Weill Cornell Medical College.
San Jose State University; University of California San Francisco.
Behav Ther. 2020 Jul;51(4):659-669. doi: 10.1016/j.beth.2019.10.004. Epub 2019 Nov 27.
The Comprehensive Behavioral Intervention for Tic Disorders (CBIT) has demonstrated efficacy in large randomized controlled trials for children (≥9 yrs), adolescents and adults with Tourette Syndrome and Chronic Tic Disorders. Given the early age of onset for tic disorders, a large portion of affected individuals with chronic tic disorders are less than 9 years of age and appropriate developmental adaptations of behavioral treatment have not yet been tested. The goal of this study was to adapt and evaluate the acceptability and utility of a family-based adaptation of CBIT for children under 9 years of age. Children 5-8 years of age (N = 15) with chronic tics were recruited from three study sites. CBIT was adapted for use with young children and included habit reversal strategies introduced in a developmentally appropriate game format and function-based interventions to reduce family accommodation of and attention to tic symptoms. Children and parents described high level of treatment satisfaction and study retention rate was 100%. Treatment response rate was 54% (CGI-I = 1 or 2) with a significant decrease in the YGTSS total score (Cohen's d = 0.73) that was largely maintained at 3-month and 1-year follow-up assessments. Treatment was associated with reduction of some symptoms of tic-related comorbid syndromes and with changes in parental accommodation and attention to tics. Future research should determine if parental attention to tics and symptom accommodation are important mediators of treatment outcome, or if participating in this intervention at a younger age may prevent the chronic course of tic symptoms.
《抽动障碍综合行为干预（CBIT）》在针对儿童（≥9 岁）、青少年和成人抽动秽语症和慢性抽动障碍的大型随机对照试验中已被证实有效。鉴于抽动障碍的发病年龄较早，许多患有慢性抽动障碍的患者年龄小于 9 岁，尚未对行为治疗的适当发展适应性进行测试。本研究的目的是改编并评估针对 9 岁以下儿童的基于家庭的 CBIT 的可接受性和实用性。从三个研究地点招募了 5-8 岁（N=15）患有慢性抽动的儿童。为幼儿改编了 CBIT，包括以适合发展的游戏形式引入的习惯逆转策略和基于功能的干预措施，以减少家庭对抽动症状的适应和关注。儿童及其父母对治疗的满意度很高，研究保留率为 100%。治疗反应率为 54%（CGI-I=1 或 2），YGTSS 总分显著下降（Cohen's d=0.73），在 3 个月和 1 年随访评估中基本保持不变。治疗与一些抽动相关共病综合征症状的减少以及父母对抽动的适应和关注的改变有关。未来的研究应确定父母对抽动的关注和症状适应是否是治疗结果的重要中介因素，或者在更年轻的时候参与这种干预是否可以防止抽动症状的慢性发展。
