P.2.013 - The role of family psychoeducation in the management of tics and tic-related impairment in grade school children

Abstract

Background Children with tics, as a rule, become very challenging cases for psychologists and psychiatrists. The high prevalence (from 3 to 50 per 1000 children for chronic motor tics and 2.5 to 9.4 per 1000 children for vocal tics.) of these disorders has led to many colloquial ideas and misinformation about appropriate and effective treatment [1]. Patients and their families are frequently unable to correctly identify the symptoms and patients sometimes get stigmatised as a consequence of their tics [2]. Therefore, a lot of authors recommend starting the treatment of tics with psychoeducation involving the patient and his/her parents [3]. Aims The primary aim of this study was to evaluate whether family psychoeducation followed by pharmacological therapy would prove superior for reducing tics. Methods The study included 80 children (from 6 to 12 years old) suffering from chronic tic disorder (CID-10), which were observed during at least 3 months prior to the study, that were randomly divided into 2 groups. The control group included children who received only medication and the experimental group included patients who took part in a family psychoeducation program (2 sessions per week) and received pharmacological treatment. We used the Yale Global Tics Severity Scale to assess the severity of tics at the beginning of the treatment and after 1 and 3 months of therapy. The exclusion criteria were children with mental retardation and Autism Spectrum Disorder. Results Our results show that after the first month there was no significant difference between the control and experimental group. In both groups we noticed a reduction on the YGTSS: from 35.3 [95% CI 34.4-36.3] to 29.8 [95% CI 28.9-30.7] in the control group vs 34.52 [95% CI 27.5-29.9] to 28.7 [95% CI 27.5-29.9] in the experimental group. The average decrease on YGTSS from baseline was 5.5 and 5.7 in the control and experimental group, respectively. However, after 3 months of therapy we found a significantly greater decrease on the Yale Global Tic Severity Scale in children who received additional family psychoeducation: from 28.7 [95% CI 27.5-29.9] to 23.5 [95% CI 22.61 – 24.38] (p Conclusion Pharmacological therapy supported by family psychoeducation resulted in a greater improvement in symptoms among children with chronic tic disorder. In long term therapy we see significant differences appear at 3 months in the study. We believe it is explained by the fact that it takes some time to develop a therapeutic connection and mechanisms of adjustment. The efficacy of family intervention and other psychotherapeutic methods highlights the ethiology of tic disorders, expands treatment options and helps children develop new mechanisms of adjusting and/or adaptation, but does not inhibit tics.