CONTEXT: Tourette disorder is a chronic and typically impairing childhood-onset neurologic condition. Antipsychotic medications, the first-line treatments for moderate to severe tics, are often associated with adverse effects. Behavioral interventions, although promising, have not been evaluated in large-scale controlled trials. OBJECTIVE: To determine the efficacy of a comprehensive behavioral intervention for reducing tic severity in children and adolescents. DESIGN, SETTING, AND PARTICIPANTS: Randomized, observer-blind, controlled trial of 126 children recruited from December 2004 through May 2007 and aged 9 through 17 years, with impairing Tourette or chronic tic disorder as a primary diagnosis, randomly assigned to 8 sessions during 10 weeks of behavior therapy (n = 61) or a control treatment consisting of supportive therapy and education (n = 65). Responders received 3 monthly booster treatment sessions and were reassessed at 3 and 6 months following treatment. INTERVENTION: Comprehensive behavioral intervention. MAIN OUTCOME MEASURES: Yale Global Tic Severity Scale (range 0-50, score >15 indicating clinically significant tics) and Clinical Global Impressions-Improvement Scale (range 1 [very much improved] to 8 [very much worse]). RESULTS:Behavioral intervention led to a significantly greater decrease on the Yale Global Tic Severity Scale (24.7 [95% confidence interval {CI}, 23.1-26.3] to 17.1 [95% CI, 15.1-19.1]) from baseline to end point compared with the control treatment (24.6 [95% CI, 23.2-26.0] to 21.1 [95% CI, 19.2-23.0]) (P < .001; difference between groups, 4.1; 95% CI, 2.0-6.2) (effect size = 0.68). Significantly more children receiving behavioral intervention compared with those in the control group were rated as being very much improved or much improved on the Clinical Global Impressions-Improvement scale (52.5% vs 18.5%, respectively; P < .001; number needed to treat = 3). Attrition was low (12/126, or 9.5%); tic worsening was reported by 4% of children (5/126). Treatment gains were durable, with 87% of available responders to behavior therapy exhibiting continued benefit 6 months following treatment. CONCLUSION: A comprehensive behavioral intervention, compared with supportive therapy and education, resulted in greater improvement in symptom severity among children with Tourette and chronic tic disorder. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00218777.
RCT Entities:
CONTEXT: Tourette disorder is a chronic and typically impairing childhood-onset neurologic condition. Antipsychotic medications, the first-line treatments for moderate to severe tics, are often associated with adverse effects. Behavioral interventions, although promising, have not been evaluated in large-scale controlled trials. OBJECTIVE: To determine the efficacy of a comprehensive behavioral intervention for reducing tic severity in children and adolescents. DESIGN, SETTING, AND PARTICIPANTS: Randomized, observer-blind, controlled trial of 126 children recruited from December 2004 through May 2007 and aged 9 through 17 years, with impairing Tourette or chronic tic disorder as a primary diagnosis, randomly assigned to 8 sessions during 10 weeks of behavior therapy (n = 61) or a control treatment consisting of supportive therapy and education (n = 65). Responders received 3 monthly booster treatment sessions and were reassessed at 3 and 6 months following treatment. INTERVENTION: Comprehensive behavioral intervention. MAIN OUTCOME MEASURES: Yale Global Tic Severity Scale (range 0-50, score >15 indicating clinically significant tics) and Clinical Global Impressions-Improvement Scale (range 1 [very much improved] to 8 [very much worse]). RESULTS: Behavioral intervention led to a significantly greater decrease on the Yale Global Tic Severity Scale (24.7 [95% confidence interval {CI}, 23.1-26.3] to 17.1 [95% CI, 15.1-19.1]) from baseline to end point compared with the control treatment (24.6 [95% CI, 23.2-26.0] to 21.1 [95% CI, 19.2-23.0]) (P < .001; difference between groups, 4.1; 95% CI, 2.0-6.2) (effect size = 0.68). Significantly more children receiving behavioral intervention compared with those in the control group were rated as being very much improved or much improved on the Clinical Global Impressions-Improvement scale (52.5% vs 18.5%, respectively; P < .001; number needed to treat = 3). Attrition was low (12/126, or 9.5%); tic worsening was reported by 4% of children (5/126). Treatment gains were durable, with 87% of available responders to behavior therapy exhibiting continued benefit 6 months following treatment. CONCLUSION: A comprehensive behavioral intervention, compared with supportive therapy and education, resulted in greater improvement in symptom severity among children with Tourette and chronic tic disorder. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00218777.
Authors: Gary R Gaffney; Paul J Perry; Brian C Lund; Kristine A Bever-Stille; Stephan Arndt; Samuel Kuperman Journal: J Am Acad Child Adolesc Psychiatry Date: 2002-03 Impact factor: 8.829
Authors: F R Sallee; R Kurlan; C G Goetz; H Singer; L Scahill; G Law; V M Dittman; P B Chappell Journal: J Am Acad Child Adolesc Psychiatry Date: 2000-03 Impact factor: 8.829
Authors: J M Swanson; H C Kraemer; S P Hinshaw; L E Arnold; C K Conners; H B Abikoff; W Clevenger; M Davies; G R Elliott; L L Greenhill; L Hechtman; B Hoza; P S Jensen; J S March; J H Newcorn; E B Owens; W E Pelham; E Schiller; J B Severe; S Simpson; B Vitiello; K Wells; T Wigal; M Wu Journal: J Am Acad Child Adolesc Psychiatry Date: 2001-02 Impact factor: 8.829
Authors: John T Walkup; Anne Marie Albano; John Piacentini; Boris Birmaher; Scott N Compton; Joel T Sherrill; Golda S Ginsburg; Moira A Rynn; James McCracken; Bruce Waslick; Satish Iyengar; John S March; Philip C Kendall Journal: N Engl J Med Date: 2008-10-30 Impact factor: 91.245
Authors: Jessica A Church; Damien A Fair; Nico U F Dosenbach; Alexander L Cohen; Francis M Miezin; Steven E Petersen; Bradley L Schlaggar Journal: Brain Date: 2008-10-24 Impact factor: 13.501
Authors: Eric A Storch; Alessandro S De Nadai; Adam B Lewin; Joseph F McGuire; Anna M Jones; P Jane Mutch; R Doug Shytle; Tanya K Murphy Journal: J Child Adolesc Psychopharmacol Date: 2011-11-09 Impact factor: 2.576
Authors: Joseph F McGuire; Brittany B Kugler; Jennifer M Park; Betty Horng; Adam B Lewin; Tanya K Murphy; Eric A Storch Journal: Child Psychiatry Hum Dev Date: 2012-12
Authors: Michael B Himle; Matthew R Capriotti; Loran P Hayes; Krishnapriya Ramanujam; Lawrence Scahill; Denis G Sukhodolsky; Sabine Wilhelm; Thilo Deckersbach; Alan L Peterson; Matt W Specht; John T Walkup; Susanna Chang; John Piacentini Journal: Behav Modif Date: 2014-04-28
Authors: Hilary Weingarden; Lawrence Scahill; Susanne Hoeppner; Alan L Peterson; Douglas W Woods; John T Walkup; John Piacentini; Sabine Wilhelm Journal: Compr Psychiatry Date: 2018-04-23 Impact factor: 3.735
Authors: Mariela Rance; Christopher Walsh; Denis G Sukhodolsky; Brian Pittman; Maolin Qiu; Stephen A Kichuk; Suzanne Wasylink; William N Koller; Michael Bloch; Patricia Gruner; Dustin Scheinost; Christopher Pittenger; Michelle Hampson Journal: Neuroimage Date: 2018-05-02 Impact factor: 6.556
Authors: Hannah Weisman; Imraan A Qureshi; James F Leckman; Lawrence Scahill; Michael H Bloch Journal: Neurosci Biobehav Rev Date: 2012-10-23 Impact factor: 8.989