title: Practitioner Review: Treatments for Tourette syndrome in children and young people - a systematic review.
abstract: Tourette syndrome (TS) and chronic tic disorder (CTD) affect 1-2% of children and young people, but the most effective treatment is unclear. To establish the current evidence base, we conducted a systematic review of interventions for children and young people.
  
  
  
  Databases were searched from inception to 1 October 2014 for placebo-controlled trials of pharmacological, behavioural, physical or alternative interventions for tics in children and young people with TS or CTD. Certainty in the evidence was assessed with the GRADE approach.
  
  
  
  Forty trials were included [pharmacological (32), behavioural (5), physical (2), dietary (1)]. For tics/global score there was evidence favouring the intervention from four trials of α2-adrenergic receptor agonists [clonidine and guanfacine, standardised mean difference (SMD) = -0.71; 95% CI -1.03, -0.40; N = 164] and two trials of habit reversal training (HRT)/comprehensive behavioural intervention (CBIT) (SMD = -0.64; 95% CI -0.99, -0.29; N = 133). Certainty in the effect estimates was moderate. A post hoc analysis combining oral clonidine/guanfacine trials with a clonidine patch trial continued to demonstrate benefit (SMD = -0.54; 95% CI -0.92, -0.16), but statistical heterogeneity was high. Evidence from four trials suggested that antipsychotic drugs improved tic scores (SMD = -0.74; 95% CI -1.08, -0.40; N = 76), but certainty in the effect estimate was low. The evidence for other interventions was categorised as low or very low quality, or showed no conclusive benefit.
  
  
  
  When medication is considered appropriate for the treatment of tics, the balance of clinical benefits to harm favours α2-adrenergic receptor agonists (clonidine and guanfacine) as first-line agents. Antipsychotics are likely to be useful but carry the risk of harm and so should be reserved for when α2-adrenergic receptor agonists are either ineffective or poorly tolerated. There is evidence that HRT/CBIT is effective, but there is no evidence for HRT/CBIT alone relative to combining medication and HRT/CBIT. There is currently no evidence to suggest that the physical and dietary interventions reviewed are sufficiently effective and safe to be considered as treatments.
authors.affiliation: National Collaborating Centre for Mental Health, University College London, London, UK.
authors.forename: Craig
authors.identifier: 0000-0002-1950-0334
authors.initials: C
authors.lastname: Whittington
authors.affiliation: National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Pennant
authors.affiliation: National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Kendall
authors.affiliation: Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Cristine
authors.initials: C
authors.lastname: Glazebrook
authors.affiliation: School of Psychological Sciences, University of Manchester, Manchester, UK.
authors.forename: Penny
authors.initials: P
authors.lastname: Trayner
authors.affiliation: Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Groom
authors.affiliation: Paediatric Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' Hospital, London, UK.
authors.forename: Tammy
authors.initials: T
authors.lastname: Hedderly
authors.affiliation: Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children, London, UK.
authors.forename: Isobel
authors.initials: I
authors.lastname: Heyman
authors.affiliation: Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Georgina
authors.initials: G
authors.lastname: Jackson
authors.affiliation: School of Psychology, University of Nottingham, Nottingham, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Jackson
authors.affiliation: Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children, London, UK.
authors.forename: Tara
authors.initials: T
authors.lastname: Murphy
authors.affiliation: National Centre for Mental Health, University of Birmingham, Birmingham, UK.
authors.forename: Hugh
authors.initials: H
authors.lastname: Rickards
authors.affiliation: Department of Neurology, St Georges Hospital, London, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Robertson
authors.affiliation: Department of Neurology, St Georges Hospital, London, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Stern
authors.affiliation: Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Hollis
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D006801:Humans; D005879:Tourette Syndrome / Q000188:drug therapy / Q000628:therapy*; D055815:Young Adult
keywords: Paediatrics; Tourette syndrome; therapy; tics