Behavior Therapy for Tics in Children: Acute and Long-Term Effects on Psychiatric and Psychosocial Functioning

Abstract

Children (n = 126) ages 9 to 17 years with chronic tic or Tourette disorder were randomly assigned to receive either behavior therapy or a control treatment over 10 weeks. This study examined acute effects of behavior therapy on secondary psychiatric symptoms and psychosocial functioning and long-term effects on these measures for behavior therapy responders only. Baseline and end point assessments conducted by a masked independent evaluator assessed several secondary psychiatric symptoms and measures of psychosocial functioning. Responders to behavior therapy at the end of the acute phase were reassessed at 3-month and 6-month follow-up. Children in the behavior therapy and control conditions did not differentially improve on secondary psychiatric or psychosocial outcome measures at the end of the acute phase. At 6-month posttreatment, positive response to behavior therapy was associated with decreased anxiety, disruptive behavior, and family strain and improved social functioning. Behavior therapy is a tic-specific treatment for children with tic disorders.

Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis

“…175 There were similar changes in anxiety scores from baseline to follow-up for CBIT compared with SP as assessed by children (SMD -0.10, 95% CI -0.45 to 0.25; n = 126) and their parents (SMD -0.15, 95% CI -0.50 to 0.20; n = 126) ( Figure 182). …”

“…In one study of children, 156 impairments in functioning within the family and school environment were assessed using the Family Assessment Measure-III (short form), Caregiver Strain Questionnaire, Social Adjustment Scale Self-Report and subscales of the Child Behaviour Checklist (CBCL). 175 There was no evidence of benefit for CBIT compared with SP for changes from baseline in the Family Assessment Measure for children (SMD -0.02, 95% CI -0.37 to 0.33; n = 126) or adults (SMD 0.16, 95% CI -0.19 to 0.51; n = 126), or for the Caregiver Strain Questionnaire (SMD -0.02, 95% CI -0.37 to 0.33; n = 126), Social Adjustment Scale Self-Report -family (SMD -0.15, 95% CI -0.50 to 0.20; n = 126), friends (SMD -0.08, 95% CI -0.43 to 0.27; n = 126) or school functioning measures (SMD 0.10, 95% CI -0.25 to 0.45; n = 126), or the CBCL activities (SMD 0.17, 95% CI -0.18 to 0.52; n = 126), social (SMD 0.08, 95% CI -0.27 to 0.43; n = 126), school (SMD -0.05, 95% CI -0.40 to 0.30; n = 126) or total competency (SMD 0.04, 95% CI -0.31 to 0.39; n = 126) subscales.…”

“…Depression One study in children 175 and one in adults 168 report changes in patient depression. The child study used the CDI and the adult study used the Beck Depression Inventory.…”

Peer Victimization in Youth with Tourette Syndrome and Other Chronic Tic Disorders

“…The association of reduced tic severity with improved psychosocial effects was recently reported in a study among children with TS/CTD that applied a behavioral intervention model designed as a treatment approach targeting tic expression, resulting in sustained total tic reduction measured at 6 months post-treatment. This reduction in tics was associated with improvement in psychosocial outcomes, including reduced anxiety [38]. Whether any associated change in peer victimization played a role in this improvement, however, was not explored.…”

1.1 Suicidal Thoughts and Behaviors in Children and Adolescents With Chronic Tic Disorders

“…This phenomenon has been demonstrated using behavioral treatment for children and adolescents with CTD in which positive response was associated with decreased anxiety, disruptive behavior, family strain, and social impairment. 52 A critical difference, however, is that the magnitude of response and the percentage of overall responders to behavioral therapy seems to be greater in youth affected by OCD relative to CTD [54][55][56][57] making it unclear if a similar pattern of results would emerge in youth with CTD. Participants that endorsed thoughts of death/dying, suicidal thoughts and/or behaviors …”