Extinction Learning in Youth With Tourette Syndrome

Study Overview
=================
Brief Summary
-----------------
Aversive sensory phenomena such as premonitory urges play a central role in the behavioral treatment model of tics. Extinction learning and extinction recall are learning processes implicated within this model, but have not been directly evaluated in youth with Tourette syndrome (TS). This study examines extinction learning and extinction recall in youth with TS using an experimental task. This study will also explore the relationship between extinction processes (i.e., extinction learning and extinction recall) and treatment outcomes with behavior therapy. Findings from this investigation will be used to update the behavioral treatment model, which serves as the basis for evidence-based behavioral interventions.

Official Title
-----------------
Extinction Learning in Youth With Tourette Syndrome

Conditions
-----------------
Tourette Syndrome in Children, Tourette Syndrome in Adolescence, Habit Reversal Training, Tic

Intervention / Treatment
-----------------
* Behavioral: Habit Reversal Training


Participation Criteria
=================
Eligibility Criteria
-----------------
Youth with TS will be eligible for participation if they meet the following inclusion criteria: age 8-17 years (inclusive) have moderate tic severity or greater as evidenced by a YGTSS Total Tic Score greater than 13 (>9 for youth with motor or vocal tics only) have not received more than 4 previous sessions of HRT be fluent in English. Medication free or on a stable dose of psychiatric medication for 8 weeks prior to enrollment. Exclusion criteria for youth with TS: An inability to complete rating scales Attend study visits.

Ages Eligible for Study
-----------------
Minimum Age: 8 Years
Maximum Age: 17 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Habit Reversal Training<br>Habit Reversal Training (HRT) is a multi-component evidence-based treatment for tics. It will be delivered over 4 two-hour sessions in an intensive format. | Behavioral: Habit Reversal Training<br>* 4 sessions of habit reversal training<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Tic severity as assessed by the Hopkins Motor and Vocal Tic Scale (HM/VTS) | Patient will nominate up to five motor and five vocal tics they deem bothersome on the HM/VTS. Each bothersome tic is then rated by a clinician on the composite two (vocal and motor) 5-point HM/VTS scale ranging from none (0) to severe (4) for the motor as well as vocal tics. The individual tic scores are summed (minimum of 0 and maximum of 40) and averaged together to create an average tic severity score. | Within 1 week after completion of HRT | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Tic severity as assessed by the Yale Global Tic Severity Scale-Revised (YGTSS) | The YGTSS is a clinician-rated semi-structured interview that measures tic symptom severity over the previous week. It consists of 10-items that assess different dimensions of tic severity for motor and vocal tics, which are rated on a 0-5 scale. The YGTSS produces a Total Tic Score (range: 0-50), with higher ratings indicating greater tic severity. The YGTSS has demonstrated treatment sensitivity to pharmacotherapy and behavioral interventions. | Within 1 week after completion of HRT | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Extinction learning, Behavior Therapy, Tourette's Disorder, Habit Reversal Training, Comprehensive Behavioral Intervention for Tics