TY - JOUR
T1 - Optimizing behavior therapy for youth with Tourette’s disorder
AU - McGuire, Joseph F.
AU - Ginder, Nathaniel
AU - Ramsey, Kesley
AU - Essoe, Joey Ka Yee
AU - Ricketts, Emily J.
AU - McCracken, James T.
AU - Piacentini, John
N1 - Funding Information:
This work was supported in part by grants from the Tourette Association of American (JFMG, JKYE), American Academy of Neurology (JFMG), American Psychological Foundation (JFMG), and NIMH T32MH073517 (JTMC and JP). The views expressed within this article represent those of the authors, were not influenced by the funding sources, and are not intended to represent the position of the NIMH.
Funding Information:
NG and KR report having nothing to disclose. JFMG reports having received research or grant support from the Tourette Association of America, American Academy of Neurology, the Brain Research Foundation, American Psychological Foundation, and the Hilda and Preston Davis Family Foundation. He has received royalties from Elsevier, and has served as a consultant for Signant Health, Syneos Health, and Luminopia. JKYE reports having received grant support from the Tourette Association of America. EJR reports having received research or grant support from the Tourette Association of America and the National Institute of Health. JTMC has received research or grant support from National Institutes of Health, Seaside Therapeutics, Roche, and Otsuka. He has served as a consultant to BioMarin and PharmaNet. JP has received grant or research support from the National Institute of Mental Health, Pfizer Pharmaceuticals through the Duke University Clinical Research Institute CAPTN Network, Psyadon Pharmaceuticals, and the Tourette Association of America. He has received financial support from the Petit Family Foundation and the Tourette Syndrome Association Center of Excellence Gift Fund. He has received royalties from Guilford Press and Oxford University Press. He has served on the speakers’ bureau of the TAA, the International Obsessive-Compulsive Disorder Foundation (IOCDF), and the Trichotillomania Learning Center (TLC).
Publisher Copyright:
© 2020, The Author(s), under exclusive licence to American College of Neuropsychopharmacology.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Tourette’s Disorder (TD) is characterized by tics that cause distress and impairment. While treatment guidelines recommend behavior therapy as a first-line intervention, patients with TD may exhibit limited therapeutic response. Given the need to improve treatment outcomes, this study examined the efficacy of augmenting behavior therapy with d-cycloserine (DCS) to reduce tic severity in a placebo-controlled quick-win/fast-fail trial. Twenty youth with TD completed a baseline assessment to characterize tic severity, premonitory urges, medical history, and psychiatric comorbidity. Youth were randomly assigned to receive a single session of habit reversal training (HRT) augmented by either 50 mg of DCS or placebo. Two bothersome tics on the Hopkins Motor/Vocal Tic Scale (HM/VTS) were targeted for treatment during HRT. One week after the HRT session, youth completed a posttreatment assessment to evaluate change in the severity of bothersome tics. All assessments were completed by independent evaluators masked to treatment group. There was a Treatment Group by Time Interaction in favor of DCS-augmented HRT (p < 0.01), controlling for baseline tic severity, tic medication, and attention deficit hyperactivity disorder. Follow-up comparisons revealed small group differences at the treatment visit (d = 0.27), with the DCS group exhibiting slightly greater severity for targeted tics. There was a large group difference at posttreatment, in which the DCS group exhibited lower severity for targeted tics (d = 1.30, p < 0.001) relative to the placebo group. Findings demonstrate the preliminary enhancement of tic severity reductions by augmenting HRT with DCS compared with placebo augmentation.
AB - Tourette’s Disorder (TD) is characterized by tics that cause distress and impairment. While treatment guidelines recommend behavior therapy as a first-line intervention, patients with TD may exhibit limited therapeutic response. Given the need to improve treatment outcomes, this study examined the efficacy of augmenting behavior therapy with d-cycloserine (DCS) to reduce tic severity in a placebo-controlled quick-win/fast-fail trial. Twenty youth with TD completed a baseline assessment to characterize tic severity, premonitory urges, medical history, and psychiatric comorbidity. Youth were randomly assigned to receive a single session of habit reversal training (HRT) augmented by either 50 mg of DCS or placebo. Two bothersome tics on the Hopkins Motor/Vocal Tic Scale (HM/VTS) were targeted for treatment during HRT. One week after the HRT session, youth completed a posttreatment assessment to evaluate change in the severity of bothersome tics. All assessments were completed by independent evaluators masked to treatment group. There was a Treatment Group by Time Interaction in favor of DCS-augmented HRT (p < 0.01), controlling for baseline tic severity, tic medication, and attention deficit hyperactivity disorder. Follow-up comparisons revealed small group differences at the treatment visit (d = 0.27), with the DCS group exhibiting slightly greater severity for targeted tics. There was a large group difference at posttreatment, in which the DCS group exhibited lower severity for targeted tics (d = 1.30, p < 0.001) relative to the placebo group. Findings demonstrate the preliminary enhancement of tic severity reductions by augmenting HRT with DCS compared with placebo augmentation.
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UR - http://www.scopus.com/inward/citedby.url?scp=85087828044&partnerID=8YFLogxK
U2 - 10.1038/s41386-020-0762-4
DO - 10.1038/s41386-020-0762-4
M3 - Article
C2 - 32653895
AN - SCOPUS:85087828044
SN - 0893-133X
VL - 45
SP - 2114
EP - 2119
JO - Neuropsychopharmacology
JF - Neuropsychopharmacology
IS - 12
ER -