Nasal Airway Respiration Anti-tic (NARA) method in pediatric Tourette syndrome: a retrospective case series.

backgroundTourette syndrome (TS) often impairs social and academic functioning in children due to disruptive motor and vocal tics. Minimally invasive and patient-driven interventions are desirable, yet existing treatments do not always provide rapid or sustained relief. This study evaluates the clinical outcomes of the Nasal Airway Respiration Anti-tic (NARA) method—a non-invasive, lip-closed nasal breathing technique—for children with TS.

methodsIn this uncontrolled retrospective case series, we identified all 8 consecutive pediatric patients (5 boys, 3 girls; ages 6–10) meeting DSM-5 criteria for TS who presented with habitual mouth breathing between 2019 and 2021. All patients were free of tic-suppressing medications at baseline. Patients had a chronic disease course (mean duration of illness: 2.5 years). No eligible patients were excluded. Patients were instructed to practice the NARA method (3–5 s nasal inhalation, 2s breath-holding, and 6–10 s exhalation with firm lip closure) for 2 min, 3 times daily. Tic severity was assessed using the Yale Global Tic Severity Scale (YGTSS) and a modified Rush Video Rating Scale (mRVRS) at baseline and follow-up (mean 18.4 months).

resultsAt the initial visit, a 120-second trial of the NARA method significantly reduced tic frequency (p = 0.038) and severity (p = 0.025). Long-term follow-up demonstrated notable improvements in YGTSS motor and vocal subscales (14.4 ± 1.7 to 2.4 ± 1.2; 13.6 ± 2.3 to 3.6 ± 1.3, respectively). Three children who had refused school attendance due to severe tics returned to regular classes. Crucially, video analysis confirmed a “carry-over effect,” showing sustained tic reduction even during natural, resting respiration (without the maneuver) at the final assessment.

conclusionsThe NARA method was associated with substantial tic reduction in this small cohort. We hypothesize that the intense physiological sensory input from nasal respiration may function as a “primary reward” that activates the thalamic centromedian nucleus to overshadow the urge-to-tic cycle. Clinically, the method’s success relied on active parental support. While placebo effects cannot be entirely ruled out in this uncontrolled study, the immediate “On/Off” reversibility of tics upon lip release implies a specific physiological antagonism distinct from simple distraction. Future prospective controlled trials are warranted to validate these preliminary findings.