One-year outcome of manualised behavior therapy of chronic tic disorders in children and adolescents

J B Nissen, A H Carlsen, P H Thomsen, J B Nissen, A H Carlsen, P H Thomsen

Abstract

Background: Chronic tic disorders are neurodevelopmental disorders that can be treated with Habit Reversal Training (HRT) and Exposure Response Prevention (ERP). Intermediate and long-term effects have been examined after individual treatment with HRT, whereas evaluation of long-term outcome after an initial treatment with ERP, or a combination of HRT and ERP is lacking. The present study examines the long-term effect after a combined treatment with HRT and ERP delivered in an individual or a group setting METHODS: Fifty-nine children and adolescents diagnosed with a chronic tic disorder were randomised to manualised treatment combining HRT and ERP as individual or group training. Forty-seven were re-examined 1 year after acute outcome. Outcome measures included Total Tic Severity score (TTS) measured by the Yale Global Tic Severity Scale (YGTSS) and Beliefs About Tics Scale (BATS) RESULTS: In a mixed model, it was shown that the initial improvement with both individual and group treatment was maintained throughout the follow-up period. There were no significant differences between the two methods of treatment delivery. Of all participants completing the 12 months evaluation, 74.4% were considered responders. There was a significant positive association between the reduction of TTS and the reduction in BATS. In a latent class post-treatment trajectory analysis, two classes were identified, where high baseline severity increased the likelihood of being in the lesser responder class. Similar, but only as a trend, having ADHD, planning difficulties or hypersensitivity increased the risk of a lesser response.

Conclusions: The present study compares the efficacy in individualised and group treatment of providing manualised therapy for child and adolescent tic disorders using two behavioural methods (combined HRT and ERP) both of which have been shown to have acute benefits but only one of which has been validated for longer term effectiveness. In the present study, both individualised and group treatments showed benefit throughout a 1-year follow-up period with several potential confounds affecting outcomes, while the relative benefits of either HRT and ERP were not addressed. Trial registration NCT04594044, 1-10-72-216-15, registered 19th October 2020, retrospectively registered, https://register.clinicaltrials.gov/prs/app/template/Home.vm?uid=U0005BW2&ts=9&sid=S000ABEY&cx=-wlx7vb The study is approved by the National Ethical Committee (1-10-72-216-15) and the Danish Data Protection Agency (1-16-02-490-15), registered 12 October 2015.

Keywords: Adolescent; Children; Chronic tics disorder; Long-term outcome; Therapy; Tourette syndrome.

Conflict of interest statement

The authors declare that they have no conflict of interest. After the study was ended, the manual was published at Akademisk forlag (Danish publisher).

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/7897385/bin/13034_2021_362_Figa_HTML.jpg
Flowchart of the combined treatment and follow-up of children and adolescents with CTD
Fig. 1
Fig. 1
a The figure shows the course of TTS score (Y-axis) from baseline to 12 months follow-up (Mean and SD. b The figure shows the course of FI score (Y-axis) from baseline to 12 months follow-up (Mean and SD)
Fig. 2
Fig. 2
The figure shows the course of BATS, SCARED, PUTS, MFQ and TTS (Y-axis) from baseline to 12 months follow-up (Mean and SD)
Fig. 3
Fig. 3
The best fit for symptom severity (TTS) trajectory classes
Fig. 4
Fig. 4
a BATS scores distributed in accordance to the symptom severity (TTS) trajectory classes. b PUTS scores distributed in accordance to the symptom severity (TTS) trajectory classes

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