Functional analysis is a core part of CBIT. It helps us understand the situations, patterns, triggers, reinforcers, and day-to-day factors that may be influencing tics. That information matters because it helps us decide what to target, what to change, what to accommodate, and what to leave alone.
Professionally, I have seen how important functional analysis is supposed to be. Personally, I have experienced how powerful it can be when it is taken seriously.
But in practice, functional analysis usually gets glossed over.
Time with a clinician is limited. Sessions are short. Families are busy. Memory is imperfect. And because tics can fluctuate so much from one moment to the next, it is very easy for the assessment to stay at a general level.
When are the tics worse?
“When he’s watching TV.”
When are they better?
“At school.”
What seems to trigger them?
“Soccer practice.”
Those answers may be true, but they are usually not detailed enough to guide the best decisions.
I have come to believe that beneath those broad answers is a goldmine of information.
There is often far more richness in a person’s lived experience than we can capture in a brief conversation. Tics do not just happen in broad categories like “school,” “home,” “screens,” or “stress.” They happen in real moments, inside real routines, with changing levels of energy, sensory load, suppression effort, social pressure, fatigue, frustration, excitement, anxiety, focus, and recovery.
I remember telling my CBIT trainer during clinical supervision that I thought functional analysis was getting skipped over. She agreed and encouraged me to bring more focus to it.
That stayed with me. But it is hard to budget enough time for that level of detail during therapy sessions.
At one point, I went through a month when my own tics were worse than they had ever been. Blocking them was not doing enough. I needed to understand what was actually happening.
So I decided to go all in on functional analysis.
For 14 days, I did the most comprehensive tracking of my life. Almost every hour, or at least every time there was a meaningful change in my mood, energy, environment, or overall state, I recorded what was happening. I included time-stamped entries for what I ate and details about how I slept.
The results were hard to ignore.
The same patterns appeared day after day, even on days that looked completely different on the surface. For example, a Saturday showed many of the same patterns as a Monday.
I was able to identify at least 10 significant points of intervention. The tracking helped me make better decisions about my energy, tics, anxiety, focus, emotional regulation, and overall wellbeing.
It changed when and how I eat.
It changed when I exercise.
It changed when I do my most focused work, and how long I do it for.
It changed how I regulate myself before providing CBIT sessions.
Most importantly, it showed me that functional analysis was not just a preliminary step before the “real work.”
It was the work that made the next steps clearer.
Since then, I have used structured tracking and functional analysis with clients, and the results have been encouraging. Again and again, I have seen that when people look more closely, they often discover patterns they could not see from memory alone.
A child may appear to have fewer tics at school, but only because they are suppressing all day.
A teen may tic more at home, not because home is the problem, but because home is where they finally have permission to release.
Or maybe it has nothing to do with suppression and release. Maybe home simply comes after an exhausting day, and the real issue is fatigue.
Those possibilities lead to different decisions.
If the issue is fatigue, the priority may be rest, pacing, recovery, or reducing overload.
If the issue is suppression, the priority may be creating safer release periods, reducing unnecessary suppression demands, or helping the person understand the cost of holding tics in all day.
If the issue is sensory load, transition difficulty, anxiety, attention, family accommodation, or environmental pressure, then the support should match that pattern.
We need to understand what is happening before we decide what to do.
That is why I designed the Tourette Functional Analysis Report.
I wanted a better way to see these patterns.
Not a vague snapshot.
A higher-resolution picture.
This report gives the assessment phase the time and structure it deserves. Instead of relying only on memory, impressions, or a short intake conversation, the process uses structured context mapping, flexible guided tracking, and careful review of a person’s day-to-day experience.
The purpose is to understand what is happening across real life, not just inside a clinical appointment.
I do not believe every tic-related challenge should immediately be treated as a tic-reduction problem.
Sometimes we need to look under the hood and understand what is contributing to the difficulty. Sometimes the highest-priority target is the tic itself. Sometimes it is fatigue, anxiety, suppression, sensory overload, recovery, transitions, school masking, family patterns, environmental demands, or overall energy and recovery patterns.
The point is that we should not have to guess.
This report slows down the assessment phase so families can make better-informed decisions about what to try next.
And often, what deserves attention first comes as a surprise.