Top

Published in:

Open Access 01-03-2021 | Tic Disorder | Original Contribution

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

Authors: A. P. Heijerman-Holtgrefe, C. W. J. Verdellen, J. M. T. M. van de Griendt, L. P. L. Beljaars, K. J. Kan, D. Cath, P. J. Hoekstra, C. Huyser, E. M. W. J. Utens

Published in: European Child & Adolescent Psychiatry | Issue 3/2021

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.

Available only for authorised users

Hirschtritt ME, Lee PC, Pauls DL et al (2015) Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in tourette syndrome. JAMA Psychiatry 72:325–333. https://doi.org/10.1001/jamapsychiatry.2014.2650CrossRefPubMedPubMedCentral

Knight T, Steeves T, Day L et al (2012) Prevalence of tic disorders: a systematic review and meta-analysis. Pediatr Neurol 47:77–90. https://doi.org/10.1016/J.PEDIATRNEUROL.2012.05.002CrossRefPubMed

Robertson MM (2008) The prevalence and epidemiology of Gilles de la Tourette syndrome: part 1: the epidemiological and prevalence studies. J Psychosom Res 65:461–472. https://doi.org/10.1016/J.JPSYCHORES.2008.03.006CrossRefPubMed

Conelea CA, Woods DW, Zinner SH et al (2013) The impact of Tourette syndrome in adults: results from the Tourette syndrome impact survey. Community Ment Health J 49:110–120. https://doi.org/10.1007/s10597-011-9465-yCrossRefPubMed

Storch EA, Lack CW, Simons LE et al (2007) A measure of functional impairment in youth with Tourette’s syndrome. J Pediatr Psychol 32:950–959. https://doi.org/10.1093/jpepsy/jsm034CrossRefPubMed

Cutler D, Murphy T, Gilmour J, Heyman I (2009) The quality of life of young people with Tourette syndrome. Child Care Health Dev 35:496–504. https://doi.org/10.1111/j.1365-2214.2009.00983.xCrossRefPubMed

McGuire JF, Arnold E, Park JM et al (2015) Living with tics: reduced impairment and improved quality of life for youth with chronic tic disorders. Psychiatry Res 225:571–579. https://doi.org/10.1016/j.psychres.2014.11.045CrossRefPubMed

Kraft JT, Dalsgaard S, Obel C et al (2012) Prevalence and clinical correlates of tic disorders in a community sample of school-age children. Eur Child Adolesc Psychiatry 21:5–13. https://doi.org/10.1007/s00787-011-0223-zCrossRefPubMed

McGuire JF, Hanks C, Lewin AB et al (2013) Social deficits in children with chronic tic disorders: phenomenology, clinical correlates and quality of life. Compr Psychiatry 54:1023–1031. https://doi.org/10.1016/j.comppsych.2013.04.009CrossRefPubMed

10.

Pérez-Vigil A, De La Cruz LF, Brander G et al (2018) Association of Tourette syndrome and chronic tic disorders with objective indicators of educational attainment: a population-based sibling comparison study. JAMA Neurol 75:1098–1105. https://doi.org/10.1001/jamaneurol.2018.1194CrossRefPubMedPubMedCentral

11.

Cath DC, Hedderly T, Ludolph AG et al (2011) European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment. Eur Child Adolesc Psychiatry 20:155–171. https://doi.org/10.1007/s00787-011-0164-6CrossRefPubMedPubMedCentral

12.

Fernández de la Cruz L, Rydell M, Runeson B et al (2017) Suicide in Tourette’s and chronic tic disorders. Biol Psychiatry 82:111–118. https://doi.org/10.1016/J.BIOPSYCH.2016.08.023CrossRefPubMed

13.

Eddy CM, Cavanna AE, Gulisano M et al (2011) Clinical correlates of quality of life in Tourette syndrome. Mov Disord 26:735–738. https://doi.org/10.1002/mds.23434CrossRefPubMed

14.

European Tourette Syndrome Research Survey 2017–18. https://www.tourettes-action.org.uk/news-294-european-tourette-syndrome-research-survey-2017-18.html. Accessed 28 Jul 2019

15.

Verdellen C, van de Griendt J, Hartmann A, Murphy T (2011) European clinical guidelines for Tourette Syndrome and other tic disorders. Part III: behavioural and psychosocial interventions. Eur Child Adolesc Psychiatry 20:197–207. https://doi.org/10.1007/s00787-011-0167-3CrossRefPubMed

16.

McGuire JF, Piacentini J, Brennan EA et al (2014) A meta-analysis of behavior therapy for Tourette Syndrome. J Psychiatr Res 50:106–112. https://doi.org/10.1016/j.jpsychires.2013.12.009CrossRefPubMed

17.

Verdellen CWJ, Keijsers GPJ, Cath DC, Hoogduin CAL (2004) Exposure with response prevention versus habit reversal in Tourettes’s syndrome: a controlled study. Behav Res Ther 42:501–511. https://doi.org/10.1016/S0005-7967(03)00154-2CrossRefPubMed

18.

Van de Griendt JMTM, Verdellen CWJ, van Dijk MK, Verbraak MJPM (2013) Behavioural treatment of tics: habit reversal and exposure with response prevention. Neurosci Biobehav Rev 37:1172–1177CrossRef

19.

Woods DW, Conelea CA, Walther MR (2007) Barriers to dissemination: exploring the criticisms of behavior therapy for tics. Clin Psychol Sci Pract 14:279–282. https://doi.org/10.1111/j.1468-2850.2007.00088.xCrossRef

20.

Blount TH, Raj JJ, Peterson AL (2018) Intensive outpatient comprehensive behavioral intervention for tics: a clinical replication series. Cogn Behav Pract 25:156–167. https://doi.org/10.1016/j.cbpra.2017.02.001CrossRef

21.

Taylor C, Greenhalgh J, Stark D et al (2017) C2.1 Delivery of behavioural interventions for tics in an intensive outpatient format followed by remote delivery: a UK paediatric case series. Arch Dis Child 102:A11–A11. https://doi.org/10.1136/archdischild-2017-084620.29CrossRef

22.

Storch EA, Geffken GR, Merlo LJ et al (2007) Family-based cognitive-behavioral therapy for pediatric obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 46:469–478. https://doi.org/10.1097/chi.0b013e31803062e7CrossRefPubMed

23.

Whiteside SP, Jacobsen AB (2010) An uncontrolled examination of a 5-day intensive treatment for pediatric OCD. Behav Ther 41:414–422. https://doi.org/10.1016/j.beth.2009.11.003CrossRefPubMed

24.

Whiteside SPH, Dammann JE, Tiede MS et al (2018) Increasing availability of exposure therapy through intensive group treatment for childhood anxiety and OCD. Behav Modif 42:707–728. https://doi.org/10.1177/0145445517730831CrossRefPubMed

25.

Hendriks L, de Kleine RA, Heyvaert M et al (2017) Intensive prolonged exposure treatment for adolescent complex posttraumatic stress disorder: a single-trial design. J Child Psychol Psychiatry Allied Discip 58:1229–1238. https://doi.org/10.1111/jcpp.12756CrossRef

26.

Öst L-G, Ollendick TH (2017) Brief, intensive and concentrated cognitive behavioral treatments for anxiety disorders in children: a systematic review and meta-analysis. Behav Res Ther 97:134–145. https://doi.org/10.1016/j.brat.2017.07.008CrossRefPubMed

27.

Yates R, Edwards K, King J et al (2016) Habit reversal training and educational group treatments for children with tourette syndrome: a preliminary randomised controlled trial. Behav Res Ther 80:43–50. https://doi.org/10.1016/J.BRAT.2016.03.003CrossRefPubMed

28.

Dabrowski J, King J, Edwards K, et al (2017) 81 Group interventions for children with tourette syndrome: a 12 month follow up study of a randomised controlled trial comparing comprehensive behavioural intervention and psycho-education. In: Poster presentation abstracts. BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health, p A25.3–A26

29.

Himle JA, Fischer DJ, Van Etten ML et al (2003) Group behavioral therapy for adolescents with tic-related and non-tic-related obsessive-compulsive disorder. Depress Anxiety. https://doi.org/10.1002/da.10088CrossRefPubMed

30.

American Psychiatric Association (2013) DSM-V diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, ArlingtonCrossRef

31.

Verdellen C, Van de Griendt J, Kriens S, Van Oostrum I (2011) Tics—therapist manual and workbook for children. Uitgeverij Boom, Amsterdam

32.

Hoogduin K, Verdellen C, Cath D (1997) Exposure and response prevention in the treatment of Gilles de la Tourette’s syndrome: four case studies. Clin Psychol Psychother 4:125–135. https://doi.org/10.1002/(SICI)1099-0879(199706)4:2%3c125:AID-CPP125%3e3.0.CO;2-ZCrossRef

33.

van de Griendt J, Verdellen C, Van Liempt T (2016) BT-Coach—behaviour therapy for tics and Tourette Syndrome. https://www.bt-tics.com/bt-coach. Accessed 30 Oct 2019

34.

Silverman WK, Alban AM (2001) ADIS-C | anxiety disorders interview schedule. Pearson, Amsterdam

35.

Leckman JF, Riddle MA, Hardin MT et al (1989) The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 28:566–573. https://doi.org/10.1097/00004583-198907000-00015CrossRefPubMed

36.

Jeon S, Walkup JT, Woods DW et al (2013) Detecting a clinically meaningful change in tic severity in Tourette syndrome: a comparison of three methods. Contemp Clin Trials 36:414–420. https://doi.org/10.1016/j.cct.2013.08.012CrossRefPubMedPubMedCentral

37.

Cavanna AE, Luoni C, Selvini C et al (2013) The Gilles de la Tourette Syndrome-Quality of Life Scale for children and adolescents (C&A-GTS-QOL): development and validation of the Italian version. Behav Neurol 27:95–103. https://doi.org/10.3233/BEN-120274CrossRefPubMedPubMedCentral

38.

Woods DW, Piacentini J, Himle MB, Chang S (2005) Premonitory Urge for Tics Scale (PUTS): Initial psychometric results and examination of the premonitory urge phenomenon in youths with tic disorders. J Dev Behav Pediatr 26:397–403. https://doi.org/10.1097/00004703-200512000-00001CrossRefPubMed

39.

Achenbach T, Edlebrock C (1993) Manual for the child behavior checklist and revised child behavior profile. Burlingt Univ, Vermont

40.

Verhulst FC, Van der Ende J (2013) Handleiding ASEBA-Vragenlijsten voor leeftijden 6 t/m 18 jaar: CBCL/6-18. YSR en TRF ASEBA, Rotterdam

41.

Nissen JB, Kaergaard M, Laursen L et al (2019) Combined habit reversal training and exposure response prevention in a group setting compared to individual training: a randomized controlled clinical trial. Eur Child Adolesc Psychiatry 28:57–68. https://doi.org/10.1007/s00787-018-1187-zCrossRefPubMed

42.

Capriotti MR, Woods DW (2013) Cognitive-behavioral treatment for tics. In: Martino D, Leckman JF (eds) Tourette syndrome. Oxford University Press, Oxford, pp 503–523CrossRef

43.

Craske MG, Treanor M, Conway CC et al (2014) Maximizing exposure therapy: an inhibitory learning approach. Behav Res Ther 58:10–23. https://doi.org/10.1016/j.brat.2014.04.006CrossRefPubMedPubMedCentral

44.

Blount TH, Lockhart A-LT, Garcia RV et al (2014) Intensive outpatient comprehensive behavioral intervention for tics: a case series. World J Clin cases 2:569–577. https://doi.org/10.12998/wjcc.v2.i10.569CrossRefPubMedPubMedCentral

45.

Dabrowski J, King J, Edwards K et al (2018) The long-term effects of group-based psychological interventions for children with tourette syndrome: a randomized controlled trial. Behav Ther 49:331–343. https://doi.org/10.1016/j.beth.2017.10.005CrossRefPubMed

46.

Viefhaus P, Feldhausen M, Görtz-Dorten A et al (2019) A new treatment for children with chronic tic disorders—resource activation. Psychiatry Res. https://doi.org/10.1016/j.psychres.2019.01.083CrossRefPubMed

Title: Tackle your Tics: pilot findings of a brief, intensive group-based exposure therapy program for children with tic disorders
Authors: A. P. Heijerman-Holtgrefe
C. W. J. Verdellen
J. M. T. M. van de Griendt
L. P. L. Beljaars
K. J. Kan
D. Cath
P. J. Hoekstra
C. Huyser
E. M. W. J. Utens
Publication date: 01-03-2021
Publisher: Springer Berlin Heidelberg
Keywords: Tic Disorder
Tourette Syndrome
Tourette Syndrome
Tic Disorder
Published in: European Child & Adolescent Psychiatry / Issue 3/2021
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI: https://doi.org/10.1007/s00787-020-01532-5

At a glance: The STEP trials

Springer Medicine

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

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2021

The developmental origins of hoarding disorder in adolescence: a longitudinal clinical interview study following an epidemiological survey

Sustained remission of child depression despite drift in parent emotion management skills 18 weeks following Parent Child Interaction Therapy: emotion development

What happens to young adults who have engaged in self-injurious behavior as adolescents? A 10-year follow-up

Mitigating adolescent social anxiety symptoms: the effects of social support and social self-efficacy in findings from the Young-HUNT 3 study

Prenatal and perinatal factors associated with ADHD risk in schoolchildren: EPINED epidemiological study

Need for psychiatric phenotyping in patients with rare genetic disorders