Moderators and predictors of response to behavior therapy for tics in Tourette syndrome

Denis G. Sukhodolsky*, Douglas W. Woods, John Piacentini, Sabine Wilhelm, Alan L. Peterson, Lily Katsovich, James Dziura, John T. Walkup, Lawrence Scahill

*Corresponding author for this work

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objective: To examine moderators and predictors of response to behavior therapy for tics in children and adults with Tourette syndrome and chronic tic disorders. Methods: Data from 2 10-week, multisite studies (1 in children and 1 in adults; total n 5 248) comparing comprehensive behavioral intervention for tics (CBIT) to psychoeducation and supportive therapy (PST) were combined for moderator analyses. Participants (177 male, 71 female) had a mean age of 21.5 6 13.9 years (range 9-69). Demographic and clinical characteristics, baseline tic-suppressing medication, and co-occurring psychiatric disorders were tested as potential moderators for CBIT vs PST or predictors of outcome regardless of treatment assignment. Main outcomes measures were the Yale Global Tic Severity Scale Total Tic score and the Clinical Global Impression-Improvement score assessed by masked evaluators. Results: The presence of tic medication significantly moderated response to CBIT vs PST (p 5 0.01). Participants showed tic reduction after CBIT regardless of tic medication status, but only participants receiving tic medication showed reduction of tics after PST. Co-occurring psychiatric disorders, age, sex, family functioning, tic characteristics, and treatment expectancy did not moderate response. Across both treatments, greater tic severity (p 5 0.005) and positive participant expectancy (p 5 0.01) predicted greater tic improvement. Anxiety disorders (p 5 0.042) and premonitory urge severity (p 5 0.005) predicted lower tic reduction. Conclusions: Presence of co-occurring attention-deficit/hyperactivity disorder, obsessivecompulsive disorder, or anxiety disorders did not moderate response to CBIT. Although participants on tic medication showed improvement after CBIT, the difference between CBIT and PST was greater for participants who were not on tic-suppressing medication. ClinicalTrials.gov identifiers: The child and adult CBIT studies are listed on clinical trials.gov (NCT00218777 and NCT00231985, respectively). Classification of evidence: This study provides Class I evidence that CBIT is effective in reducing tic severity across subgroups of patients with chronic tic disorders, although the difference between treatments was smaller for participants on tic-suppressing medications, suggesting reduced efficacy in this subgroup.

Original languageEnglish (US)
Pages (from-to)1029-1036
Number of pages8
JournalNeurology
Volume88
Issue number11
DOIs
StatePublished - Mar 14 2017

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Tics
Tourette Syndrome
Behavior Therapy
Tic Disorders
Therapeutics
Anxiety Disorders
Psychiatry

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Sukhodolsky, D. G., Woods, D. W., Piacentini, J., Wilhelm, S., Peterson, A. L., Katsovich, L., ... Scahill, L. (2017). Moderators and predictors of response to behavior therapy for tics in Tourette syndrome. Neurology, 88(11), 1029-1036. https://doi.org/10.1212/WNL.0000000000003710
Sukhodolsky, Denis G. ; Woods, Douglas W. ; Piacentini, John ; Wilhelm, Sabine ; Peterson, Alan L. ; Katsovich, Lily ; Dziura, James ; Walkup, John T. ; Scahill, Lawrence. / Moderators and predictors of response to behavior therapy for tics in Tourette syndrome. In: Neurology. 2017 ; Vol. 88, No. 11. pp. 1029-1036.
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Sukhodolsky, DG, Woods, DW, Piacentini, J, Wilhelm, S, Peterson, AL, Katsovich, L, Dziura, J, Walkup, JT & Scahill, L 2017, 'Moderators and predictors of response to behavior therapy for tics in Tourette syndrome', Neurology, vol. 88, no. 11, pp. 1029-1036. https://doi.org/10.1212/WNL.0000000000003710

Moderators and predictors of response to behavior therapy for tics in Tourette syndrome. / Sukhodolsky, Denis G.; Woods, Douglas W.; Piacentini, John; Wilhelm, Sabine; Peterson, Alan L.; Katsovich, Lily; Dziura, James; Walkup, John T.; Scahill, Lawrence.

In: Neurology, Vol. 88, No. 11, 14.03.2017, p. 1029-1036.

Research output: Contribution to journalArticle

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AU - Sukhodolsky, Denis G.

AU - Woods, Douglas W.

AU - Piacentini, John

AU - Wilhelm, Sabine

AU - Peterson, Alan L.

AU - Katsovich, Lily

AU - Dziura, James

AU - Walkup, John T.

AU - Scahill, Lawrence

PY - 2017/3/14

Y1 - 2017/3/14

N2 - Objective: To examine moderators and predictors of response to behavior therapy for tics in children and adults with Tourette syndrome and chronic tic disorders. Methods: Data from 2 10-week, multisite studies (1 in children and 1 in adults; total n 5 248) comparing comprehensive behavioral intervention for tics (CBIT) to psychoeducation and supportive therapy (PST) were combined for moderator analyses. Participants (177 male, 71 female) had a mean age of 21.5 6 13.9 years (range 9-69). Demographic and clinical characteristics, baseline tic-suppressing medication, and co-occurring psychiatric disorders were tested as potential moderators for CBIT vs PST or predictors of outcome regardless of treatment assignment. Main outcomes measures were the Yale Global Tic Severity Scale Total Tic score and the Clinical Global Impression-Improvement score assessed by masked evaluators. Results: The presence of tic medication significantly moderated response to CBIT vs PST (p 5 0.01). Participants showed tic reduction after CBIT regardless of tic medication status, but only participants receiving tic medication showed reduction of tics after PST. Co-occurring psychiatric disorders, age, sex, family functioning, tic characteristics, and treatment expectancy did not moderate response. Across both treatments, greater tic severity (p 5 0.005) and positive participant expectancy (p 5 0.01) predicted greater tic improvement. Anxiety disorders (p 5 0.042) and premonitory urge severity (p 5 0.005) predicted lower tic reduction. Conclusions: Presence of co-occurring attention-deficit/hyperactivity disorder, obsessivecompulsive disorder, or anxiety disorders did not moderate response to CBIT. Although participants on tic medication showed improvement after CBIT, the difference between CBIT and PST was greater for participants who were not on tic-suppressing medication. ClinicalTrials.gov identifiers: The child and adult CBIT studies are listed on clinical trials.gov (NCT00218777 and NCT00231985, respectively). Classification of evidence: This study provides Class I evidence that CBIT is effective in reducing tic severity across subgroups of patients with chronic tic disorders, although the difference between treatments was smaller for participants on tic-suppressing medications, suggesting reduced efficacy in this subgroup.

AB - Objective: To examine moderators and predictors of response to behavior therapy for tics in children and adults with Tourette syndrome and chronic tic disorders. Methods: Data from 2 10-week, multisite studies (1 in children and 1 in adults; total n 5 248) comparing comprehensive behavioral intervention for tics (CBIT) to psychoeducation and supportive therapy (PST) were combined for moderator analyses. Participants (177 male, 71 female) had a mean age of 21.5 6 13.9 years (range 9-69). Demographic and clinical characteristics, baseline tic-suppressing medication, and co-occurring psychiatric disorders were tested as potential moderators for CBIT vs PST or predictors of outcome regardless of treatment assignment. Main outcomes measures were the Yale Global Tic Severity Scale Total Tic score and the Clinical Global Impression-Improvement score assessed by masked evaluators. Results: The presence of tic medication significantly moderated response to CBIT vs PST (p 5 0.01). Participants showed tic reduction after CBIT regardless of tic medication status, but only participants receiving tic medication showed reduction of tics after PST. Co-occurring psychiatric disorders, age, sex, family functioning, tic characteristics, and treatment expectancy did not moderate response. Across both treatments, greater tic severity (p 5 0.005) and positive participant expectancy (p 5 0.01) predicted greater tic improvement. Anxiety disorders (p 5 0.042) and premonitory urge severity (p 5 0.005) predicted lower tic reduction. Conclusions: Presence of co-occurring attention-deficit/hyperactivity disorder, obsessivecompulsive disorder, or anxiety disorders did not moderate response to CBIT. Although participants on tic medication showed improvement after CBIT, the difference between CBIT and PST was greater for participants who were not on tic-suppressing medication. ClinicalTrials.gov identifiers: The child and adult CBIT studies are listed on clinical trials.gov (NCT00218777 and NCT00231985, respectively). Classification of evidence: This study provides Class I evidence that CBIT is effective in reducing tic severity across subgroups of patients with chronic tic disorders, although the difference between treatments was smaller for participants on tic-suppressing medications, suggesting reduced efficacy in this subgroup.

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Sukhodolsky DG, Woods DW, Piacentini J, Wilhelm S, Peterson AL, Katsovich L et al. Moderators and predictors of response to behavior therapy for tics in Tourette syndrome. Neurology. 2017 Mar 14;88(11):1029-1036. https://doi.org/10.1212/WNL.0000000000003710