A parent-mediated habit reversal intervention for chronic tic disorders in children

Abstract

Chronic tic disorders (CTDs), including Tourette's disorder and persistent motor or vocal tic disorder, are neurobiological conditions affecting an estimated 3 to 4 percent of children and adolescents. These disorders include the presence of motor and/or phonic tics, which can range in number, frequency, and severity. Although CTDs are typically treated through medications, the available medications have the potential of adverse side effects, do not result in long-term coping strategies, and may not be effective or preferable for all individuals. Habit reversal training (HRT), a behavioral intervention for tics, has been identified as a well-established treatment. The purpose of habit reversal is to build an individual's awareness of his or her tics and disrupt tics through developing a competing behavioral response. One avenue or service delivery that has not yet been explored for individuals with CTDs is use of a parent-mediated approach to habit reversal. Parent-mediated interventions have been used successfully with children with challenging behavior and autism. They are based on a triadic model, in which a therapist works directly with a parent to teach the therapeutic techniques. Parents, in turn, work directly with their children while receiving feedback from the therapist. The current study investigated a parent-mediated habit reversal intervention for the treatment of chronic tic disorders in two children. A delayed multiple baseline design was used. Baseline data were collected for three sessions. Intervention was delivered over six sessions, during which time coaching was faded. Follow up data collection occurred one month after the end of treatment. Based on changes in parental fidelity of implementation from baseline to intervention, this study provides preliminary evidence for parents being trained as therapists and providing habit reversal training strategies to their children. This treatment was reported as vi acceptable by both parent participants and by one of the child participants. Treatment motivation remained high and stable throughout baseline, intervention, and follow up. Child motivation was more variable during baseline, intervention, and follow up. Tic severity was also variable and more research would be needed to determine the impact of treatment for tics. Limitations and implications for future research are provided. vii