Therapist-guided and parent-guided internet-delivered behaviour therapy for paediatric Tourette's disorder: a pilot randomised controlled trial with long-term follow-up

Per Andrén; Kristina Aspvall; Lorena Fernández de la Cruz; Paulina Wiktor; Sofia Romano; Erik Andersson; Tara Murphy; Kayoko Isomura; Eva Serlachius; David Mataix-Cols

doi:10.1136/bmjopen-2018-024685

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 Feb 15;9(2):e024685. doi: 10.1136/bmjopen-2018-024685.

Authors

Per Andrén^{1

2}, Kristina Aspvall^{1

2}, Lorena Fernández de la Cruz^{1

2}, Paulina Wiktor³, Sofia Romano³, Erik Andersson¹, Tara Murphy^{4

5}, Kayoko Isomura^{1

2}, Eva Serlachius^{1

2}, David Mataix-Cols^{1

2}

Affiliations

¹ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
² Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
³ Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
⁴ Tourette Syndrome Clinic, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
⁵ Institute of Child Health, University College London, London, UK.

Abstract

Objective: Behaviour therapy (BT) for Tourette's disorder (TD) and persistent (chronic) motor or vocal tic disorder (PTD) is rarely available. We evaluated the feasibility of adapting two existing BT protocols for TD/PTD (habit reversal training (HRT) and exposure and response prevention (ERP)) into a therapist-guided and parent-guided online self-help format.

Design: A pilot, single-blind, parallel group randomised controlled trial.

Setting: A specialist outpatient clinic in Sweden.

Participants: Twenty-three young people with TD/PTD, aged 8-16.

Interventions: Two 10-week therapist-guided and parent-guided internet-delivered programmes (called BIP TIC HRT and BIP TIC ERP).

Outcome: The primary outcome measure was the Yale Global Tic Severity Scale. Blinded evaluators rated symptoms at baseline, post-treatment and 3-month follow-up (primary endpoint). All participants were naturalistically followed up to 12 months after treatment.

Results: Patients and parents rated the interventions as highly acceptable, credible and satisfactory. While both interventions resulted in reduced tic-related impairment, parent-rated tic severity and improved quality of life, only BIP TIC ERP resulted in a significant improvement on the primary outcome measure. Within-group effect sizes and responder rates were, respectively: d=1.12 and 75% for BIP TIC ERP, and d=0.50 and 55% for BIP TIC HRT. The therapeutic gains were maintained up to 12 months after the end of the treatment. Adverse events were rare in both groups. The average therapist support time was around 25 min per participant per week.

Conclusions: Internet-delivered BT has the potential to greatly increase access to evidence-based treatment for young people with TD/PTD. Further evaluation of the efficacy and cost-effectiveness of this treatment modality is warranted.

Trial registration number: NCT02864589; Pre-results.

Keywords: Tourette’s disorder; behaviour therapy; persistent (chronic) motor or vocal tic disorder; telemedicine.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Behavior Therapy / methods*
Child
Cost-Benefit Analysis
Female
Follow-Up Studies
Humans
Internet*
Logistic Models
Male
Parents
Personal Satisfaction
Pilot Projects
Quality of Life
Single-Blind Method
Sweden
Tourette Syndrome / psychology
Tourette Syndrome / therapy*
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT02864589