,and retain all their improvement. One of these patients later relapsed and again im- proved with re-institution of Haldol.

The ineMental finding which merits mention concerns two of the tiequer,s (both girls) who had clear-cut symptoms of an obses- sive-compulsive neurosis in addition to the tics. Both were pre- occupied with thoughts of the deaths of maternal figures, with funerals, caskets, etc., as well as with "mean and nasty" ideas. One of the girls also had the compulsion to mark the wall with X's, while the other girl needed to insure that the doors of her house were locked for the night and that she h~d actually said "good night" to her mother, an act she tended to repeat over and

.FEI~NANI)O TAPIA~ M].D, 649

over. In both eases the obsessive-compulsive features di,sappeared quite rapidly and so completely that they ceased to be a eoaeern while the ties continued to be treated.

Perhaps a tentative therapeutic speculation tan be offered at this time. The drug seems to be particularly effective against what- ever me,ehanism sets up: the obsessive-compulsive, ruminative con- cerns which in turn bring on or aggravate ties, T.ourette's d~sease, and, perhaps some forms of stuttering. This drug, while used under experimentally-controlled conditions, did not show any untoward side-effects nor blood, kidney, or liver changes in children under 12 years of .age.

University of Mi.ssouri School of Medicine Columbia, Missouri 65201

R E F E R E N C E S

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2. Chapel, J . L.; Brown, N., and Jenkins~ R. L.: Tourette's Disease: symptomatic relief with tIMoperidol. Am. J. Psychiat., 121: 608-610, 1964.

5. Connell, P. tL, et al. : Drug treatment of adolescent ticquers. Brit. J . Psychiat., 113: 375-381, 1967.

4. G:~ttuso, R.: tIMoperidol in the t reatment of stuttering. Clin. Orl. (Sicily), 14: 227-234, 1962. (Translated by E. F. Mussen.)

5. (~oldman, R.: The use of Mellar~l as an adjunct to the t reatment of stuttering. Excerpta Medica Internat ional Congress Series No. 150. (Proceedings of the IV World Congress of Psychiatry, 1966.)

6. H:~(~kett, J. D.; I-toffman, M.; Macloed, A. S., and Suttees, R.: A study of the effects of chlorpromazine as an aid to therapy for s tut ter ing with a one-yeur follow-up. Paper presented at the American Speech and Hearing Association Convention, New York, 1958.

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8. Mahler, M., and I~angell, L.: A psychosomatic study of maladie des tics. PsY- cttI~'r. QuArT., 17: 519, 1943.

9. Meffert, M. L.: The effects of Serpasil (reserpine) on the severity of stuttering. M.A. Thesis. Univ. of Virginia. Charlottesville, Va. 1956.

10. Sehuell, H.: Differences Which Mat ter : A Study of Boys and Girls. Von-Boeekman- Jones. Austin, Texas. 1947.

] 1. Tapia, F. : Girls with conditions more commonly seen in boys. Dis. Nerv. Sys., 29: 5, 323-326, 1968.