Behavioral Therapy for Tourette Syndrome
Condition: Tourette Syndrome
MeSH terms: Tourette Syndrome; Syndrome
Study type: Interventional

Summary: 
      This research is being done to determine whether a home-based behavioral therapy can be
      successfully used to treat tics in children with Tourette syndrome (TS). Behavioral therapy
      administered by a trained therapist has been shown to be helpful in reducing tics in children
      with Tourette syndrome. In this study, the investigators want to determine whether an
      instructional video can provide parents of children with TS with the tools necessary to
      successfully use behavioral therapy at home. The investigators also want to determine the
      effectiveness of home-based behavioral therapy as compared to improvement achieved when the
      therapy is provided by a trained therapist.
    

Detailed description: 
      Tourette syndrome (TS) is a neurodevelopmental disorder with childhood onset characterized by
      the presence of chronic motor and vocal (phonic) tics. Tics typically begin between the ages
      of 4 - 7 years, frequently persist, and often lead to psychosocial, physical, functional, and
      academic difficulties. Epidemiological studies have shown that about 20-30% of children
      exhibit tics in a classroom setting whereas the estimated prevalence of impairing cases of TS
      is 1/100 - 1/1000 individuals. There is no cure for tics and a variety of behavioral and
      pharmacotherapies have been used successfully to suppress tics. Comprehensive Behavioral
      Intervention for Tics (CBIT) has been shown to be beneficial in several large trials as has
      habit reversal training (HRT), one of its major components. In the past, it has been
      suggested that only "competent and trained practitioners should administer CBIT." This
      proposal challenges that concept and believes that one can establish a successful front-line
      home-based CBIT treatment program that would be beneficial for the treatment of patients with
      tic symptoms throughout the country.

      CBIT is a safe, effective, front-line treatment for TS. Nevertheless, the investigators
      emphasize the acute shortage of appropriately trained clinicians available to assist affected
      individuals. Hence, in this proposal the investigators will assess the effectiveness of a
      behavioral home-based, parent administered treatment by investigating at Johns Hopkins
      Hospital whether the home-based digital video disc (DVD) reduces tic severity comparable to
      that achieved with face-to-face treatment administered by an experienced therapist. The
      investigators' confidence in the success of this project is based on prior experiences with
      another childhood movement disorder, primary complex motor stereotypies. The potential
      significance of this project is enormous, recognizing that home-based therapy reduces health
      care costs, visits to practitioners, the need to train large numbers of therapists, and most
      importantly provides direct, available care for a greater number individuals affected with
      tics.
    

Intervention name(s): Therapist-directed Behavioral Therapy; Home-based DVD Therapy
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The therapist-directed behavioral therapy group will have their first appointment scheduled within one week of assignment. In the Therapist-directed face-face training program, training instructions will be manualized, in order to match the parent instructional guidelines provided in the home-based DVD. This manual will include the specific psychoeducation, awareness training, competing response training, differential reinforcement of incompatible behaviors, and other adaptive behavioral instructions contained within the home-based DVD. The therapist will match the sequence and required components within the behavior-based training DVD. Face-face training will be administered across 10 weeks (6 weekly sessions followed by 2 bi-weekly sessions).; In order to mimic the slight delay between randomization and start of the therapist-directed treatment, those assigned to the Home-based DVD cohort will have the DVD and training materials mailed to their homes. Parents will also receive a written instructional form and a log sheet for tracking the use of the DVD and the time and duration of practice sessions. Any questions regarding patient care and treatment will be directed to Dr. Singer.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Tics; Behavioral therapy; Neurologic Examination