One-year outcome of manualised behavior therapy of chronic tic disorders in children and adolescents

Abstract

Background Chronic tic disorders are neurodevelopmental disorders that can be treated with Habit Reversal Training (HRT) and Exposure Response Prevention (ERP). Intermediate and long-term effects have been examined after individual treatment with HRT, whereas evaluation of long-term outcome after an initial treatment with ERP, or a combination of HRT and ERP is lacking. The present study examines the long-term effect after a combined treatment with HRT and ERP delivered in an individual or a group setting Methods Fifty-nine children and adolescents diagnosed with a chronic tic disorder were randomised to manualised treatment combining HRT and ERP as individual or group training. Forty-seven were re-examined 1 year after acute outcome. Outcome measures included Total Tic Severity score (TTS) measured by the Yale Global Tic Severity Scale (YGTSS) and Beliefs About Tics Scale (BATS) Results In a mixed model, it was shown that the initial improvement with both individual and group treatment was maintained throughout the follow-up period. There were no significant differences between the two methods of treatment delivery. Of all participants completing the 12 months evaluation, 74.4% were considered responders. There was a significant positive association between the reduction of TTS and the reduction in BATS. In a latent class post-treatment trajectory analysis, two classes were identified, where high baseline severity increased the likelihood of being in the lesser responder class. Similar, but only as a trend, having ADHD, planning difficulties or hypersensitivity increased the risk of a lesser response. Conclusions The present study compares the efficacy in individualised and group treatment of providing manualised therapy for child and adolescent tic disorders using two behavioural methods (combined HRT and ERP) both of which have been shown to have acute benefits but only one of which has been validated for longer term effectiveness. In the present study, both individualised and group treatments showed benefit throughout a 1-year follow-up period with several potential confounds affecting outcomes, while the relative benefits of either HRT and ERP were not addressed. Trial registration NCT04594044, 1-10-72-216-15, registered 19th October 2020, retrospectively registered, https://register.clinicaltrials.gov/prs/app/template/Home.vm?uid=U0005BW2&ts=9&sid=S000ABEY&cx=-wlx7vb The study is approved by the National Ethical Committee (1-10-72-216-15) and the Danish Data Protection Agency (1–16-02-490-15), registered 12 October 2015.

European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part II: psychological interventions

“…Effect sizes were not reported Rizzo et al (2018) [ 14 ] BT vs. PE PT vs. PE BT vs. PT N = 110 Age 8–17 YGTSS-TTS : BT: 19.8 (pre) to 11.4 (post) PT: 24.1 (pre) to 15.7 (post) PE: 22.0 (pre) to 21.7 (post) FU : YGTSS-TTS at 3 months post BT/PE and 5 months post initiation of PT: BT: 12.4 PT: 14.7 PE: 20.7 Duration : 8 sessions (weekly, first two sessions 1.5 h, remaining sessions 1 h) Interventions : BT included HRT or ERP; PT included risperidone, aripiprazole or pimozide Results : Significant between-group effects on the YGTSS-TTS for BT vs. PE and PT vs. PE (in favor of BT and PT) Limitations : Uncertain whether the study was powered to detect significant between-group effects between BT and PT. Effect sizes were not reported Andrén et al (2019) [ 59 ] Internet ERP vs. Internet HRT N = 23 Age 8–16 YGTSS-TTS : Internet ERP: 23.8 (pre) to 18.3 (3FU) Within-group effect size: 1.12 Internet HRT: 23.5 (pre) to 20.2 (3FU) Within-group effect size: 0.50 12FU : YGTSS-TTS: Internet ERP: 16.9 Internet HRT: 19.4 Duration : 10 weeks of therapist-supported (via text messages) internet-delivered treatment Interventions : In addition to the ERP or HRT core elements, both groups included functional analysis and parent training Design : Study did not aim to compare groups Results : Significant within-group effect on the YGTSS-TTS for the Internet ERP group, but not the Internet HRT group Follow-up : Effects were maintained at 12FU Nissen et al (2019, 2021) [ 43 , 52 ] Individual HRT + ERP vs Group HRT + ERP N = 59 Age 9–17 YGTSS-TTS : Individual HRT + ERP: 23.8 (pre) to 14.3 (post) Within-group effect size: 1.21 Group HRT + ERP: 23.4 (pre) to 15.9 (post) Within-group effect size: 1.38 12FU : YGTSS-TTS: Individual HRT + ERP: 12.7 Group HRT + ERP: 12.8 Duration : 8 regular sessions and 1 booster session, delivered individually or in a group format Results : No significant between-group effect on the YGTSS-TTS. Significant within-group effects on the YGTSS-TTS for each group Follow-up ...…”

“…There was no statistically significant difference between the groups, apart from the YGTSS Impairment Score (in favor of the individual setting). The within-group treatment effects were maintained for both groups at a 12-month follow-up [ 52 ].…”

Influence of Tiapride and Topiramate on Tic Severity and Behavioral/Emotional Problems in Children with Tourette Syndrome: A Retrospective Study

“…One behavioral therapy is in line with the results of our study. In it, 47 TD children and adolescents were re-examined 1 year after manualized treatment, and the outcome demonstrated that none of the scores, namely the PUTS score, BATS score, CBCL, SCARED score, or MFQ score, differed when comparing the therapeutic patients and nontherapeutic patients at 12 months [ 20 ]. These two questionnaires may be the reason for the large standard deviation.…”

Recent progress on Tourette syndrome

“…These therapies consist of exposure and response prevention (ERP), habit reversal therapy (HRT), or its descendant comprehensive behavioral interventions for tics (CBIT) 99 . A randomized control trial evaluating the long-term effect of both HRT and ERP in children and adults with tic disorders showed that the benefit of the therapies persisted at the 1-year follow-up visit in 74% of participants 100 . Despite robust evidence of the behavioral therapies to reduce tic frequency and severity and diminish the urges, finding a trained therapist can be challenging.…”