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Adaptation of Behavioral Treatment for Youth with Tourette’s Syndrome and Complex Comorbidity

  • Tourette’s Syndrome (M Yadegar and F Espil, Section Editors)
  • Published:
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Abstract 

Purpose of Review

Comorbidity complicates behavioral treatment for youth with Tourette’s syndrome (TS). The Comprehensive Behavioral Intervention for Tic (CBIT) is a first-line intervention, and several clinical guidelines exist to assist clinicians in developing effective treatment plans for youth with TS. Unfortunately, there is currently little guidance on how to alter CBIT and similar evidence-based behavioral interventions in complex cases of TS with comorbidity. We present potential treatment adaptations for youth with TS and comorbidities and discuss factors that may impact clinical decision-making.

Recent Findings

Behavioral treatments have produced favorable tic-related outcomes (e.g., reducing the severity and functional impact of tics); however, less consideration has been given to the sequelae of comorbidity, including the accompanying behaviors and underlying emotional distress that may interfere with treatment such as emotional dysregulation, poor distress tolerance, attention/executive functioning deficits, low motivation, impulsivity, avoidance, and oppositional behaviors.

Summary

Current understanding of adaptations for behavioral treatment suggests beginning with a comprehensive assessment, followed by detailed treatment planning with the collaboration of the patient, caregivers, and healthcare team. Future research is needed to further examine best practices for youth with TS and comorbid conditions.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Association; 2013.

  2. Bloch MH, Leckman JF. Clinical course of Tourette syndrome. J Psychosom Res. 2009;67(6):497–501. https://doi.org/10.1016/j.jpsychores.2009.09.002.

    Article  PubMed  PubMed Central  Google Scholar 

  3. •• Pringsheim T, Okun MS, Müller-Vahl K, Martino D, Jankovic J, Cavanna AE, et al. Practice guideline recommendations summary: treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology. 2019;92(19):896–906. https://doi.org/10.1212/wnl.0000000000007466. (This study summarizes recent practice recommendations for individuals with Tourette’s syndrome and other tic disorders, utilizing a multidisciplinary panel of clinicians, researchers, and patient representatives.)

  4. Hollis C, Pennant M, Cuenca J, Glazebrook C, Kendall T, Whittington C, et al. Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis. Health Technol Assess. 2016;20(4):1–450, vii-viii. https://doi.org/10.3310/hta20040.

  5. Hirschtritt ME, Lee PC, Pauls DL, Dion Y, Grados MA, Illmann C, et al. Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome. JAMA Psychiat. 2015;72(4):325–33. https://doi.org/10.1001/jamapsychiatry.2014.2650.

    Article  Google Scholar 

  6. Whittington C, Pennant M, Kendall T, Glazebrook C, Trayner P, Groom M, et al. Practitioner review: treatments for Tourette syndrome in children and young people – a systematic review. J Child Psychol Psychiatry. 2016;57(9):988–1004. https://doi.org/10.1111/jcpp.12556.

    Article  PubMed  Google Scholar 

  7. Woods DW, Piacentini J, Chang S, Deckersbach T, Ginsburg GS, Peterson AL, et al. Managing Tourette syndrome: a behavioral intervention for children and adults therapist guide (treatments that work). 1st ed. New York: Oxford University Press; 2008.

    Book  Google Scholar 

  8. Deeb W, Malaty IA, Mathews CA. Chapter 8 - Tourette disorder and other tic disorders. In: Reus VI, Lindqvist D, editors. Handbook of Clinical Neurology. Elsevier; 2019. p. 123–53.

    Google Scholar 

  9. Robertson MM. Mood disorders and Gilles de la Tourette’s syndrome: an update on prevalence, etiology, comorbidity, clinical associations, and implications. J Psychosom Res. 2006;61:349–58.

    Article  PubMed  Google Scholar 

  10. Murphy TK, Lewin AB, Storch EA, Stock S. Practice parameter for the assessment and treatment of children and adolescents with tic disorders. J Am Acad Child Adolesc Psychiatry. 2013;52(12):1341–59. https://doi.org/10.1016/j.jaac.2013.09.015.

    Article  PubMed  Google Scholar 

  11. Bitsko RH, Danielson ML, Leeb RT, Bergland B, Fuoco MJ, Ghandour RM, et al. Indicators of social competence and social participation among US children with Tourette syndrome. J Child Neurol. 2020;35(9):612–20. https://doi.org/10.1177/0883073820924257.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lewin AB, Storch EA, Conelea CA, Woods DW, Zinner SH, Budman CL, et al. The roles of anxiety and depression in connecting tic severity and functional impairment. J Anxiety Disord. 2011;25(2):164–8. https://doi.org/10.1016/j.janxdis.2010.08.016.

    Article  PubMed  Google Scholar 

  13. Lewin AB, Chang S, McCracken J, McQueen M, Piacentini J. Comparison of clinical features among youth with tic disorders, obsessive-compulsive disorder (OCD), and both conditions. Psychiatry Res. 2010;178(2):317–22. https://doi.org/10.1016/j.psychres.2009.

    Article  PubMed  PubMed Central  Google Scholar 

  14. • Billnitzer A, Jankovic J. Current management of tics and Tourette syndrome: behavioral, pharmacologic, and surgical treatments. Neurotherapeutics. 2020;17(4):1681–93. https://doi.org/10.1007/s13311-020-00914-6. (This paper discusses various treatment options for individuals with Tourette’s syndrome, including treatment for comorbid conditions such as OCD and ADHD.)

    Article  PubMed  PubMed Central  Google Scholar 

  15. Azrin NH, Nunn RG. A method of eliminating nervous habits and tics. Behav Res Ther. 1973;11:619–28.

    Article  CAS  PubMed  Google Scholar 

  16. Deckersbach T, Rauch S, Buhlmann U, Wilhelm S. Habit reversal versus supportive psychotherapy in Tourette’s disorder: a randomized controlled trial and predictors of treatment response. Behav Res Ther. 2006;44:1079–90.

    Article  PubMed  Google Scholar 

  17. Capriotti MR, Brandt BC, Turkel JE, Lee HJ, Woods DW. Reinforcement and premonitory urges in youth with Tourette syndrome: an experimental evaluation. Behav Modif. 2014;38(2):276–96. https://doi.org/10.1177/0145445514531015.

    Article  PubMed  Google Scholar 

  18. Woods DW, Piacentini J, Scahill L, Peterson AL, Wilhelm S, Chang S, et al. Behavior therapy for tics in children: acute and long-term effects on psychiatric and psychosocial functioning. J Child Neurol. 2011;26:858–65.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Eapen V, Cavanna A, Robertson M. Comorbidities, social impact, and quality of life in Tourette syndrome. Front Psychiatry. 2016;7(97). https://doi.org/10.3389/fpsyt.2016.00097.

  20. Müller-Vahl KR, Szejko N, Verdellen C, Roessner V, Hoekstra PJ, Hartmann A, et al. European clinical guidelines for Tourette syndrome and other tic disorders: summary statement. Eur Child Adolesc Psychiatry. 2022;31(3):377–82. https://doi.org/10.1007/s00787-021-01832-4.

    Article  PubMed  Google Scholar 

  21. Reynolds CR, Kamphaus RW. Behavior Assessment System for Children. 3rd ed. Bloomington, MN: Pearson; 2015.

  22. Achenbach TM. The Child Behavior Checklist and related instruments. In: Maruish ME, editor. The use of psychological testing for treatment planning and outcomes assessment. Lawrence Erlbaum Associates Publishers; 1999. p. 429–66.

    Google Scholar 

  23. Zurhellen W, Lessin HR, Chan E, Allan CC, Wolraich M, Sprecher E, et al. Caring for children with ADHD: a practical resource toolkit for clinicians, 3rd Edition. American Academy of Pediatrics; 2019.

  24. Scahill L, Riddle MA, McSwinggin-Hardin M, Ort SI, King RA, Goodman WK, et al. Children’s Yale-Brown Obsessive Compulsive Scale: reliability and validity. J Am Acad Child Adolesc Psychiatry. 1997;36(6):844–52.

    Article  CAS  PubMed  Google Scholar 

  25. Kovacs M. The Children’s Depression, Inventory (CDI). Psychopharmacol Bull. 1985;21(4):995–8.

    CAS  PubMed  Google Scholar 

  26. Birmaher B, Khetarpal S, Brent D, Marlane C, Balach L, Kaufman J, et al. The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. Journal of the American Academy of Child & Adolescent Psychiatry. 1997;36(4):545–53. https://doi.org/10.1097/00004583-199704000-00018.

    Article  CAS  Google Scholar 

  27. Lewin AB, McGuire JF, Murphy T, Storch EA. The importance of considering parent’s preferences when planning treatment for their children - the case of childhood obsessive-compulsive disorder. J Child Psychol Psychiatry. 2014;55(12):1314–6.

    Article  PubMed  Google Scholar 

  28. Pringsheim T, Doja A, Gorman D, McKinlay D, Day L, Billinghurst L, et al. Canadian guidelines for the evidence-based treatment of tic disorders: pharmacotherapy. Can J Psychiatry. 2012;57(3):133–43. https://doi.org/10.1177/070674371205700302.

    Article  PubMed  Google Scholar 

  29. Davis ML, Fletcher T, McIngvale E, Cepeda SL, Schneider SC, La Buissonnière AV, et al. Clinicians’ perspectives of interfering behaviors in the treatment of anxiety and obsessive-compulsive disorders in adults and children. Cogn Behav Ther. 2020;49(1):81–96. https://doi.org/10.1080/16506073.2019.1579857.

    Article  PubMed  Google Scholar 

  30. Espil FM, Elkin TD, Young J. Manualized and modular behavior therapy for a child with Tourette’s disorder, inattention, and disruptive behavior: a case example. Clin Case Stud. 2017;16(2):149–65. https://doi.org/10.1177/1534650116679732.

    Article  Google Scholar 

  31. • Bennett SM, Capriotti MR, Bauer C, Chang S, Keller AE, Walkup JT, et al. Development and open trial of a psychosocial intervention for young children with chronic tics: the CBIT-JR study. Behav Ther. 2020;51(4):659–69. https://doi.org/10.1016/j.beth.2019.10.004. (This study demonstrates the performance of the Comprehensive Behavioral Intervention for Tics (CBIT) adapted for young children (ages 5-8) with chronic tic disorders, showing significant decrease in tic severity and impairment.)

    Article  PubMed  Google Scholar 

  32. McGuire JF, Arnold E, Park JM, Nadeau JM, Lewin AB, Murphy T, et al. Living with tics: reduced impairment and improved quality of life for youth with chronic tic disorders. Psychiatry Res. 2015;225(3):571–9. https://doi.org/10.1016/j.psychres.2014.11.045.

    Article  PubMed  Google Scholar 

  33. Martin F, Oliver T. Behavioral activation for children and adolescents: a systematic review of progress and promise. Eur Child Adolesc Psychiatry. 2019;28(4):427–41. https://doi.org/10.1007/s00787-018-1126-z.

    Article  PubMed  Google Scholar 

  34. Forgatch MS, Kjøbli J. Parent Management Training-Oregon Model: adapting intervention with rigorous research. Fam Process. 2016;55(3):500–13. https://doi.org/10.1111/famp.12224.

    Article  PubMed  Google Scholar 

  35. Harvey AG, Watkins ER, Mansell W, Shafran R. Cognitive behavioural processes across psychological disorders: a transdiagnostic approach to research and treatment. Oxford: Oxford University Press; 2004.

    Book  Google Scholar 

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Correspondence to Adam B. Lewin.

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Bolen, M., Bolton, C. & Lewin, A.B. Adaptation of Behavioral Treatment for Youth with Tourette’s Syndrome and Complex Comorbidity. Curr Dev Disord Rep 9, 169–177 (2022). https://doi.org/10.1007/s40474-022-00266-0

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