Behavior Therapy Reduces Tic Severity, But Less for Youth with ADHD

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Patients (N=126) with a mean age of 11.7 (range 9-17) were recruited from 3 treatment centers and were assigned to a behavior therapy group or control group for 8 sessions over 10 weeks.
Patients (N=126) with a mean age of 11.7 (range 9-17) were recruited from 3 treatment centers and were assigned to a behavior therapy group or control group for 8 sessions over 10 weeks.

The authors of a study published in Psychiatry Research demonstrated that behavior therapy may significantly reduce the severity of tics in youth diagnosed with Tourette disorder or other vocal or motor tic disorders. However, for youth with comorbid attention-deficit/hyperactivity disorder (ADHD), the type of behavioral therapy administered in this study showed a weaker effect.

Tic disorders affect approximately 0.4% to 1.6% of children and are commonly accompanied by ADHD, obsessive-compulsive disorder, and anxiety. Antipsychotic medications have been shown to reduce tic severity, as has behavior therapy. However, the mechanisms behind the efficacy of behavior therapy have yet to be clarified by research.

Patients (N=126) with a mean age of 11.7 (range 9 to 17) were recruited from 3 treatment centers and were assigned to a behavior therapy group or a control group for 8 sessions over 10 weeks. Children in the behavior therapy group received Comprehensive Behavior Intervention for Tics, an established technique to reduce tic severity. Eligible participants had a Yale Global Tic Severity Scale total score >13 (>9 for children with only motor or vocal tics), English fluency, and an IQ >80.

Investigators excluded potential candidates with a current diagnosis of substance dependence, a pervasive developmental disorder, mania, psychosis, or ≥4 previous sessions of behavior therapy for reducing tic severity.

Assessments administered to patients included the Stop-Signal Task, the Stroop Color Word Test, Auditory Consonant Trigrams, and the Weather Prediction Task. At baseline, youth with co-occurring ADHD had impaired working memory relative to youth without ADHD. In addition, children taking antipsychotics showed a slightly slower processing speed as assessed by Stroop. Otherwise, at baseline, there were no associations between neurocognitive correlates and tic symptom severity.

The findings suggested that tic severity was reduced without the diminishment of cognitive functioning. The investigators explained that this result may counter the concern that “the cognitive resources required to engage in treatment...may lead to greater impairment than the tics themselves.”

Investigators noted the study was limited by its exploratory nature and suggested future research should examine neurocognitive constructs in Tourette disorder in children.

Reference

Chang SW, McGuire JF, Walkup JT, et al. Neurocognitive correlates of treatment response in children with Tourette's Disorder [published online January 2, 2018]. doi:10.1016/j.psychres.2017.12.066.

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