Impact of movie and video game elements on tic manifestation in children

Raz, Gal; Davidovitch, Shiri; Halevi, Mor; Zuckerman, Maya; Ben‐Haim, Yael; Koryto, Yuval; Steinberg, Tamar; Leitner, Yael; Rotstein, Michael S.

doi:10.1111/ene.16120

Cited by 4 publications

References 43 publications

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Gamified Closed‐Loop Intervention Enhances Tic Suppression in Children: A Randomized Trial

Rotstein,

Zimmerman‐Brenner,

Davidovitch

et al. 2024

Movement Disorders

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BackgroundGamification of behavioral intervention for tic disorders (TDs) potentially enhances compliance and offers key clinical advantages. By delivering immediate positive feedback upon tic‐suppression, games may counteract negative reinforcement, which presumably contribute to tic consolidation by relieving uncomfortable premonitory urges.ObjectivesWe developed a gamified protocol (XTics), which leverages this potential by combining gamified tic‐triggering with immediate feedback, and evaluated its clinical value in enhancing tic suppression.MethodsXTics encompasses two conditions: Immediate and Contingent Reward (ICR), where game progression is contingent upon successful tic suppression, and Delayed Reward (DR), where game events' outcomes are random. Employing a randomized crossover design, 35 participants (aged 7–15 years) underwent daily gaming sessions over a week per condition. Improvements in our primary measures, including the inter‐tic interval (ITI) and tic severity assessment by blinded evaluators (Yale Global Tic Severity‐Total Tic Score [YGTSS‐TTS], Rush), and parents (Parent Tic Questionnaire [PTQ]), were compared between ICR and DR, and assessed across conditions for the 4‐week protocol.ResultsNo participant voluntarily left the study before completing its two‐phase protocol. As expected, ITI showed significantly larger improvement (Z = 4.19, P = 2.85 × 10–5) after ICR (1442 ± 2250%) versus DR (242 ± 493%) training, increasing at a higher pace (t(67) = 3.15, P = 0.0025). Similarly, Rush tic severity scores reduced more post‐ICR versus DR (t(47) = 3.47, P = 0.002). We observed a clinically significant reduction of 25.69 ± 23.39% in YGTSS‐TTS following a f4‐week protocol including both conditions. Parent‐reported tic severity decreased by 42.99 ± 31.69% from baseline to 3 months post‐treatment.ConclusionsThe combination of gamified tic‐triggering with immediate and contingent rewards demonstrates a promising approach for enhancing treatment efficacy in TDs, boosting traditional therapeutic methods. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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Gamified Closed‐Loop Intervention Enhances Tic Suppression in Children: A Randomized Trial

Rotstein,

Zimmerman‐Brenner,

Davidovitch

et al. 2024

Movement Disorders

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Gamified closed-loop non-pharmacological intervention enhances tic suppression in children

Rotstein,

Zimmerman-Brenner,

Davidovitch

et al. 2024

Preprint

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Background: The gamification of behavioral intervention for tic disorders (TDs) may not only enhance compliance with treatment protocols but also offer a key clinical advantage. By providing immediate positive feedback when tics are suppressed, games can counteract negative reinforcement processes that reinforce tics, which assumingly alleviates unpleasant premonitory urges. We developed a gamified protocol (XTics), which leverages this potential by combining gamified tic triggers with immediate reinforcement of tic suppression. We evaluate the clinical value of immediate reward contingency in enhancing tic suppression performance. Methods: XTics comprises two conditions: tic-contingent and non-contingent. In the tic-contingent version, game progression was determined by real-time input from an experimenter who monitored the participant's tics, rewarding tic suppression with favorable outcomes. Conversely, in the non-contingent version, game events occurred randomly. Using a crossover design, we trained 35 participants (aged 7-15) in both versions, with each participant undergoing a preliminary behavioral training and three hourly sessions for each condition. We Page 2 both evaluated the overall protocol's four-week impact on tic severity measures and compared contingent and non-contingent conditions. Results: We achieved complete adherence to the protocol, while the participants increased their tic-free intervals by an average of 558% from the first to the last training day. YGTSS, a clinical measure of tic severity, showed an average clinically meaningful reduction of 25.69±23.39%, which was larger than that observed in control interventions and comparable to the effects of longer non-pharmacological treatments. Parent-reported tic severity decreased by 42.99±31.69% from baseline to three months post-treatment. When contrasting the tic-contingent with the tic-non-contingent training versions, we observed a larger improvement in tic-free interval duration in the former case (t(67)=3.15, p=.0025). Additionally, Rush, another measure of tic severity, demonstrated a greater reduction following training with the contingent compared to the non-contingent version (t(47)=3.47, p=.002). Conclusion: The combination of gamified tic triggering with immediate and contingent rewards demonstrates a promising approach for enhancing treatment efficacy in TDs, offering an engaging boost to traditional therapeutic methods.

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