title: Moderators and predictors of response to behavior therapy for tics in Tourette syndrome.
abstract: OBJECTIVE
  To examine moderators and predictors of response to behavior therapy for tics in children and adults with Tourette syndrome and chronic tic disorders.
  
  
  METHODS
  Data from 2 10-week, multisite studies (1 in children and 1 in adults; total n = 248) comparing comprehensive behavioral intervention for tics (CBIT) to psychoeducation and supportive therapy (PST) were combined for moderator analyses. Participants (177 male, 71 female) had a mean age of 21.5 ± 13.9 years (range 9-69). Demographic and clinical characteristics, baseline tic-suppressing medication, and co-occurring psychiatric disorders were tested as potential moderators for CBIT vs PST or predictors of outcome regardless of treatment assignment. Main outcomes measures were the Yale Global Tic Severity Scale Total Tic score and the Clinical Global Impression-Improvement score assessed by masked evaluators.
  
  
  RESULTS
  The presence of tic medication significantly moderated response to CBIT vs PST (p= 0.01). Participants showed tic reduction after CBIT regardless of tic medication status, but only participants receiving tic medication showed reduction of tics after PST. Co-occurring psychiatric disorders, age, sex, family functioning, tic characteristics, and treatment expectancy did not moderate response. Across both treatments, greater tic severity (p= 0.005) and positive participant expectancy (p= 0.01) predicted greater tic improvement. Anxiety disorders (p= 0.042) and premonitory urge severity (p= 0.005) predicted lower tic reduction.
  
  
  CONCLUSIONS
  Presence of co-occurring attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, or anxiety disorders did not moderate response to CBIT. Although participants on tic medication showed improvement after CBIT, the difference between CBIT and PST was greater for participants who were not on tic-suppressing medication.
  
  
  BACKGROUND
  The child and adult CBIT studies are listed on clinical trials.gov (NCT00218777 and NCT00231985, respectively).
  
  
  METHODS
  This study provides Class I evidence that CBIT is effective in reducing tic severity across subgroups of patients with chronic tic disorders, although the difference between treatments was smaller for participants on tic-suppressing medications, suggesting reduced efficacy in this subgroup.
authors.affiliation: From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA. denis.sukhodolsky@yale.edu.
authors.forename: Denis G
authors.initials: DG
authors.lastname: Sukhodolsky
authors.affiliation: From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Woods
authors.affiliation: From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA.
authors.forename: John
authors.initials: J
authors.lastname: Piacentini
authors.affiliation: From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA.
authors.forename: Sabine
authors.initials: S
authors.lastname: Wilhelm
authors.affiliation: From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Peterson
authors.affiliation: From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA.
authors.forename: Lily
authors.initials: L
authors.lastname: Katsovich
authors.affiliation: From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA.
authors.forename: James
authors.initials: J
authors.lastname: Dziura
authors.affiliation: From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA.
authors.forename: John T
authors.initials: JT
authors.lastname: Walkup
authors.affiliation: From Yale University School of Medicine (D.G.S., L.K., J.D.), New Haven, CT; Marquette University (D.W.W.), Milwaukee, WI; University of California at Los Angeles Geffen School of Medicine (J.P.); Massachusetts General Hospital/Harvard Medical School (S.W.), Boston; University of Texas Health Science Center at San Antonio (A.L.P.); Weill Cornell Medical College (J.T.W.), New York, NY; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Scahill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001289:Attention Deficit Disorder with Hyperactivity / Q000209:etiology / Q000534:rehabilitation; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D020323:Tics / Q000209:etiology* / Q000534:rehabilitation*; D005879:Tourette Syndrome / Q000150:complications*; D016896:Treatment Outcome; D055815:Young Adult