Internet-based Behaviour Therapy for Tourette's Disorder and Chronic Tic Disorder
Condition: Tourette's Disorder; Persistent (Chronic) Motor or Vocal Tic Disorder
MeSH terms: Tics; Tic Disorders; Tourette Syndrome
Study type: Interventional

Summary: 
      The purpose of this study is to evaluate the feasibility and acceptability of two different
      modalities of therapist-guided Internet-delivered behaviour therapy (IBT) for children and
      adolescents (7-17 years) with Tourette's Disorder (TD) or Persistent (Chronic) Motor or Vocal
      Tic Disorder (PTD).
    

Detailed description: 
      The primary objective of this study is to evaluate the feasibility and acceptability of two
      different modalities of therapist-guided Internet-delivered behaviour therapy (IBT) for
      children and adolescents (7-17 years) with Tourette's Disorder (TD) or Persistent (Chronic)
      Motor or Vocal Tic Disorder (PTD). The two modalities of IBT are habit reversal training
      (HRT) and exposure and response prevention (ERP). Secondary objectives are to evaluate
      whether IBT can decrease tic frequency and tic-related impairment, and, as both HRT and ERP
      have been proven efficacious in treating TD/PTD face-to-face, are any of the two treatments
      better suited to be delivered via the internet?

      The design of the study is a randomized-controlled trial with 20 participants. Participants
      will be stratified by ADHD/ADD status.

      The treatment duration is 10 weeks.

      Feasibility and acceptability will be assumed if:

        -  The two treatments can be successfully adapted to a therapist guided internet-delivered
           format (technical feasibility)

        -  Patients/parents are willing to try the offered treatment modalities

        -  Participants complete the active parts of the treatment

        -  Referrers are open to the idea of internet-delivered treatment for TD or PTD

        -  We can recruit sufficient numbers of patients for a fully powered efficacy trial

      Regarding the secondary objective, the primary outcome is tic severity measured by the Yale
      Global Tic Severity Scale (YGTSS). Participants will be assessed directly after treatment
      (post), and at 3, 6 and 12 months after treatment. Assessments at post-treatment and 3 month
      follow up will be performed by assessors blinded to the treatment condition. After 3 months,
      we will naturalistically follow up patients up to 12 months after the end of treatment. Data
      collection will finish 12 months after treatment.
    

Intervention name(s): Internet-delivered habit reversal training; Internet-delivered exposure and response prevention
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The I-HRT group will receive a 10-week therapist-guided, parent-assisted, Internet-delivered behavioural treatment. The treatment is based on existing literature on habit reversal training (i.e. Woods, D.W. (2008). Managing Tourette syndrome: A behavioral intervention for children and adults therapist guide. OUP, USA.) with added interactive features as videos and illustrations. In short, the participants practice to become more aware of their tics and inhibit them by performing competing responses (movements). The treatment is therapist guided: the participants have regular (up to 5 days a week) contact with a personally assigned therapist via written text in the platform and occasionally via the telephone. The children and parents have separate logins and access partly different content.; The I-ERP group receives a 10-week therapist-guided, parent-assisted, Internet-delivered behavioural treatment. The treatment is based on existing literature on exposure and response prevention (i.e. Verdellen, C. et al. (2011). Tics: Therapist manual & workbook for children. Boom, Amsterd.) with added interactive features as videos and illustrations. In short, the participants practice to suppress their tics for longer and longer times, at the same time as premonitory urges are intentionally provoked. The treatment is therapist-guided: the children and parents have regular (up to 5 days a week) contact with a personally assigned therapist via written text in the platform and occasionally via the telephone. The children and parents have separate logins and access partly different content.
Other intervention name(s): HRT, HR; ERP
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Tourette, Tic, Tics