Introduction
Comprehensive Behavioral Intervention for Tics (CBIT) has been shown to be efficacious for Chronic Tic Disorders (CTDs), but utilization is limited by a lack of treatment providers and perceived financial and time burden of commuting to treatment. A promising alternative to in-person delivery is Voice over Internet Protocol (VoIP), allowing for remote, real-time treatment delivery to patients’ homes. However, little is known about the effectiveness of VoIP for CTDs. Therefore, the present study examined the preliminary efficacy, feasibility, and acceptability of VoIP-delivered CBIT (CBIT-VoIP).
Methods
Twenty youth (8–17) with CTDs participated in a randomized, waitlist-controlled pilot trial of CBIT-VoIP. The main outcome was pre- to post-treatment change in clinician-rated tic severity (Yale Global Tic Severity Scale). The secondary outcome was clinical responder rate (Clinical Global Impressions – Improvement Scale), assessed using ratings of ‘very much improved’ or ‘much improved’ indicating positive treatment response.
Results
Intention-to-treat analyses with the last observation carried forward were performed. At post-treatment (10-weeks), significantly greater reductions in clinician-rated, [F (1, 18) = 3.05, p < 0.05, partial η2 = 0.15], and parent-reported tic severity, [F (1, 18) = 6.37, p < 0.05, partial η2 = .26] were found in CBIT-VoIP relative to waitlist. One-third (N = 4) of those in CBIT-VoIP were considered treatment responders. Treatment satisfaction and therapeutic alliance were high. Discussion: CBIT can be delivered via VoIP with high patient satisfaction, using accessible, low-cost equipment. CBIT-VoIP was generally feasible to implement, with some audio and visual challenges. Modifications to enhance treatment delivery are suggested.
Problem behavior of 52 children with Williams syndrome ages 6 to 17 years old was examined based on both parent and teacher report. Generally good inter-rater agreement was found. Common areas of problem behavior based both on parent and teacher report included attention problems, anxiety difficulties, repetitive behaviors (e.g., obsessions, compulsions, picking nose or skin), and social problems, reflecting a robust behavioral phenotype in Williams syndrome present across contexts. Some rater differences were observed; most notably, parents reported more attention and mood difficulties than did teachers, while teachers reported more oppositionality and aggression than did parents. Relations to intellectual functioning, age, and gender were examined. The implications of the findings for understanding the behavioral phenotype associated with Williams syndrome are discussed.
Parents of children with autism spectrum disorder (ASD) report significantly higher stress than parents of children with other developmental disorders. Symptoms that overlap with the autism spectrum are often present in other developmental disorders, which could significantly increase parenting stress. Additionally, the severity of ASD symptoms within a group of children with ASD can greatly vary. In the present study, problem behaviors, cognitive and adaptive functioning, and parenting stress were examined in a group of 40 children aged 2-5 years who were referred for an autism evaluation. The children presented with varying levels of symptoms often associated with ASD, and some met criteria for an autism spectrum disorder diagnosis. This approach allowed for both categorical and dimensional consideration of ASDassociated symptoms and the relation to parenting stress in children with and without autism. When examined based on ultimate clinical diagnosis of ASD or non-ASD, child behavior problems and parenting stress were similar across groups. Clinicianbased autism severity ratings (based on the Autism Diagnostic Observation Schedule) did not significantly predict parenting stress; however, parental report of the severity of ASD-associated symptoms (from the Social Responsiveness Scale) showed a significant relation to stress. Cognitive ability did not uniquely contribute to stress. Problem behaviors as assessed by the Child Behavior Checklist accounted for the largest proportion of the variance in parenting stress; adaptive behaviors and severity of parent-or clinician-rated autism-associated symptoms did not uniquely contribute above and beyond problem behaviors. Parents who reported more behavior problems or more autism-associated symptoms reported higher parenting stress. Clinical applications and the need for more research on parenting stress and problem behaviors in children displaying autism symptomatology are highlighted. J Dev Phys Disabil
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