3.55 Children With Tourette's Disorder: Diagnostic Process, Co-Occurring Mental and Developmental Disorders, and Influences on Tic Severity

AbstractBackgroundAlthough behavior therapy reduces tic severity, it is unknown whether it improves co-occurring psychiatric symptoms and functional outcomes for adults with Tourette's disorder (TD). This information is essential for effective treatment planning. This study examined the effects of behavior therapy on psychiatric symptoms and functional outcomes in older adolescents and adults with TD.MethodA total of 122 individuals with TD or a chronic tic disorder participated in a clinical trial comparing behavior therapy to psychoeducation and supportive therapy. At baseline, posttreatment, and follow-up visits, participants completed assessments of tic severity, co-occurring symptoms (inattention, impulsiveness, hyperactivity, anger, anxiety, depression, obsessions, and compulsions), and psychosocial functioning. We compared changes in tic severity, psychiatric symptoms, and functional outcomes using repeated measure and one-way analysis of variance.ResultsAt posttreatment, participants receiving behavior therapy reported greater reductions in obsessions compared to participants in supportive therapy ($\eta _p^2 $ = 0.04, p = 0.04). Across treatments, a positive treatment response on the Clinical Global Impression of Improvement scale was associated with a reduced disruption in family life ($\eta _p^2 $ = 0.05, p = 0.02) and improved functioning in a parental role ($\eta _p^2 $ = 0.37, p = 0.02). Participants who responded positively to eight sessions of behavior therapy had an improvement in tic severity ($\eta _p^2 $ = 0.75, p < 0.001), inattention ($\eta _p^2 $ = 0.48, p < 0.02), and functioning ($\eta _p^2 $ = 0.39–0.42, p < 0.03–0.04) at the 6-month follow-up.ConclusionBehavior therapy has a therapeutic benefit for co-occurring obsessive symptoms in the short-term, and reduces tic severity and disability in adults with TD over time. Additional treatments may be necessary to address co-occurring symptoms and improve functional outcomes.

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The role of affect lability on tic severity and impairment in youth with Tourette's disorder

Journal of Obsessive-Compulsive and Related Disorders ◽

10.1016/j.jocrd.2020.100578 ◽

2020 ◽

Vol 27 ◽

pp. 100578

Author(s):

Kesley A. Ramsey ◽

Joey Ka-Yee Essoe ◽

Eric A. Storch ◽

Adam B. Lewin ◽

Tanya K. Murphy ◽

...

Keyword(s):

Tourette’S Disorder ◽

Tourette's Disorder ◽

Tic Severity

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

10.31234/osf.io/dp3qz ◽

2018 ◽

Cited By ~ 1

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).

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30.4 PILOT STUDY OF AN ORAL ORTHOTIC IN REDUCING TIC SEVERITY IN CHRONIC TIC DISORDER AND TOURETTE'S DISORDER

Journal of the American Academy of Child & Adolescent Psychiatry ◽

10.1016/j.jaac.2016.07.292 ◽

2016 ◽

Vol 55 (10) ◽

pp. S305

Author(s):

Shannon M. Bennett ◽

Jeffrey Hindin ◽

Justin W. Mohatt ◽

John T. Walkup

Keyword(s):

Pilot Study ◽

Tourette’S Disorder ◽

Tic Disorder ◽

Tourette's Disorder ◽

Chronic Tic Disorder ◽

Tic Severity

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Peer Problems in Tourette's Disorder

PEDIATRICS ◽

10.1542/peds.87.6.936 ◽

1991 ◽

Vol 87 (6) ◽

pp. 936-942

Author(s):

Aidan Stokes ◽

Harry N. Bawden ◽

Joan E. Backman ◽

Joseph M. Dooley ◽

Peter R. Camfield

Keyword(s):

Peer Relationships ◽

Social Adjustment ◽

Child Behavior Checklist ◽

Rating Scales ◽

Neuropsychological Testing ◽

Tourette’S Disorder ◽

Tourette's Disorder ◽

Summary Scale ◽

Tic Severity ◽

Evaluation Inventory

To explore the social adjustment and peer relationships of children with Tourette's disorder, 29 patients with mild to moderate Tourette's disorder were studied. Children underwent neuropsychological testing. The patients completed self-esteem scales and their parents and teachers completed behavior rating scales. Peer relationships were examined with the Pupil Evaluation Inventory, which is a sociometric questionnaire completed by the child's classmates and provides measures of aggression, withdrawal, and likability. As a group, Tourette's disorder patients were significantly more withdrawn, more aggressive, and less popular than their classmates. Thirty-five percent of the children with Tourette's disorder received the lowest rating in the class on one or more of the Pupil Evaluation Inventory factors. These social problems were not predicted by the frequency or duration of tics. A clinical diagnosis of attention-deficit hyperactivity disorder and teachers' ratings on the summary scale of the Child Behavior Checklist and the Pupil Evaluation Inventory did predict poor adjustment. It is concluded that social adjustment is a major difficulty for many children with Tourette's disorder, irrespective of tic severity.

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Distinguishing Illness Severity From Tic Severity in Children and Adolescents With Tourette's Disorder

Journal of the American Academy of Child & Adolescent Psychiatry ◽

10.1097/00004583-200005000-00008 ◽

2000 ◽

Vol 39 (5) ◽

pp. 556-561 ◽

Cited By ~ 44

Author(s):

BARBARA J. COFFEY ◽

JOSEPH BIEDERMAN ◽

DANIEL A. GELLER ◽

THOMAS J. SPENCER ◽

GRACE S. KIM ◽

...

Keyword(s):

Children And Adolescents ◽

Illness Severity ◽

Tourette’S Disorder ◽

Tourette's Disorder ◽

Tic Severity

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The effects of nicotine plus haloperidol compared to nicotine only and placebo nicotine only in reducing tic severity and frequency in Tourette's disorder

Biological Psychiatry ◽

10.1016/0006-3223(92)90315-q ◽

1992 ◽

Vol 31 (8) ◽

pp. 832-840 ◽

Cited By ~ 75

Author(s):

Brain J. McConville ◽

Paul R. Sanberg ◽

M.Harold Fogelson ◽

Judy King ◽

Paul Cirino ◽

...

Keyword(s):

Tourette’S Disorder ◽

Tourette's Disorder ◽

Tic Severity

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Anxiety Disorders and Tic Severity in Juveniles With Tourette's Disorder

Journal of the American Academy of Child & Adolescent Psychiatry ◽

10.1097/00004583-200005000-00009 ◽

2000 ◽

Vol 39 (5) ◽

pp. 562-568 ◽

Cited By ~ 92

Author(s):

BARBARA J. COFFEY ◽

JOSEPH BIEDERMAN ◽

JORDAN W. SMOLLER ◽

DANIEL A. GELLER ◽

PRIYA SARIN ◽

...

Keyword(s):

Anxiety Disorders ◽

Tourette’S Disorder ◽

Tourette's Disorder ◽

Tic Severity

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0997 The Sleep Disturbance Scale For Children In Youth With Tourette’S Disorder

SLEEP ◽

10.1093/sleep/zsaa056.993 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A378-A379

Author(s):

G E Montalbano ◽

M Rozenman ◽

T Peris ◽

P Tan ◽

J Piacentini ◽

...

Keyword(s):

Sleep Disturbance ◽

Sleep Problems ◽

Tic Disorders ◽

Healthy Children ◽

Healthy Controls ◽

Tourette’S Disorder ◽

Significant Group ◽

Tourette's Disorder ◽

Abnormal Movements ◽

Tic Severity

Abstract Introduction Sleep disturbance is common in youth with Persistent Tic Disorders (PTDs), including Tourette’s Disorder. However, studies elucidating the nature of sleep problems in PTDs are limited. The present study examines the types of sleep disturbance present in youth with PTDs relative to healthy controls, and investigates the relationship between sleep disturbance and tic severity. Methods Participants were 56 youth ages 8 to 17 (M=11.9, SD=2.86), including individuals with PTDs (n=27), and healthy controls (n=29). An interviewer evaluated psychiatric diagnosis using the Anxiety Disorders Interview Schedule, and tic severity using the Yale Global Tic Severity Scale (YGTSS). Parents rated sleep using the Sleep Disturbance Scale for Children (SDSC), and tic severity using the Parent Tic Questionnaire (PTQ). Independent-samples t-tests and bivariate correlations were performed. Results Higher SDSC Total scores, t(30)=-3.74, p=.001) were found in youth with PTDs relative to healthy controls. Youth with PTDs endorsed elevated sleep disturbance with respect to: Disorders of Initiating and Maintaining Sleep, t(35)=-2.43, p=.02), Sleep-Wake Transition Disorders, t(37)=-3.04, p=.004), and Disorders of Excessive Somnolence, t(33)=-2.36, p=.02). No significant group differenceswere shown for Sleep Breathing Disorders, Disorders of Arousal, and Sleep Hyperhydrosis. There was a positive association between SDSC Total scores and YGTSS Total (p=.01, r=.56) and YGTSS Impairment scores (p= .03, r=.33). Finally, there was a positive relationship between SDSC Total and PTQ Total scores (p=.01, r=.61). Conclusion Findings suggest youth with PTDs are more likely to experience sleep disturbance than healthy children, particularly difficulties with sleep initiation and maintenance, abnormal movements during sleep, and daytime sleepiness. Further, there is a relationship between sleep disturbance and tic severity. Findings highlight the need for sleep screening and targeted sleep intervention in youth with PTDs. Support N/A

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