Cognitive Behavior Therapy and Habit Reversal Training for the Treatment of Chronic Tic Disorders in Children

CTDs and Tourette syndrome are neurobehavioral disorders that are characterized by a
persistent pattern of motor and vocal tics. Tics are intermittent movements or sounds that
occur repeatedly. They can be either brief, rapid, and darting movements or more purposeful
movements, such as repetitively locking and unlocking a door. Vocal tics can be simple, as
in sniffing or grunting, or more complex, such as complete words or phrases. Tic disorders
can cause considerable distress in affected children, and can lead to social and academic
impairment. If left untreated, CTDs can last into adulthood. The standard treatment for
suppressing CTDs is medication; dopamine-blocking drugs are used most commonly. These
medications, however, are associated with a range of adverse effects that can result in poor
treatment compliance and premature treatment termination. Recent research suggests that HRT
may be an effective, lower risk treatment for CTDs. HRT is a behavioral treatment based on
increasing awareness of one's behaviors and replacing unwanted behaviors with less
bothersome ones. This study will determine the effectiveness of CBT with HRT in treating
CTDs in children and adolescents.

Participants in this double blind study will be randomly assigned to receive either CBT plus
HRT or standard care, which will consist of psychoeducation and supportive therapy. All
participants will partake in 8 sessions of their assigned therapy over the course of 10
weeks. After the initial 10 weeks, those who responded to treatment will report back to the
study site for 3 monthly booster sessions. Changes in tic severity, effects of the therapies
on overall functioning and quality of life, and possible predictors of treatment outcome
will be assessed.

Inclusion Criteria:

- Meets DSM-IV diagnostic criteria for chronic tic disorder (chronic motor or vocal tic
disorder or Tourette syndrome)

- Score of at least 3 on the Clinical Global Impressions Severity Scale

- Score of at least 14 on the Yale Global Tic Severity Scale (YGTSS) or at least 10 for
individuals with motor tics only

- Unmedicated or currently on a stable medication treatment for tics, obsessive
compulsive disorder (OCD), ADHD, anxiety, and/or depressive disorder for at least 6
weeks, with no planned changes for the duration of study participation

- Child speaks English

Exclusion Criteria:

- Score greater than 30 on the YGTSS

- IQ less than 80 on the Wechsler Abbreviated Scale of Intelligence (WASI)

- Meets DSM-IV criteria for substance abuse or dependence within the 3 months prior to
study entry

- Meets DSM-IV criteria for conduct disorder within the 3 months prior to study entry

- Lifetime DSM-IV diagnosis of pervasive developmental disorder, mania, or psychotic
disorder

- Any serious psychiatric, psychosocial, or neurological condition (i.e., OCD, ADHD,
major depressive disorder, anxiety, severe aggression, or family discord) requiring
immediate treatment other than what is provided in the current study (i.e.,
medication, school intervention, or family therapy)

- Previous treatment with four or more sessions of HRT for tics