Tackle your Tics: pilot findings of a brief, intensive group-based exposure therapy program for children with tic disorders

A P Heijerman-Holtgrefe,E M W J Utens,K J Kan,D Cath,C Huyser,L P L Beljaars,C W J Verdellen,P J Hoekstra,J M T M Van De Griendt

doi:10.1007/s00787-020-01532-5

Abstract

Tourette syndrome (TS) and other chronic tic disorders (CTD) are prevalent neurodevelopmental disorders, which can have a huge burden on families and society. Behavioral treatment is a first-line intervention for tic disorders. Despite demonstrated efficacy, tic reduction and utilization rates of behavioral treatment remain relatively low. Patient associations point to an urgent need for easy-to-undergo treatments that focus both on tic reduction and improvement of quality of life. To enhance treatment outcome and overcome treatment barriers, this pilot study’s aim was to investigate the feasibility and preliminary results of a brief, intensive group-based treatment. Tackle your Tics is a 4-day intensive and comprehensive group-based program for children and adolescents (9–17 years) with a tic disorder, consisting of exposure and response prevention (ERP) treatment and additional supporting components, such as coping strategies, relaxing activities and parent support. Assessments were performed pre- and post-treatment and at 2 months follow-up, to test outcomes on tic severity and quality of life, and explore premonitory urges, emotional and behavioral functioning and treatment satisfaction (N = 14, of whom 13 completed the treatment). Parents and children rated this treatment positive on a treatment satisfaction questionnaire. On tic severity (Yale Global Tic Severity Scale) and quality of life (Gilles de la Tourette Syndrome Quality of Life Scale for children and adolescents), improvements between pre-treatment and follow-up were found. Intensive ERP in group format is promising as a feasible treatment to improve both tic severity as well as quality of life. Larger controlled trials are needed to establish its effectiveness.

Highlights

Tourette syndrome (TS) and other Chronic tic disorders (CTD) are characterized by the presence of sudden motor movements and/or vocalizations that persist for more than a year, frequently associated with comorbid problems [1]
A comparative study of exposure and response prevention (ERP) versus habit reversal (HR) showed that both treatments resulted in significant tic reduction with no difference between the two treatment conditions [17]
From the eligible children who met the inclusion criteria, only one did not participate since the timing of the groups conflicted with school activities

Summary

Introduction

Tourette syndrome (TS) and other Chronic tic disorders (CTD) are characterized by the presence of sudden motor movements and/or vocalizations that persist for more than a year, frequently associated with comorbid problems (e.g., hyperactivity, compulsions) [1]. Tic disorders are prevalent disorders (0.77–1% for TS [2, 3]) and can have a serious, long-lasting impact on quality of life [4,5,6,7], daily functioning [5], emotional/behavioral problems [8, 9] and school results [10]. Tic severity alone does not define individual impairment or quality of life [7, 13]. Patient organizations emphasize the need for effective and available treatments, that focus on tic reduction and on enhancing quality of life [14]. Research into behavioral treatment for tics report moderate-to-high effect sizes (0.57–1.5), but tic reductions remain relatively low (on average 30% on the Yale Global Tic Severity Scale, YGTSS) [16]. A comparative study of ERP versus HR showed that both treatments resulted in significant tic reduction with no difference between the two treatment conditions [17]

Methods

Results

Conclusion