Homework adherence predicts therapeutic improvement from behavior therapy in Tourette's disorder

Joey K.Y. Essoe, Emily J. Ricketts, Kesley A. Ramsey, John Piacentini, Douglas W. Woods, Alan L. Peterson, Lawrence Scahill, Sabine Wilhelm, John T. Walkup, Joseph F. McGuire*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Behavior therapy is a first-line intervention for Tourette's Disorder (TD), and a key component is the practice of therapeutic skills between treatment visits (i.e., homework). This study examined the relationship between homework adherence during behavior therapy for TD and therapeutic outcomes, and explored baseline predictors of homework adherence during treatment. Participants included 119 individuals with TD (70 youth, 49 adults) who received behavior therapy in a clinical trial. After a baseline assessment of tic severity and clinical characteristics, participants received 8 sessions of behavior therapy. Therapists recorded homework adherence at each therapy session. After treatment, tic severity was re-assessed by independent evaluators masked to treatment condition. Greater overall homework adherence predicted tic severity reductions and treatment response across participants. Early homework adherence predicted therapeutic improvement in youth, whereas late adherence predicted improvement in adults. Baseline predictors of greater homework adherence in youth included lower hyperactivity/impulsivity and caregiver strain. Meanwhile in adults, baseline predictors of increased homework adherence included younger age, lower hyperactivity/impulsivity, obsessive-compulsive severity, anger, and greater work-related disability. Homework adherence is an integral component of behavior therapy and linked to therapeutic improvement. Strategies that improve homework adherence may optimize the efficacy of behavioral treatments and improve treatment outcomes.

Original languageEnglish (US)
Article number103844
JournalBehaviour Research and Therapy
StatePublished - May 2021


  • Behavior therapy
  • Comprehensive behavioral intervention for tics
  • Homework adherence
  • Tics

ASJC Scopus subject areas

  • Experimental and Cognitive Psychology
  • Psychiatry and Mental health
  • Clinical Psychology


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