Behavior Therapy for Children with Chronic Tic Disorders

慢性抽动障碍儿童的行为治疗

• 批准号: 6937678
• 负责人: John C. Piacentini
• 金额: $ 72.35万
• 依托单位: TOURETTE ASSOCIATION OF AMERICA, INC.
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-08-05 至 2008-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6937678
• 关键词: Tourette' s syndrome; abnormal involuntary movement; adolescence (12-20); behavior therapy; behavioral /social science research tag; child mental disorders; chronic disease /disorder; clinical research; cognition; combination therapy; functional ability; habits; human subject; human therapy evaluation; longitudinal human study; mental disorder chemotherapy; middle childhood (6-11); neuropsychological tests; neuropsychology; patient oriented research; psychosocial rehabilitation; quality of life; short term memory

Chronic tic disorders (CTD), including Tourette Syndrome (TS), are neurobehavioral disorders characterized by a persistent pattern of motor and vocal tics. Tics can be brief, rapid and darting movements or more complex and purposeful in appearance. Vocal tics can be simple (e.g., sniffing, grunting) or more complex sounds (e.g., words and phrases). Tics wax and wane over time with peak severity in early teens. Childhood tic disorders can be associated with considerable distress, discrimination, and social and academic impairment, with impairment into adulthood observed in some cases. The exact causes of CTD are unknown with both genetic and environmental factors implicated in etiology. Substantial evidence implicates dysfunction of cortical-subcortical pathways involving the thalamus, basal ganglia and the frontal cortex. Behavioral/environmental factors may play a role in tic maintenance and generalization. The standard treatment for tic suppression is medication, particularly centrally acting dopamine blocking drugs. However, these medications are associated with a range of adverse effects that can result in poor compliance and premature treatment termination. Preliminary work by investigators listed on this application suggests that habit reversal training (HRT) is a promising intervention for tics. HRT is a multicomponent behavioral treatment based on awareness training and competing response. It can be applied in combination with medication and/or as a monotherapy. While initial HRT results are encouraging, studies to date have all been case studies or small randomized trials. Large trials are needed to demonstrate HRT efficacy. In response to PA 00-094 (Early Identification and Treatment of Mental Disorders in Children and Adolescents), this application describes a multisite investigation to evaluate the efficacy of a manualized HRT program for tic reduction in youngsters with CTD. To conduct this study, the Tourette Syndrome Association (TSA) assembled a Behavioral Sciences Consortium (BSC), a multidisciplinary group of investigators representing some of the leading TS research programs in the country including Yale, Massachusetts General Hospital (MGH)/Harvard, UCLA, and Johns Hopkins. Two additional centers, Wilford Hall Medical Center (WHMC) and the University of Wisconsin-Milwaukee (UWM), have investigators with specific expertise in HRT. The mission of the BSC is to develop, test, and disseminate behavioral interventions for patients with CTD. In this study, 120 youngsters with CTD will be randomly assigned to 8 sessions (10 weeks) of HRT or comparison psychosocial treatment followed by 3 monthly booster sessions for responders. The primary outcome will be change in tic severity assessed by blind clinician raters. The effects on overall functioning, quality of life, and possible predictors of treatment outcome will also be explored. Working under subcontract to TSA, JHU, UCLA, and UWM will serve as recruitment sites while investigators from MGH, WHMC, and Yale will provide specific quality assurance and assessment services via separate subcontracts, and a DSMB will be assembled for data and safety monitoring purposes. The Yale Infomatics group will provide data management services.

慢性抽动疾病（CTD），包括Tourette综合征（TS），是神经行为疾病，其特征是运动和声音的持续模式。抽动可以是短暂的，快速和飞镖的运动，也可以是更复杂和有目的的外观。声音抽动可以简单（例如，嗅探，咕unt声）或更复杂的声音（例如单词和短语）。淡淡的蜡和随着时间的流逝，青少年早期的峰值严重程度。童年的疾病可能与相当大的困扰，歧视以及社会和学术障碍有关 在某些情况下观察到成年。 CTD的确切原因与遗传学和环境因素有关，涉及病因。大量证据表明，涉及丘脑，基底神经节和额叶皮质的皮质皮质途径的功能障碍。行为/环境因素可能在抽动维持和概括中起作用。抑制作用的标准治疗方法是药物，尤其是中央作用的多巴胺阻断药物。但是，这些药物与一系列不良反应有关，可能导致依从性差和过早治疗终止。在此应用程序中列出的调查人员的初步工作表明，习惯逆转培训（HRT）是抽搐的有前途的干预措施。 HRT是基于意识训练和竞争反应的多组分行为处理。它可以与药物和/或单一疗法结合使用。虽然最初的HRT结果令人鼓舞，但迄今为止的研究都是案例研究或小型随机试验。需要进行大型试验来证明HRT功效。 响应PA 00-094（早期鉴定和治疗儿童的精神障碍和 青少年），该应用程序描述了一项多站点研究，以评估手动HRT计划在使用CTD的年轻人中减少TIC的功效。为了进行这项研究，图雷特综合征协会（TSA）组装了一个行为科学联盟（BSC），该联盟（BSC）是代表该国一些领先的TS研究计划的多学科研究人员，包括耶鲁大学，包括马萨诸塞州耶鲁大学，马萨诸塞州综合医院（MGH）/哈佛大学，UCLA，UCLA，UCLA和Johns Hopkins。 Wilford Hall医疗中心（WHMC）和威斯康星大学 - 米尔沃基大学（UWM）的另外两个中心具有在HRT方面具有特定专业知识的调查人员。 BSC的使命是为CTD患者开发，测试和传播行为干预措施。在这项研究中，有120名CTD的年轻人将随机分配给8个会议（10周）的HRT或比较心理社会治疗，然后为响应者进行3个每月的助推器会议。主要结果将是盲人临床医生评估者评估的TIC严重程度的变化。还将探索对整体功能，生活质量以及治疗结果可能预测指标的影响。根据TSA，JHU，UCLA和UWM的分包合同工作将作为招聘站点，而来自MGH，WHMC和YALE的调查人员将提供特定的质量 通过单独的分包合同进行保证和评估服务，将组装DSMB以进行数据和安全监控目的。耶鲁大学Infomatics组将提供数据管理服务。