Behavioral Therapy Tied to Reduced Tic Severity in Youth With Tourette Syndrome

Tourette syndrome concept. Diagnostic form and book on a table.
Researchers sought to determine the long-term durability of CBIT in youth with Tourette syndrome and persistent motor or vocal tic disorders.

Behavioral therapy may be an effective first-line intervention for youth with Tourette syndrome and other tic disorders, according to a study published in the Journal of American Academy of Child & Adolescent Psychiatry.

Antipsychotic medications and the Comprehensive Behavioral Intervention for Tics (CBIT) carry the most evidence of effectiveness for tic disorders. CBIT, which does not carry antipsychotic medications, includes psychoeducation, monitoring tics between sessions, functional assessment of causes and effects of ticcing, functional interventions to reduce environmental variables on ticcing, Habit Reversal Training, relaxation training, and relapse prevention. Prior studies have indicated CBIT is helpful, but few studies have prospectively assessed its long-term utility.

In the current study, researchers analyzed long-term outcomes of youth who participated in a randomized controlled trial (RCT) that compared 8 sessions over 10 weeks of CBIT (n=61) or supportive and educational treatment (PST; n=65). It also assessed the role of early, successful behavioral management.

The researchers recruited 80 (mean age 22.87 years; 75% men; 86.3% White) of the 126 individuals in the initial RCT between March 2014 and January 2019 for the long-term follow-up, a mean 11.17 years after the study treatment. To assess current tic severity and tic-related impairment, participants completed in-person or video interviews. The researchers used the Yale Global Tic Severity Scale (YGTSS) and the Clinical Global Impression of Severity (CGI-S) scale to assess the participants. Participants received $100 for completing the assessment.

Seventy-six participants had been diagnosed with Tourette disorder. The others were diagnosed with persistent motor disorder or persistent vocal tic disorder. In the follow-up period, 31 participants received tic-influencing medication or behavioral therapy for tics.

Participants tended to report mild-to-moderate level of tic severity and tic-related impairment and mild illness on the CGI-S at the long-term follow-up assessment. A total of 40% had partially or fully experienced remission.

Participants who received CBIT treatment experienced significant, lasting improvement, beginning at posttreatment, compared with those who received PST (meandiff = 8.64, P =.015, d=1.47).

Clinically meaningful improvement from baseline to long-term follow-up was more common among participants who responded to CBIT compared with those who didn’t respond to CBIT, and participants who received PST. However, the difference between responders to CBIT responders and nonresponders to PST was not statistically significant.

Fourteen participants in the CBIT group and no participants in the PST group achieved partial remission.

At week 10, tic impairment was reduced among participants who responded to treatment compared with those with no treatment response (meandiff =4.80, P =.027). Tic impairment decreased from baseline to posttreatment (meandiff =10.94, P =.001).

Participants who responded to treatment and those who did not had different treatment response by time interaction at posttreatment follow-up (meandiff =11.93, P <.001). Tic impairment decreased for participants who responded to treatment at posttreatment. All participants had similar tic impairment scores by long-term follow-up.

Overall, treatment with behavioral therapy led to symptom remission and a reduction in tic severity in youth with Tourette syndrome along with individuals with other tic disorders.

Study limitations included the fact that only 6 individuals who participated in the PST group responded to treatment, adjunctive intervention and other variables in the period between the studies, and recall of participants.

“This study represents the longest systematic prospective follow-up intervals of youth with [persistent tic disorders], and the longest of its kind for individuals receiving CBIT,” the researchers said. “Given the durability of treatment response among youth who receive behavior therapy at earlier ages, guidelines recommending CBIT as the first-line intervention appear to be warranted,” they concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Espil FM, Woods DW, Specht MW, et al. Long-term outcomes of behavioral therapy for youth with Tourette disorder. J Am Acad Child Adolesc Psychiatry. 2022;61(6): 764-771. doi: 10.1016/j.jaac.2021.08.022

This article originally appeared on Neurology Advisor