Behavior therapy for children with tourette disorder

A randomized controlled trial

John Piacentini*, Douglas W. Woods, Lawrence Scahill, Sabine Wilhelm, Alan L. Peterson, Susanna Chang, Golda S. Ginsburg, Thilo Deckersbach, James Dziura, Sue Levi-Pearl, John T. Walkup

*Corresponding author for this work

Research output: Contribution to journalArticle

323 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1929-1937
Number of pages9
JournalJAMA - Journal of the American Medical Association
Volume303
Issue number19
DOIs
StatePublished - May 19 2010

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Tourette Syndrome
Behavior Therapy
Tics
Randomized Controlled Trials
Confidence Intervals
Tic Disorders
Therapeutics
Education
Numbers Needed To Treat
Nervous System
Antipsychotic Agents
Outcome Assessment (Health Care)
Control Groups

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Piacentini, John ; Woods, Douglas W. ; Scahill, Lawrence ; Wilhelm, Sabine ; Peterson, Alan L. ; Chang, Susanna ; Ginsburg, Golda S. ; Deckersbach, Thilo ; Dziura, James ; Levi-Pearl, Sue ; Walkup, John T. / Behavior therapy for children with tourette disorder : A randomized controlled trial. In: JAMA - Journal of the American Medical Association. 2010 ; Vol. 303, No. 19. pp. 1929-1937.
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title = "Behavior therapy for children with tourette disorder: A randomized controlled trial",
abstract = "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.",
author = "John Piacentini and Woods, {Douglas W.} and Lawrence Scahill and Sabine Wilhelm and Peterson, {Alan L.} and Susanna Chang and Ginsburg, {Golda S.} and Thilo Deckersbach and James Dziura and Sue Levi-Pearl and Walkup, {John T.}",
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Piacentini, J, Woods, DW, Scahill, L, Wilhelm, S, Peterson, AL, Chang, S, Ginsburg, GS, Deckersbach, T, Dziura, J, Levi-Pearl, S & Walkup, JT 2010, 'Behavior therapy for children with tourette disorder: A randomized controlled trial', JAMA - Journal of the American Medical Association, vol. 303, no. 19, pp. 1929-1937. https://doi.org/10.1001/jama.2010.607

Behavior therapy for children with tourette disorder : A randomized controlled trial. / Piacentini, John; Woods, Douglas W.; Scahill, Lawrence; Wilhelm, Sabine; Peterson, Alan L.; Chang, Susanna; Ginsburg, Golda S.; Deckersbach, Thilo; Dziura, James; Levi-Pearl, Sue; Walkup, John T.

In: JAMA - Journal of the American Medical Association, Vol. 303, No. 19, 19.05.2010, p. 1929-1937.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Behavior therapy for children with tourette disorder

T2 - A randomized controlled trial

AU - Piacentini, John

AU - Woods, Douglas W.

AU - Scahill, Lawrence

AU - Wilhelm, Sabine

AU - Peterson, Alan L.

AU - Chang, Susanna

AU - Ginsburg, Golda S.

AU - Deckersbach, Thilo

AU - Dziura, James

AU - Levi-Pearl, Sue

AU - Walkup, John T.

PY - 2010/5/19

Y1 - 2010/5/19

N2 - 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.

AB - 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.

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