title: Behavior therapy for children with Tourette disorder: a randomized controlled trial.
abstract: BACKGROUND
  Tourette disorder is a chronic and typically impairing childhood-onset neurologic condition. Antipsychotic medications, the first-line treatments for moderate to severe tics, are often associated with adverse effects. Behavioral interventions, although promising, have not been evaluated in large-scale controlled trials.
  
  
  OBJECTIVE
  To determine the efficacy of a comprehensive behavioral intervention for reducing tic severity in children and adolescents.
  
  
  METHODS
  Randomized, observer-blind, controlled trial of 126 children recruited from December 2004 through May 2007 and aged 9 through 17 years, with impairing Tourette or chronic tic disorder as a primary diagnosis, randomly assigned to 8 sessions during 10 weeks of behavior therapy (n = 61) or a control treatment consisting of supportive therapy and education (n = 65). Responders received 3 monthly booster treatment sessions and were reassessed at 3 and 6 months following treatment.
  
  
  METHODS
  Comprehensive behavioral intervention.
  
  
  METHODS
  Yale Global Tic Severity Scale (range 0-50, score >15 indicating clinically significant tics) and Clinical Global Impressions-Improvement Scale (range 1 [very much improved] to 8 [very much worse]).
  
  
  RESULTS
  Behavioral intervention led to a significantly greater decrease on the Yale Global Tic Severity Scale (24.7 [95% confidence interval {CI}, 23.1-26.3] to 17.1 [95% CI, 15.1-19.1]) from baseline to end point compared with the control treatment (24.6 [95% CI, 23.2-26.0] to 21.1 [95% CI, 19.2-23.0]) (P < .001; difference between groups, 4.1; 95% CI, 2.0-6.2) (effect size = 0.68). Significantly more children receiving behavioral intervention compared with those in the control group were rated as being very much improved or much improved on the Clinical Global Impressions-Improvement scale (52.5% vs 18.5%, respectively; P < .001; number needed to treat = 3). Attrition was low (12/126, or 9.5%); tic worsening was reported by 4% of children (5/126). Treatment gains were durable, with 87% of available responders to behavior therapy exhibiting continued benefit 6 months following treatment.
  
  
  CONCLUSIONS
  A comprehensive behavioral intervention, compared with supportive therapy and education, resulted in greater improvement in symptom severity among children with Tourette and chronic tic disorder.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00218777.
authors.affiliation: UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Room 68-251, Los Angeles, CA 90024, USA. jpiacentini@mednet.ucla.edu
authors.forename: John
authors.initials: J
authors.lastname: Piacentini
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Woods
authors.forename: Lawrence
authors.initials: L
authors.lastname: Scahill
authors.forename: Sabine
authors.initials: S
authors.lastname: Wilhelm
authors.forename: Alan L
authors.initials: AL
authors.lastname: Peterson
authors.forename: Susanna
authors.initials: S
authors.lastname: Chang
authors.forename: Golda S
authors.initials: GS
authors.lastname: Ginsburg
authors.forename: Thilo
authors.initials: T
authors.lastname: Deckersbach
authors.forename: James
authors.initials: J
authors.lastname: Dziura
authors.forename: Sue
authors.initials: S
authors.lastname: Levi-Pearl
authors.forename: John T
authors.initials: JT
authors.lastname: Walkup
mesh_terms: D000293:Adolescent; D001521:Behavior Therapy; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D005879:Tourette Syndrome / Q000628:therapy*; D016896:Treatment Outcome