A preliminary study of comprehensive behavioral intervention for tics in Chinese children with chronic tic disorder or Tourette syndrome

Abstract

ObjectiveTo investigate the adaptability of Comprehensive Behavioral Intervention for Tics (CBIT) for a Chinese population, and evaluate the efficacy of combined CBIT and pharmacotherapy (CBIT + PT) compared to CBIT or pharmacotherapy (PT) alone for reducing tics and for improving the quality of life (QoL) in a sample of Chinese children with chronic tic disorders (CTD) and Tourette syndrome (TS).Materials and methodsIn this 10-week randomized controlled pilot trial, 37 outpatients aged between 6 and 16 years affected by TS and CTD were randomly assigned to receive CBIT (n = 22) or PT alone (n = 15). Considering the feasibility, the patients allocated to the CBIT treatment group could further choose whether to simultaneously take medicine voluntarily, resulting in a CBIT alone group (n = 12) and a CBIT + PT group (n = 10).ResultsAt baseline, no significant difference was found between the three groups in the demographic and clinical characteristics (p > 0.05). All three groups showed a significant reduction in tic severity after treatment assessed by the Yale Global Tic Severity Scale (YGTSS) severity score [F(2,33) = 35.05, p < 0.001, ηp2 = 0.51], the score of the Clinical Global Impression scale for Improvement (CGI-I) [F(1,34) = 13.87, p = 0.001, ηp2 = 0.29], and YGTSS impairment score [F(2,33) = 31.71, p < 0.001, ηp2 = 0.48]. Significant interactions were found between the time-point and group in emotional functioning [F(2,29) = 4.39, p = 0.02, ηp2 = 0.23], psychosocial functioning [F(2,29) = 5.93, p = 0.007, ηp2 = 0.29], and total QoL score [F(1,34) = 3.72, p = 0.04, ηp2 = 0.20] of Pediatric Quality of Life Inventory (PedsQL 4.0) for children suggesting a significantly larger improvement in emotional functioning, psychosocial functioning, and total QoL score of the life quality in the CBIT group for children self-report. PedsQL for proxy report only showed a significant main effect of time-point in physical functioning [F(1,33) = 8.35, p = 0.01, ηp2 = 0.2], emotional functioning [F(1,33) = 10.75, p = 0.002, ηp2 = 0.25], psychosocial functioning [F(1,34) = 11.38, p = 0.002, ηp2 = 0.26], and total Qol score [F(1,34) = 13.21, p = 0.001, ηp2 = 0.29].ConclusionCBIT is probably effective in reducing tic severity in Chinese children with tic disorders. CBIT + PT may not be superior to CBIT alone in reducing tic severity and improving quality of life. CBIT alone showed advantages in improving quality of life over CBIT + PT and PT alone. CBIT might be an appropriate treatment option for patients with tic disorder in Chinese mainland.