Behavior Therapy for Children with Chronic Tic Disorders

慢性抽动障碍儿童的行为治疗

• 批准号: 7093060
• 负责人: John C. Piacentini
• 金额: $ 72.73万
• 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/7093060
• 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.

慢性抽动障碍(CTD)，包括抽动症(TS)，是以持续的运动和发声抽动为特征的神经行为障碍。抽搐可以是简短、快速和猛烈的动作，也可以是更复杂、更有目的的外观。发声抽搐可以是简单的(例如，抽鼻子、咕哝)，也可以是更复杂的声音(例如，单词和短语)。抽搐随着时间的推移而兴衰，严重程度在青少年早期达到顶峰。儿童抽动障碍可与相当大的痛苦、歧视以及社交和学习障碍有关， 成人期在某些情况下可观察到。CTD的确切原因尚不清楚，病因中既有遗传因素，也有环境因素。大量证据表明，涉及丘脑、基底节和额叶皮质的皮质-皮质下通路功能障碍。行为/环境因素可能在TIC的维持和推广中发挥作用。抑制抽动的标准治疗方法是药物治疗，特别是中枢作用的多巴胺阻断药物。然而，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终止治疗。这份申请表上列出的研究人员的初步工作表明，习惯逆转训练(HRT)是一种很有前途的抽搐干预方法。HRT是一种基于意识训练和竞争反应的多成分行为治疗。它可以与药物联合使用和/或作为单一疗法使用。虽然最初的HRT结果令人鼓舞，但到目前为止的研究都是个案研究或小型随机试验。需要进行大规模试验才能证明激素替代疗法的有效性。 对PA 00-094(儿童和儿童精神障碍的早期识别和治疗)的回应 青少年)，本申请描述了一项多点调查，以评估手动HRT计划在CTD青少年中减少抽动的有效性。为了进行这项研究，抽动秽语综合征协会(TSA)召集了行为科学联盟(BSC)，这是一个由多学科研究人员组成的小组，代表了美国一些领先的TS研究项目，包括耶鲁大学、马萨诸塞州综合医院(MGH)/哈佛大学、加州大学洛杉矶分校和约翰斯·霍普金斯大学。另外两个中心，威尔福德-霍尔医学中心(WHMC)和威斯康星大学-密尔沃基大学(UWM)，拥有在HRT方面具有特定专业知识的研究人员。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，120名患有CTD的青少年将被随机分配到8个疗程(10周)的HRT或对照心理社会治疗中，然后每月为应答者进行3次强化治疗。主要结果将是由临床盲人评分员评估抽动的严重程度的改变。还将探讨对整体功能、生活质量和治疗结果的可能预测因素的影响。根据TSA、JHU、UCLA和UWM的分包合同，招聘地点将作为招聘地点，而来自MGH、WHMC和耶鲁的调查人员将提供具体质量 将通过单独的分包合同提供保证和评估服务，并将为数据和安全监测目的组装一个数据和安全监测系统。耶鲁信息集团将提供数据管理服务。