Therapist-guided and parent-guided internet-delivered behaviour therapy for paediatric Tourette's disorder: a pilot randomised controlled trial with long-term follow-up

Per Andrén, Kristina Aspvall, Lorena Fernández de la Cruz, Paulina Wiktor, Sofia Romano, Erik Andersson, Tara Murphy, Kayoko Isomura, Eva Serlachius, David Mataix-Cols, Per Andrén, Kristina Aspvall, Lorena Fernández de la Cruz, Paulina Wiktor, Sofia Romano, Erik Andersson, Tara Murphy, Kayoko Isomura, Eva Serlachius, David Mataix-Cols

Abstract

Objective: Behaviour therapy (BT) for Tourette's disorder (TD) and persistent (chronic) motor or vocal tic disorder (PTD) is rarely available. We evaluated the feasibility of adapting two existing BT protocols for TD/PTD (habit reversal training (HRT) and exposure and response prevention (ERP)) into a therapist-guided and parent-guided online self-help format.

Design: A pilot, single-blind, parallel group randomised controlled trial.

Setting: A specialist outpatient clinic in Sweden.

Participants: Twenty-three young people with TD/PTD, aged 8-16.

Interventions: Two 10-week therapist-guided and parent-guided internet-delivered programmes (called BIP TIC HRT and BIP TIC ERP).

Outcome: The primary outcome measure was the Yale Global Tic Severity Scale. Blinded evaluators rated symptoms at baseline, post-treatment and 3-month follow-up (primary endpoint). All participants were naturalistically followed up to 12 months after treatment.

Results: Patients and parents rated the interventions as highly acceptable, credible and satisfactory. While both interventions resulted in reduced tic-related impairment, parent-rated tic severity and improved quality of life, only BIP TIC ERP resulted in a significant improvement on the primary outcome measure. Within-group effect sizes and responder rates were, respectively: d=1.12 and 75% for BIP TIC ERP, and d=0.50 and 55% for BIP TIC HRT. The therapeutic gains were maintained up to 12 months after the end of the treatment. Adverse events were rare in both groups. The average therapist support time was around 25 min per participant per week.

Conclusions: Internet-delivered BT has the potential to greatly increase access to evidence-based treatment for young people with TD/PTD. Further evaluation of the efficacy and cost-effectiveness of this treatment modality is warranted.

Trial registration number: NCT02864589; Pre-results.

Keywords: Tourette’s disorder; behaviour therapy; persistent (chronic) motor or vocal tic disorder; telemedicine.

Conflict of interest statement

Competing interests: LFC and DM-C receive royalties for contributing articles to UpToDate, Wolters Kluwer Health.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials flow diagram. BIP TIC ERP, internet-delivered exposure and response prevention; BIP TIC HRT, internet-delivered habit reversal training; BT, behaviour therapy; PTD, persistent (chronic) motor or vocal tic disorder; TD, Tourette’s disorder; YGTSS, Yale Global Tic Severity Scale, Total Tic Severity Score.
Figure 2
Figure 2
Graphical representation of the YGTSS Total Tic Severity Score across the five assessment points. Primary endpoint is the 3-month follow-up; after this point, assessments are not blinded. Error bars indicate 95% CIs. 3FU, 3-month follow-up; 6FU, 6-month follow-up; 12FU, 12-month-follow-up; BIP TIC ERP, internet-delivered exposure and response prevention; BIP TIC HRT, internet-delivered habit reversal training; Post, post-treatment; YGTSS, Yale Global Tic Severity Scale.

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