Predictors of therapeutic treatment outcome in adolescent chronic tic disorders

Abstract

Background Chronic tic disorders may have a major impact on a child's function. A significant effect has been shown for combined habit reversal training (HRT) and exposure response prevention (ERP) treatment delivered in an individual and group setting. Aims The present study examines predictors and moderators of treatment outcome after an acute therapeutic intervention. Method Fifty-nine children and adolescents were randomised to manualised treatment combining HRT and ERP as individual or group training. Age, gender, baseline tic severity, Premonitory Urge for Tics Scale (PUTS) scores, Beliefs about Tic Scale (BATS) scores, hypersensitivity and comorbid psychiatric symptoms were analysed as predictors of outcome. The same characteristics were examined as moderators for individual versus group treatment. Outcome measures included the change in total tic severity (TTS) score and functional impairment score (as measured by the Yale Global Tic Severity Scale (YGTSS)). Results Internalising symptoms predicted a lesser decrease in functional impairment. The occurrence of obsessive–compulsive symptoms predicted a larger decrease in TTS. Baseline hypersensitivity and high scores on depressive symptoms favoured individual treatment. High baseline PUTS scores favoured group therapy. Conclusions This is the first study examining factors predicting and moderating perceived functional impairment following a therapeutic intervention. The study adds to the knowledge on predictors and moderators of TTS. Furthermore, this is the first study examining the effect of the BATS score. The study points towards factors that may influence treatment outcome and that require consideration when choosing supplemental treatment. This applies to comorbid anxiety and depressive symptoms, and to the child's belief about their tics and premonitory urge. Declaration of interest None.

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

“…Using data from a randomized trial evaluating a combination of HRT and ERP (described in more detail in a later section) [ 43 ], Nissen et al investigated possible predictors and moderators of treatment response [ 44 ]. Their data suggest that internalizing symptoms (anxiety) predicted a lesser reduction in functional impairment and that participants’ (negative) beliefs about their tics were shown to have a negative effect on treatment outcome.…”

Psychometric Properties of the Chinese Version of the Premonitory Urge for Tics Scale: A Preliminary Report

“…It has been reported that PU plays an important role in the tic generation (Rae et al, 2019 ). This has led some experts to recommend that the PU could be considered as a target symptom in reducing the tic symptoms (Nissen et al, 2019a , b ).…”

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

“…Nissen et al [ 19 ] has previously shown that Beliefs About Tics Scale (BATS) [ 21 ] scores at the 8th session moderated the perceived FI [ 19 ]. In the present study, there was a significant positive association between the BATS scores and TTS over the follow-up period also pointing towards an importance of persistent thoughts.…”

“…Of interest, a weaker, but positive association was also seen for mood and feelings questionnaire (MFQ) supporting the importance of a child`s mood. When evaluating immediate outcome, we have previously shown that a high scores on the MFQ favoured individual treatment [ 19 ]. The present study suggests, that mood also may influence long-term outcome independently of the setting.…”

“…A total of 66.7% of the participants were considered responders. Internalising symptoms predicted a lesser decrease in FI, whereas the occurrence of obsessive–compulsive symptoms was associated with a larger decrease in TTS [ 19 ].…”