Gamified Closed‐Loop Intervention Enhances Tic Suppression in Children: A Randomized Trial

Abstract

BackgroundGamification of behavioral intervention for tic disorders (TDs) potentially enhances compliance and offers key clinical advantages. By delivering immediate positive feedback upon tic‐suppression, games may counteract negative reinforcement, which presumably contribute to tic consolidation by relieving uncomfortable premonitory urges.ObjectivesWe developed a gamified protocol (XTics), which leverages this potential by combining gamified tic‐triggering with immediate feedback, and evaluated its clinical value in enhancing tic suppression.MethodsXTics encompasses two conditions: Immediate and Contingent Reward (ICR), where game progression is contingent upon successful tic suppression, and Delayed Reward (DR), where game events' outcomes are random. Employing a randomized crossover design, 35 participants (aged 7–15 years) underwent daily gaming sessions over a week per condition. Improvements in our primary measures, including the inter‐tic interval (ITI) and tic severity assessment by blinded evaluators (Yale Global Tic Severity‐Total Tic Score [YGTSS‐TTS], Rush), and parents (Parent Tic Questionnaire [PTQ]), were compared between ICR and DR, and assessed across conditions for the 4‐week protocol.ResultsNo participant voluntarily left the study before completing its two‐phase protocol. As expected, ITI showed significantly larger improvement (Z = 4.19, P = 2.85 × 10–5) after ICR (1442 ± 2250%) versus DR (242 ± 493%) training, increasing at a higher pace (t(67) = 3.15, P = 0.0025). Similarly, Rush tic severity scores reduced more post‐ICR versus DR (t(47) = 3.47, P = 0.002). We observed a clinically significant reduction of 25.69 ± 23.39% in YGTSS‐TTS following a f4‐week protocol including both conditions. Parent‐reported tic severity decreased by 42.99 ± 31.69% from baseline to 3 months post‐treatment.ConclusionsThe combination of gamified tic‐triggering with immediate and contingent rewards demonstrates a promising approach for enhancing treatment efficacy in TDs, boosting traditional therapeutic methods. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.