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Original Contribution
May 19, 2010

Behavior Therapy for Children With Tourette Disorder: A Randomized Controlled Trial

Author Affiliations

Author Affiliations: University of California at Los Angeles (Drs Piacentini and Chang); University of Wisconsin–Milwaukee (Dr Woods); Yale Child Study Center, New Haven, Connecticut (Drs Scahill and Dziura); Massachusetts General Hospital/Harvard Medical School, Cambridge (Drs Wilhelm and Deckersbach); University of Texas Health Science Center at San Antonio (Dr Peterson); Johns Hopkins Medical Institutions, Baltimore, Maryland (Drs Ginsburg and Walkup); and the Tourette Syndrome Association, Bayside, New York (Ms Levi-Pearl). Dr Walkup is now with Weill Cornell Medical College, New York, New York.

JAMA. 2010;303(19):1929-1937. doi:10.1001/jama.2010.607
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

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