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Habit-reversal behavioral therapy effective for children with Tourette disorder

Clinical Question:
Is habit-reversal behavioral therapy effective treatment for children with Tourette disorder?

Bottom Line:
A clinically meaningful treatment response occurred significantly more often among children with Tourette disorder who received habit-reversal behavioral training than among children who received standard supportive therapy (number needed to treat [NNT] = 3; 95% CI, 2-4). . (LOE = 1a)

Reference:
Piacentini J, Woods DW, Scahill L, et al. Behavior therapy for children with Tourette disorder. A randomized controlled trial. JAMA 2010;303(19):1929-1937.  [PMID:20483969]

Study Design:
Randomized controlled trial (single-blinded)

Funding:
Government

Allocation:
Concealed

Setting:
Outpatient (specialty)

Synopsis:
Although antipsychotic medications are effective in the management of Tourette disorder, they are often poorly tolerated with side effects including weight gain, cognitive impairment, and adverse motor effects. These investigators identified 126 children, aged 9 to 17 years, meeting standard criteria for Tourette or chronic tic disorder of moderate to severe intensity. Eligible patients randomly received (concealed allocation assignment) 8 sessions over 10 weeks of either the experimental behavioral intervention or standard control supportive therapy and education about tics. The behavioral intervention, described as habit-reversal therapy, consisted of awareness training and self-monitoring of tics with completing-response training that teaches patients to initiate voluntary behavior to disrupt the tic urge. Individuals masked to treatment group assignment assessed outcomes using validated tic severity and global-health evaluation tools. Complete follow-up occurred for 91% of participants at 6 months. Using intention-to-treat analysis, at 3 months the rate of a clinically meaningful treatment response occurred significantly more often among children receiving habit-reversal therapy than among those receiving standard therapy (52.5% vs 18.5%; NNT= 3; 2-4). At 6 months, 87% of positive responders to behavioral therapy exhibited continued benefit compared with baseline.

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