Exposure and Response Prevention for Children and Adolescents with Tourette Syndrome Delivered via Web-Based Videoconference versus Face-to-Face Method

Abstract

Chronic tic disorders, such as Tourette syndrome, are characterized by motor and vocal tics. Tics present a considerable burden for some patients, and therefore, effective treatment is important. One evidence-based treatment option is a behavioral therapy called exposure and response prevention (ERP). Despite its effectiveness, access to ERP remains limited due to a lack of treatment sites. Web-based videoconferences can connect patients at home with a therapist located in the hospital, allowing for treatment delivery over a wide geographic area. The primary aim of this study was to compare the development of tics during and 1 year after ERP delivery, respectively, via web-based videoconferences and traditional face-to-face methods in a naturalistic setting. In total, 116 patients treated using either the face-to-face method (n = 72) or web-based videoconferences (n = 44) were included. The primary outcome measure was tic severity. In both training modalities, tic severity decreased during ERP and the effect lasted in the follow-up period. No statistically significant differences in tic severity between the training modalities were found at baseline, last training session, or at follow-up. Our results suggest that ERP delivered via web-based videoconferences is a good alternative to the traditional face-to-face method.

Keywords

exposure and response prevention - behavioral therapy - web-based videoconference - Tourette syndrome - telemedicine - tics

Publication History

Received: 17 August 2022

Accepted: 18 November 2022

Accepted Manuscript online:
24 November 2022

Article published online:
11 January 2023

• References

• 1 American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed: DSM-5. Washington, D.C: American Psychiatric Publishing, 2013
• 2 Knight T, Steeves T, Day L, Lowerison M, Jette N, Pringsheim T. Prevalence of tic disorders: a systematic review and meta-analysis. Pediatr Neurol 2012; 47 (02) 77-90
• 3 Scharf JM, Miller LL, Mathews CA, Ben-Shlomo Y. Prevalence of Tourette syndrome and chronic tics in the population-based Avon longitudinal study of parents and children cohort. J Am Acad Child Adolesc Psychiatry 2012; 51 (02) 192-201 .e5
• 4 Khalifa N, VON Knorring AL. Psychopathology in a Swedish population of school children with tic disorders. J Am Acad Child Adolesc Psychiatry 2006; 45 (11) 1346-1353
• 5 Bloch MH, Leckman JF. Clinical course of Tourette syndrome. J Psychosom Res 2009; 67 (06) 497-501
• 6 Khalifa N, von Knorring A-L. Prevalence of tic disorders and Tourette syndrome in a Swedish school population. Dev Med Child Neurol 2003; 45 (05) 315-319
• 7 Quezada J, Coffman KA. Current approaches and new developments in the pharmacological management of Tourette syndrome. CNS Drugs 2018; 32 (01) 33-45
• 8 Cath DC, Hedderly T, Ludolph AG. et al; ESSTS Guidelines Group. European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment. Eur Child Adolesc Psychiatry 2011; 20 (04) 155-171
• 9 Leckman JF, Zhang H, Vitale A. et al. Course of tic severity in Tourette syndrome: the first two decades. Pediatrics 1998; 102 (1 Pt 1): 14-19
• 10 Leckman JF. Phenomenology of tics and natural history of tic disorders. In: Brain and Development. Vol 25. Elsevier; 2003
• 11 Leckman JF, Walker DE, Cohen DJ. Premonitory urges in Tourette's syndrome. Am J Psychiatry 1993; 150 (01) 98-102
• 12 Groth C, Mol Debes N, Rask CU, Lange T, Skov L. Course of Tourette syndrome and comorbidities in a large prospective clinical study. In: Journal of the American Academy of Child and Adolescent Psychiatry. Vol 56. Elsevier Inc.; 2017: 304-312
• 13 Mol Debes NMMM, Hjalgrim H, Skov L. Validation of the presence of comorbidities in a Danish clinical cohort of children with Tourette syndrome. J Child Neurol 2008; 23 (09) 1017-1027
• 14 Scahill L, Erenberg G, Berlin Jr CM. et al; Tourette Syndrome Association Medical Advisory Board: Practice Committee. Contemporary assessment and pharmacotherapy of Tourette syndrome. NeuroRx 2006; 3 (02) 192-206
• 15 Azrin NHH, Nunn RGG. Habit-reversal: a method of eliminating nervous habits and tics. Behav Res Ther 1973; 11 (04) 619-628
• 16 Rizzo R, Pellico A, Silvestri PR, Chiarotti F, Cardona F. A randomized controlled trial comparing behavioral, educational, and pharmacological treatments in youths with chronic tic disorder or Tourette syndrome. Front Psychiatry 2018; 9: 100
• 17 McGuire JF, Piacentini J, Brennan EA. et al. A meta-analysis of behavior therapy for Tourette syndrome. J Psychiatr Res 2014; 50: 106-112
• 18 Woods D, Piacentini J, Chang S. et al. Managing Tourette Syndrome: A Behavioral Intervention for Children and Adults. 1st ed. Oxford University Press; 1 edition; 2008
• 19 McGuire JF, Ricketts EJ, Piacentini J, Murphy TK, Storch EA, Lewin AB. Behavior therapy for tic disorders: an evidenced-based review and new directions for treatment research. Curr Dev Disord Rep 2015; 2 (04) 309-317
• 20 Andrén P, Jakubovski E, Murphy TL. et al. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part II: psychological interventions. Eur Child Adolesc Psychiatry 2022; 31 (03) 403-423
• 21 van de Griendt JMTMTM, Verdellen CWJJ, van Dijk MK, Verbraak MJPMPM. Behavioural treatment of tics: habit reversal and exposure with response prevention. Neurosci Biobehav Rev 2013; 37 (06) 1172-1177
• 22 Verdellen CWJJ, Keijsers GPJJ, Cath DC, Hoogduin CALL. Exposure with response prevention versus habit reversal in Tourettes's syndrome: a controlled study. Behav Res Ther 2004; 42 (05) 501-511
• 23 Cook CR, Blacher J. Evidence-based psychosocial treatments for tic disorders. Clin Psychol Sci Pract 2007; 14 (03) 252-267
• 24 Himle MB, Woods DW, Piacentini JC, Walkup JT. Brief review of habit reversal training for Tourette syndrome. J Child Neurol 2006; 21 (08) 719-725
• 25 van de Griendt JMTM, van Dijk MK, Verdellen CWJ, Verbraak MJPM. The effect of shorter exposure versus prolonged exposure on treatment outcome in Tourette syndrome and chronic tic disorders—an open trial. Int J Psychiatry Clin Pract 2018; 22 (04) 262-267
• 26 Verdellen CWJ, Hoogduin CAL, Kato BS, Keijsers GPJ, Cath DC, Hoijtink HB. Habituation of premonitory sensations during exposure and response prevention treatment in Tourette's syndrome. Behav Modif 2008; 32 (02) 215-227
• 27 Ricketts EJ, Goetz AR, Capriotti MR. et al. A randomized waitlist-controlled pilot trial of voice over Internet protocol-delivered behavior therapy for youth with chronic tic disorders. J Telemed Telecare 2016; 22 (03) 153-162
• 28 Himle MB, Freitag M, Walther M, Franklin SA, Ely L, Woods DW. A randomized pilot trial comparing videoconference versus face-to-face delivery of behavior therapy for childhood tic disorders. Behav Res Ther 2012; 50 (09) 565-570
• 29 Hollis C, Hall CL, Jones R. et al. Therapist-supported online remote behavioural intervention for tics in children and adolescents in England (ORBIT): a multicentre, parallel group, single-blind, randomised controlled trial. Lancet Psychiatry 2021; 8 (10) 871-882
• 30 Leckman JF, Riddle MA, Hardin MT. et al. The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 1989; 28 (04) 566-573
• 31 Scahill L, Riddle MA, McSwiggin-Hardin M. et al. Children's Yale-Brown Obsessive Compulsive Scale: reliability and validity. J Am Acad Child Adolesc Psychiatry 1997; 36 (06) 844-852
• 32 Storch EA, Murphy TK, Geffken GR. et al. Psychometric evaluation of the Children's Yale-Brown Obsessive-Compulsive Scale. Psychiatry Res 2004; 129 (01) 91-98
• 33 Szomlaiski N, Dyrborg J, Rasmussen H, Schumann T, Koch SV, Bilenberg N. Validity and clinical feasibility of the ADHD rating scale (ADHD-RS) A Danish Nationwide Multicenter Study. Acta Paediatr 2009; 98 (02) 397-402
• 34 Himle MB, Olufs E, Himle J, Tucker BTP, Woods DW. Behavior therapy for tics via videoconference delivery: an initial pilot test in children. Cognit Behav Pract 2010; 17 (03) 329-337
• 35 Haas M, Jakubovski E, Kunert K. et al. ONLINE-TICS: internet-delivered behavioral treatment for patients with chronic tic disorders. J Clin Med 2022; 11 (01) 250
• 36 Andrén P, Holmsved M, Ringberg H. et al. Therapist-supported internet-delivered exposure and response prevention for children and adolescents with tourette syndrome: a randomized clinical trial. JAMA Netw Open 2022; 5 (08) e2225614
• 37 Andrén P, Aspvall K, Fernández de la Cruz L. et al. Therapist-guided and parent-guided internet-delivered behaviour therapy for paediatric Tourette's disorder: a pilot randomised controlled trial with long-term follow-up. BMJ Open 2019; 9 (02) e024685
• 38 Rachamim L, Zimmerman-Brenner S, Rachamim O, Mualem H, Zingboim N, Rotstein M. Internet-based guided self-help comprehensive behavioral intervention for tics (ICBIT) for youth with tic disorders: a feasibility and effectiveness study with 6 month-follow-up. Eur Child Adolesc Psychiatry 2020; 1: 3