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Group behavioral interventions for tics and comorbid symptoms in children with chronic tic disorders

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Abstract

Exposure and Response Prevention (ERP), Habit Reversal Training (HRT) and Comprehensive Behavioral Intervention for Tics (CBIT) are effective in reducing tic severity. ERP and HRT have recently gained primary support in a group setting, while CBIT has not been examined similarly. We compared the efficacy of group-CBIT to group-Educational Intervention for Tics (group-EIT) for tics and comorbid symptoms. Children with Tourette Syndrome (TS) or Chronic Tic Disorder (CTD) were randomized to group-CBIT or group-EIT. Tics and comorbid symptoms were assessed in forty-six children pre- and postintervention, and 3-month later. Yale Global Tic Severity Scale (YGTSS) Motor tic severity decreased following both interventions, and was maintained at follow-up for group-CBIT only. The Parent Tic Questionnaire (PTQ) showed significant decrease in total and motor tic severity following group-CBIT only, a gain maintained three months later. YGTSS impairment score decreased following both interventions and was maintained at follow-up. YGTSS vocal tic severity score increased following both interventions, and then decreased significantly at follow up. Co-morbid symptoms including anxiety, behavioral problems, and aggressive behavior decreased following both interventions. Children with behavioral problems benefitted less while children with higher intellectual ability benefit more from intervention. Both group interventions showed efficacy in reducing tic impairment and comorbid symptoms. Group-CBIT was superior to group-EIT in reducing motor tic severity at 3-month follow-up, showing an advantage for tic-focused treatment. Based on the PTQ, group-CBIT was superior to group-EIT in reducing motor, vocal, and total tic scores, a gain maintained three months later. Clinical trial registry information-Group Intervention for Children with Chronic Tics Syndrome: CBIT vs Psychoeducational Intervention URL: http://clinicaltrials.gov, Identifier: NCT02407951, http://www.controlled-trials.com).

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Acknowledgement

We thank the children and their families who made this study possible. A special thanks to the Tourette Syndrome Association in Israel (TSAI) that provided grant management and recruitment support.

Funding

This work was supported partially by funds received from the Tourette Syndrome Association in Israel (TSAI).

Author information

Author notes

  1. Sharon Zimmerman-Brener and Tammy Pilowsky-Peleg contributed equally to this work.

Authors and Affiliations

  1. Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel

    Sharon Zimmerman-Brenner, Lilach Rachamim & Amit Ben-Zvi

  2. Tourette Syndrome Association in Israel (TSAI), Tel Aviv-Yaffo, Israel

    Sharon Zimmerman-Brenner

  3. Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel

    Tammy Pilowsky-Peleg & Noa Gur

  4. Neuropsychology Unit, Schneider Children’s Medical Center of Israel, Petach Tikvah, Israel

    Tammy Pilowsky-Peleg & Noa Gur

  5. Cohen & Harris Resilience Center, Association for Children at Risk, Tel Aviv-Yaffo, Israel

    Lilach Rachamim

  6. Tourette Syndrome Clinic, Great Ormond Street Hospital for Children, NHS Foundation Trust London, London, UK

    Tara Murphy

  7. Pediatric Neurology Unit, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv-Yaffo, Israel

    Aviva Fattal-Valevski & Michael Rotstein

  8. Pediatric Movement Disorders Clinic, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv-Yaffo, Israel

    Michael Rotstein

  9. Pediatric Movement Disorders Service, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv-Yaffo, Israel

    Michael Rotstein

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  1. Sharon Zimmerman-Brenner
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  2. Tammy Pilowsky-Peleg
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  4. Amit Ben-Zvi
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Contributions

SZ-B: Research project: Conception, Organization, Execution; Statistical Analysis: Design, Review and Critique; Manuscript: Co-writing of the first draft, Review and Critique. TPP: Research project: Conception, Organization; Statistical Analysis: Design, Review and Critique; Manuscript: Co-writing of the first draft, Review and Critique. LR: Research project: Conception; Statistical Analysis, Co-writing of the first draft, Review and Critique; Manuscript: Review and Critique. AB-Z: Research project: Organization, Execution. NG: Research project: Organization, Execution; Statistical Analysis: Design, Execution, Review and Critique. TM: Research project: Conception; Manuscript: Review and Critique. AF-V: Research project: Organization; Manuscript: Review and Critique. MR: Research project: Conception, Organization, Execution; Statistical Analysis: Design, Review and Critique; Manuscript: Co-writing of the first draft, Review and Critique.

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Correspondence to Michael Rotstein.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Committee at Tel Aviv Sourasky Medical Center and with the 1975 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all the patients included in the study prior to enrollment.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Committee at Tel Aviv Sourasky Medical Center and with the 1975 Helsinki Declaration and its later amendments or comparable ethical standards (IRB# 0437–14-TLV).

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Informed consent was obtained from all the patients included in the study prior to enrollment.

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Zimmerman-Brenner, S., Pilowsky-Peleg, T., Rachamim, L. et al. Group behavioral interventions for tics and comorbid symptoms in children with chronic tic disorders. Eur Child Adolesc Psychiatry 31, 637–648 (2022). https://doi.org/10.1007/s00787-020-01702-5

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