Behavioral Interventions for Children and Adults with Tic Disorder

Over the past decade, behavioral interventions have become increasingly recognized and recommended as effective first-line therapies for treating individuals with tic disorders. In this article, we describe a basic theoretical and conceptual framework through which the reader can understand the application of these interventions for treating tics. The three primary behavioral interventions for tics with the strongest empirical support (habit reversal, Comprehensive Behavioral Intervention for Tics, and exposure and response prevention) are described. Research on the efficacy and effectiveness of these treatments is summarized along with a discussion of the research evaluating the delivery of these treatments in different formats and modalities. The article closes with a review of the possible mechanisms of change underlying behavioral interventions for tics and areas for future research.

A Review on Functional Analyses of Tics

Tic disorders are characterized by a class of responses assumed to be neurobiological in origin. Still, several studies have shown that tic frequency can be influenced by antecedent environmental events and social consequences. Prior reviews have summarized the effects of environmental events but have not examined relations between tic diagnosis, behavioral deficits (e.g., intellectual disability), tic topography, and the consequences observed to maintain tics. These variables might be important when attempting to predict or identify relevant consequences. A more thorough understanding of the variables that maintain and give rise to tics might also be useful in predicting responsiveness to treatment and intervention refinement. We reviewed and summarized results from the 13 attempts to experimentally identify maintaining consequences for tics (i.e., functional analyses) that have been published to date. We examined patterns of functions across tic diagnoses (i.e., Tourette's syndrome or not), communication impairments (i.e., an intellectual disability or reported language difficulty), and tic topography. Results suggested that individuals with Tourette's syndrome and those without communication impairments are more likely to have functional analysis outcomes consistent with automatic reinforcement, but exceptions in both directions highlight the utility of functional analysis in treating tics.

Habit reversal training for children with tourette syndrome: update and review

TOPIC

Habit reversal training (HRT) is emerging as an efficacious behavioral intervention for Tourette syndrome in children and adults.

PURPOSE

The purpose of this article is to review the recent literature investigating the efficacy of HRT for treating children with chronic tic disorders.

SOURCES

This review examines single-subject design studies and randomized, controlled trials of HRT conducted in children with chronic tic disorders since 2000.

CONCLUSIONS

Intervention built on HRT appears to be effective for decreasing tic severity in children and adolescents. Results from a recent multisite trial suggest that incorporation of functional analysis may enhance the effectiveness of traditional HRT.

Functional assessment of challenging behavior: toward a strategy for applied settings

The development of experimental functional analysis and more recently functional analysis checklists have become common technologies for evaluating antecedent events and the consequences of problematic behaviors. Children and developmentally disabled persons across the life span with challenging behaviors have been the primary focus of this research. The primary purpose of this paper is to present an overview the developments in this rapidly expanding research literature, particularly as it involves the application of the functional assessment paradigm in applied settings where resources and time are scarce. Implication of the functional assessment research for clinical practice are discussed along with strengths and weakness of the current technology.