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.

Trial registration: ClinicalTrials.gov NCT00218777.

Conflict of interest statement

Declaration of Conflicting Interests: The authors declared a potential conflict of interest (eg, a financial relationship with the commercial organizations or products discussed in this article) as follows: Drs Scahill, Dzuria, and Liu receive support from the Yale University Clinical and Translational Sciences Award grant UL1 RR 024139 from the National Center for Research Resources, National Institutes of Health (NIH). Drs Woods, Piacentini, Scahill, Peterson, Wilhelm, Chang, Deckersbach, and Walkup all report receiving royalties from Oxford University Press for treatment manuals on tic disorders. Drs Woods, Piacentini, Scahill, Peterson, Wilhelm, Chang, and Walkup all report receiving honoraria for CME presentations from the Tourette Syndrome Association. Drs Woods, Piacentini, and Walkup also receive royalties from Guilford Press for a book on Tourette disorder. Dr Woods also reports receiving book royalties from New Harbinger and Springer Publications and receives speaking honoraria from the Tourette Syndrome Association. Dr Piacentini also reports receiving grant support in the form of free medication and matching placebo from Eli Lilly for clinical trials funded by the NIMH, speaking honoraria from Janssen Cilag, royalties from Oxford University Press for treatment manuals on child obsessive-compulsive disorder and APA Books for other books on child mental health, speaking honoraria from Janssen-Cilag, and support in the form of free medication and matching placebo from Pfizer for clinical trials funded by NIMH. Dr Scahill also reports receiving royalties from Oxford University Press for a textbook on pediatric psychopharmacology and has served as a consultant for Janssen Pharmaceutic, Bristol-Myers Squibb, Neuropharm, Supernus, and Shire Pharmaceuticals and has received research support from Seaside Therapeutics and Shire Pharmaceuticals and support in the form of free medication and matching placebo from Janssen and Shire for clinical trials funded by NIMH. Dr Wilhelm also reports receiving support in the form of free medication and matching placebo from Forest Laboratories for clinical trials funded by NIH and receives book royalties from Guilford Publications, New Harbinger Publications, and Oxford University Press and speaking honoraria from PRIMEDIA Healthcare, a publicly traded company, working as a logistics collaborator for the MGH Psychiatry Academy. (The education programs conducted by the MGH Psychiatry Academy were supported through Independent Medical Education grants from pharmaceutical companies co-supporting the overall program along with participant tuition.) Dr Deckersbach also reports receiving consulting fees from the Constella Group for serving as a reviewer for the Congressionally Directed Medical Research Program. Dr Walkup has received consulting fees from Eli Lilly and JAZZ Pharmaceuticals and lecture fees from CMP Media, Medical Education Reviews, McMahon Group, DiMedix, and the Tourette Syndrome Association. He has received free drug and matching placebo from Pfizer and Lilly and free drug from Abbott for NIMH-funded clinical trials. He has received fees for consultation with defense counsel and submission of written reports in litigation involving GlaxoSmithKline. Drs Peterson, Chang, Specht, Dzuria, and Liu report no disclosures. Mr McGuire and Ms Conelea, Ms Rozenmann, and Ms Levi-Pearl report no disclosures.