scholarly journals Effectiveness of Behaviour Therapy for Children and Adolescents with Tourette Syndrome and Chronic Tic Disorder in a Naturalistic Setting

2020 ◽  
Author(s):  
Per Andrén ◽  
Vera Wachtmeister ◽  
Julia Franzé ◽  
Caroline Speiner ◽  
Lorena Fernández de la Cruz ◽  
...  
Keyword(s):  
Young People ◽  
Tourette Syndrome ◽  
Post Treatment ◽  
Behaviour Therapy ◽  
Tic Disorder ◽  
Chronic Tic Disorder ◽  
Naturalistic Setting ◽  
Tic Severity ◽  
Randomised Controlled

AbstractIt is unclear if the results of randomised controlled trials (RCTs) of behaviour therapy (BT) for Tourette syndrome (TS) and chronic tic disorder (CTD) can be generalised to naturalistic clinical settings and are durable long-term. In this naturalistic study, 74 young people with TS/CTD received BT at a specialist clinic. Data were collected at baseline, post-treatment, and at 3-, 6-, and 12-month follow-ups. Measures included the Yale Global Tic Severity Scale (YGTSS) and the Clinical Global Impression-Improvement scale (CGI-I), amongst others. Tic severity and tic-related impairment improved after treatment, with large within-group effect sizes. At post-treatment, 57% of the participants were classified as treatment responders according to the CGI-I. Tic severity and tic-related impairment improved further through the follow-up, with 75% treatment responders at the 12-month follow-up. BT is an effective and durable treatment for young people with TS/CTD in a naturalistic specialist clinical setting, with comparable effects to RCTs.

scholarly journals Effectiveness of behaviour therapy for children and adolescents with Tourette syndrome and chronic tic disorder in a real-world setting

2020 ◽  
Author(s):  
Per Andrén ◽  
Vera Wachtmeister ◽  
Julia Franzé ◽  
Caroline Speiner ◽  
Lorena Fernández de la Cruz ◽  
...  
Keyword(s):  
Young People ◽  
Tourette Syndrome ◽  
Real World ◽  
Post Treatment ◽  
Reversal Training ◽  
Behaviour Therapy ◽  
Tic Disorder ◽  
Chronic Tic Disorder ◽  
Habit Reversal Training ◽  
Tic Severity

Background: Treatment guidelines recommend behaviour therapy (BT) as the first-line intervention for patients with Tourette syndrome (TS) and chronic tic disorder (CTD). The efficacy of BT has been documented in randomised controlled trials (RCTs), but it is unclear to what extent these results are generalisable to real-world clinical settings, and whether the therapeutic gains are maintained long-term.Methods: In this naturalistic study, 74 young people with TS/CTD (aged 6 to 17) received BT (including psychoeducation, exposure with response prevention, habit reversal training or a combination of these treatments) at a specialist clinic in Stockholm, Sweden. Data were routinely collected at baseline, post-treatment, and at 3-, 6-, and 12-month follow-ups. Measures included the clinician-rated Yale Global Tic Severity Scale (YGTSS) and the Clinical Global Impression – Improvement scale (CGI-I), amongst others.Results: Tic severity and tic-related impairment (as measured by the YGTSS) improved significantly after treatment, with large within-group effect sizes (d=1.03 for the YGTSS Total Tic Severity Score, and d=1.37 for the YGTSS Impairment Score). At post-treatment, 57% of the participants were classified as treatment responders according to the CGI-I. Both tic severity and tic-related impairment continued to improve further through the follow-up, with 75% of the participants being rated as responders 12 months after the end of treatment. Significant improvements were also observed across a range of secondary measures.Conclusions: BT is an effective and durable treatment for young people with TS/CTD in a real-world clinical setting, with effects comparable to those reported in RCTs.

scholarly journals Evaluation of a cognitive psychophysiological model for management of tic disorders: an open trial

2016 ◽  
Vol 209 (1) ◽  
pp. 76-83 ◽  
Author(s):  
Kieron O'Connor ◽  
Marc Lavoie ◽  
Pierre Blanchet ◽  
Marie-Ève St-Pierre-Delorme
Keyword(s):  
Tourette Syndrome ◽  
Self Esteem ◽  
Current Treatment ◽  
Open Trial ◽  
Tic Disorders ◽  
Tic Disorder ◽  
Chronic Tic Disorder ◽  
Tic Severity ◽  
Sensorimotor Processes

BackgroundTic disorders, in particular chronic tic disorder and Tourette syndrome, affect about 1% of the population. The current treatment of choice is pharmacological or behavioural, addressing tics or the premonitory urges preceding tic onset.AimsThe current study reports an open trial evaluating the effectiveness of a cognitive psychophysiological treatment addressing Tourette-specific sensorimotor activation processes rather than the tic.MethodForty-nine people with Tourette syndrome and 36 people with chronic tics completed 10 weeks of individual cognitive psychophysiological therapy. Outcome measures included two tic severity scales and psychosocial measures.ResultsPost-treatment both groups had significantly improved on the tic scales with strong effect sizes across tic locations and complex and simple tics, maintained at 6-month follow-up with further change in perfectionism and self-esteem.ConclusionsThe cognitive psychophysiological approach targeting underlying sensorimotor processes rather than tics in Tourette's and chronic tic disorder reduced symptoms with a large effect size.

scholarly journals Therapist- and parent-guided Internet-delivered behaviour therapy for paediatric Tourette’s Disorder: a pilot randomised controlled trial with long-term follow-up

2018 ◽  
Author(s):  
Per Andrén ◽  
Kristina Aspvall ◽  
Lorena Fernández de la Cruz ◽  
Paulina Wiktor ◽  
Sofia Romano ◽  
...  
Keyword(s):  
Young People ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Behaviour Therapy ◽  
Tourette’S Disorder ◽  
Tourette's Disorder ◽  
Tic Severity ◽  
Randomised Controlled

Objective: Behaviour therapy (BT) for Tourette’s Disorder (TD) and Persistent Motor or Vocal Tic Disorder (PTD) is rarely available. We evaluated the feasibility of adapting two existing BT protocols for TD/PTD (habit reversal training [HRT] and exposure and response prevention [ERP]) into a therapist- and parent-guided online self-help format.Design: A pilot, single-blind, parallel group randomised controlled trial.Setting: A university hospital in Sweden.Participants: Twenty-three young people with TD/PTD, aged 8-16.Interventions: Two 10-week therapist- and parent-guided Internet-delivered programmes (called BIP TIC HRT and BIP TIC ERP).Outcome: The primary outcome measure was the Yale Global Tic Severity Scale (YGTSS). Blinded evaluators rated symptoms at baseline, post-treatment, and 3-month follow-up (primary endpoint). All participants were naturalistically followed-up to 12 months after treatment.Results: Patients and parents rated the interventions as highly acceptable, credible, and satisfactory. While both interventions resulted in reduced tic-related impairment, parent-rated tic severity, and improved quality of life, only BIP TIC ERP resulted in a significant improvement on the primary outcome measure. Within-group effect sizes and responder rates were, respectively: d=1.12 and 75% for BIP TIC ERP, and d=0.50 and 55% for BIP TIC HRT. The therapeutic gains were maintained up to 12 months after the end of the treatment. Adverse events were rare in both groups. The average therapist support time was around 25 minutes per participant per week.Conclusions: Internet-delivered BT has the potential to greatly increase access to evidence-based treatment for young people with TD/PTD. Further evaluation of the efficacy and cost-effectiveness of this treatment modality is warranted.Trial registration number: NCT02864589 (ClinicalTrials.gov).Funding: The trial was supported by the Stockholm County Council (PPG project 2016-0108).

scholarly journals Therapist-guided and parent-guided internet-delivered behaviour therapy for paediatric Tourette’s disorder: a pilot randomised controlled trial with long-term follow-up

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e024685 ◽  
Author(s):  
Per Andrén ◽  
Kristina Aspvall ◽  
Lorena Fernández de la Cruz ◽  
Paulina Wiktor ◽  
Sofia Romano ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Young People ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Controlled Trial ◽  
Primary Outcome Measure ◽  
Behaviour Therapy ◽  
Tic Severity ◽  
Randomised Controlled

ObjectiveBehaviour therapy (BT) for Tourette’s disorder (TD) and persistent (chronic) motor or vocal tic disorder (PTD) is rarely available. We evaluated the feasibility of adapting two existing BT protocols for TD/PTD (habit reversal training (HRT) and exposure and response prevention (ERP)) into a therapist-guided and parent-guided online self-help format.DesignA pilot, single-blind, parallel group randomised controlled trial.SettingA specialist outpatient clinic in Sweden.ParticipantsTwenty-three young people with TD/PTD, aged 8–16.InterventionsTwo 10-week therapist-guided and parent-guided internet-delivered programmes (called BIP TIC HRT and BIP TIC ERP).OutcomeThe primary outcome measure was the Yale Global Tic Severity Scale. Blinded evaluators rated symptoms at baseline, post-treatment and 3-month follow-up (primary endpoint). All participants were naturalistically followed up to 12 months after treatment.ResultsPatients and parents rated the interventions as highly acceptable, credible and satisfactory. While both interventions resulted in reduced tic-related impairment, parent-rated tic severity and improved quality of life, only BIP TIC ERP resulted in a significant improvement on the primary outcome measure. Within-group effect sizes and responder rates were, respectively: d=1.12 and 75% for BIP TIC ERP, and d=0.50 and 55% for BIP TIC HRT. The therapeutic gains were maintained up to 12 months after the end of the treatment. Adverse events were rare in both groups. The average therapist support time was around 25 min per participant per week.ConclusionsInternet-delivered BT has the potential to greatly increase access to evidence-based treatment for young people with TD/PTD. Further evaluation of the efficacy and cost-effectiveness of this treatment modality is warranted.Trial registration numberNCT02864589; Pre-results.

scholarly journals The prevalence of tic disorders in children and adolescents in Brazil

2014 ◽  
Vol 72 (12) ◽  
pp. 942-948 ◽  
Author(s):  
Helvio L. Alves ◽  
Elizabeth M. A. B. Quagliato
Keyword(s):  
Special Education ◽  
Children And Adolescents ◽  
Tourette Syndrome ◽  
Special Education Students ◽  
Tic Disorders ◽  
Education Students ◽  
Tic Disorder ◽  
Item Questionnaire ◽  
Chronic Tic Disorder

Tourette syndrome (TS) and tic disorders represent events of familiar magnitude characterized by involuntary movements and/or vocalization. To determine the prevalence of TS/tic disorders we studied a sample of 762 subjects (388 M, 374 F), between 1992 and 1997, age 6 to 43 years old, taken out of a population of 10,155 subjects (4,918 M, 5,237 F; age: 3-56 years old). A structured 4-item questionnaire, direct interview (multistaged), >1 yr follow-up, were used. 9,565 subjects (4,614 M, 4,951 F) sent back the questionnaires, 3,354 of these (1,671 M, 1,683 F) with positive answers to tics. 42 subjects (31 M, 11 F, age: 7-21 years old, mean: 11 years old) met the DSM-III-R criteria. The total minimal prevalence of TS is 0.43%, with a 3:1 ratio male/female. The minimal prevalence of chronic tic disorder is 2.27%. The total minimal prevalence for tic disorders at all is 2.91%. No special education students participation.

scholarly journals Predicting Clinical Course from Subcortical Shape in Provisional Tic Disorder

2021 ◽  
Author(s):  
Tiffanie Che ◽  
Soyoung Kim ◽  
Deanna J. Greene ◽  
Ashley Heywood ◽  
Jimin Ding ◽  
...  
Keyword(s):  
Tic Disorders ◽  
Healthy Controls ◽  
Linear Regression Models ◽  
Tic Disorder ◽  
Surface Maps ◽  
Chronic Tic Disorder ◽  
Tic Severity ◽  
Group A ◽  
Diffeomorphic Metric Mapping

The ongoing NewTics study examines children who have had tics for less than 9 months (NT group) - a population on which little research exists. Here, we further investigate relationships between subcortical shape and tic symptom outcomes. 138 children were assessed at baseline and a 12-month follow-up: 79 with NT, 27 tic-free healthy controls (HC), and 32 with chronic tic disorder or Tourette syndrome (TS), using T1-weighted MRI and total tic scores (TTS) from the Yale Global Tic Severity Scale to evaluate symptom change. Subcortical surface maps were generated using FreeSurfer-initialized large deformation diffeomorphic metric mapping, and linear regression models were constructed to correlate structural shapes with TTS while accounting for covariates, with relationships mapped onto structure surfaces. When compared to healthy controls, smaller mean volumes were found in the TS group for the caudate, nucleus accumbens, pallidum, and thalamus. NT had smaller mean volumes than controls in the caudate, pallidum, and thalamus. Surface maps illustrate distinct patterns of inward deformation (localized volume loss) in the TS group compared to NT children. In the NT group, a larger hippocampus at baseline significantly correlated with the worsening of tic symptoms at 12 months. Outward deformation in the hippocampus and inward deformation in the accumbens at baseline are also related to worsening tic symptoms at follow-up. Since the NT group has had tics only for a few months, we can rule out the possibility that these subcortical volume differences are caused by living with tics for years; they are more likely related to the cause of tics. These observations constitute some of the first prognostic biomarkers for tic disorders and suggest localized circuitry that may be associated with outcome of tic disorders.

scholarly journals Efficacy and cost-effectiveness of therapist-guided internet-delivered behaviour therapy for children and adolescents with Tourette syndrome: study protocol for a single-blind randomised controlled trial

2021 ◽  
Author(s):  
Per Andrén ◽  
Lorena Fernández de la Cruz ◽  
Kayoko Isomura ◽  
Fabian Lenhard ◽  
Charlotte L Hall ◽  
...  
Keyword(s):  
Health Economic ◽  
Primary Endpoint ◽  
Controlled Trial ◽  
Health Economic Evaluation ◽  
Primary Objective ◽  
Behaviour Therapy ◽  
Tic Severity ◽  
Randomised Controlled ◽  
Single Blind

Background: Treatment guidelines recommend behaviour therapy (BT) for patients with Tourette syndrome (TS) and chronic tic disorder (CTD). However, BT is rarely accessible due to limited availability of trained therapists and long travel distances to specialist clinics. Internet-delivered BT has the potential of overcoming these barriers through remote delivery of treatment with minimal therapist support. In the current protocol, we outline the design and methods of a randomised controlled trial (RCT) evaluating an internet-delivered BT programme referred to as BIP TIC. The trial’s primary objective is to determine the clinical efficacy of BIP TIC for reducing tic severity in young people with TS/CTD, compared with an active control intervention. Secondary objectives are to investigate the 12-month durability of the treatment effects and to perform a health economic evaluation of the intervention.Methods: In this single-blind superiority RCT, 220 participants (9-17 years) with TS/CTD throughout Sweden will be randomised to 10-12 weeks of either therapist-supported internet-delivered BT based on exposure with response prevention (BIP TIC) or therapist-supported internet-delivered education. Data will be collected at baseline, 3 and 5 weeks into the treatment, at post-treatment, and 3, 6, and 12 months post-treatment. The primary endpoint is the 3-month follow-up. The primary outcome is tic severity as measured by the Yale Global Tic Severity Scale – Total tic severity score. Treatment response is operationalised as scores of “Very much improved” or “Much improved” on the Clinical Global Impression – Improvement scale, administered at the primary endpoint. Outcome assessors will be blind to treatment condition at all assessment points. A health economic evaluation of BIP TIC will be performed, both in the short term (primary endpoint) and the long term (12-month follow-up). There are no planned interim analyses. Discussion: Participant recruitment started on 26 April 2019 and finished on 9 April 2021. The final participant will reach the primary endpoint in September 2021 and the 12-month follow-up in June 2022. Data analysis for the primary objective will commence after the last participant reaches the primary endpoint.

Cognitive Behaviour Therapy for Adolescents with Body Dysmorphic Disorder: A Case Series

2012 ◽  
Vol 40 (4) ◽  
pp. 452-461 ◽  
Author(s):  
Georgina Krebs ◽  
Cynthia Turner ◽  
Isobel Heyman ◽  
David Mataix-Cols
Keyword(s):  
Depressive Symptoms ◽  
Young People ◽  
Cognitive Behaviour Therapy ◽  
Body Dysmorphic Disorder ◽  
Post Treatment ◽  
Response Prevention ◽  
Exposure And Response Prevention ◽  
Behaviour Therapy ◽  
Cognitive Behaviour

Background: Body dysmorphic disorder (BDD) is relatively common in adolescents and can have serious negative consequences. However, the treatment of BDD in young people has received virtually no empirical attention to date, and the evidence-base for cognitive behaviour therapy (CBT) in this population is limited to a small number of single case reports. Aims: This study aimed to investigate treatment outcomes associated with CBT, primarily consisting of exposure and response prevention, in a group of young people with BDD. Method: Six adolescents with a diagnosis of BDD received a course of developmentally appropriate CBT for BDD with parental involvement. BDD and depressive symptoms were evaluated at pre-treatment, post-treatment and at 3- or 6-month follow-up, using the Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS) and the Beck Depression Inventory-Youth, respectively. Results: Scores on the BDD-YBOCS indicated a 44% improvement in BDD symptoms at post-treatment and a 57% improvement at follow-up for the group. Considering response as a ≥30% reduction in BDD-YBOCS score, four of the six adolescents were classified as treatment responders. Improvements in depressive symptoms were observed among the treatment responders, but not the non-responders. Conclusions: These findings indicate the potential efficacy of CBT, including exposure and response prevention for adolescents with BDD, and highlight the need for further controlled trials.

scholarly journals Efficacy and cost-effectiveness of therapist-guided internet-delivered behaviour therapy for children and adolescents with Tourette syndrome: study protocol for a single-blind randomised controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Per Andrén ◽  
Lorena Fernández de la Cruz ◽  
Kayoko Isomura ◽  
Fabian Lenhard ◽  
Charlotte L. Hall ◽  
...  
Keyword(s):  
Health Economic ◽  
Primary Endpoint ◽  
Controlled Trial ◽  
Health Economic Evaluation ◽  
Primary Objective ◽  
Behaviour Therapy ◽  
Tic Severity ◽  
Randomised Controlled ◽  
Single Blind

Abstract Background Treatment guidelines recommend behaviour therapy (BT) for patients with Tourette syndrome (TS) and chronic tic disorder (CTD). However, BT is rarely accessible due to limited availability of trained therapists and long travel distances to specialist clinics. Internet-delivered BT has the potential of overcoming these barriers through remote delivery of treatment with minimal therapist support. In the current protocol, we outline the design and methods of a randomised controlled trial (RCT) evaluating an internet-delivered BT programme referred to as BIP TIC. The trial’s primary objective is to determine the clinical efficacy of BIP TIC for reducing tic severity in young people with TS/CTD, compared with an active control intervention. Secondary objectives are to investigate the 12-month durability of the treatment effects and to perform a health economic evaluation of the intervention. Methods In this single-blind superiority RCT, 220 participants (9–17 years) with TS/CTD throughout Sweden will be randomised to 10–12 weeks of either therapist-supported internet-delivered BT based on exposure with response prevention (BIP TIC) or therapist-supported internet-delivered education. Data will be collected at baseline, 3 and 5 weeks into the treatment, at post-treatment, and 3, 6, and 12 months post-treatment. The primary endpoint is the 3-month follow-up. The primary outcome is tic severity as measured by the Yale Global Tic Severity Scale – Total Tic Severity Score. Treatment response is operationalised as scores of “Very much improved” or “Much improved” on the Clinical Global Impression – Improvement scale, administered at the primary endpoint. Outcome assessors will be blind to treatment condition at all assessment points. A health economic evaluation of BIP TIC will be performed, both in the short term (primary endpoint) and the long term (12-month follow-up). There are no planned interim analyses. Discussion Participant recruitment started on 26 April 2019 and finished on 9 April 2021. The total number of included participants was 221. The final participant is expected to reach the primary endpoint in September 2021 and the 12-month follow-up in June 2022. Data analysis for the primary objective will commence after the last participant reaches the primary endpoint. Trial registration ClinicalTrials.gov NCT03916055. Registered on 16 April 2019.

Sign in / Sign up

Export Citation Format

Share Document