Voice over Internet Protocol Delivered Behavior Therapy for Tourette Syndrome

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A Comprehensive Behavioral Intervention for Tics (CBIT) is an emerging treatment for children with Tourette Syndrome (TS) and has been shown to be efficacious in separate randomized trials with children and adults; however, many families of children with TS are prevented from accessing it due to limited availability of adequately trained treatment providers. Recent research has shown that videoconference-delivered CBIT is as effective as face to face delivery, and that both modalities are efficacious. Despite its effectiveness, traditional videoconferencing has limitations including lack of portability, ease of access, the need for third party clinics, and cost. A newer, more convenient alternative to increase access is the use of Voice over Internet Protocol (VoIP) transmission, allowing for the direct delivery of CBIT to patients' homes. Therefore the broad, long-term objective of the proposed research is to increase access to CBIT through developing and testing the feasibility and preliminary efficacy of VoIP-delivered CBIT. Specifically, this project seeks to modify the existing CBIT protocol for tics to be administered via VoIP, assess the cross-modality reliability of a tic severity rating scale, the Yale Global Tic Severity Scale (YGTSS) administered via VoIP and face to face, determine the acceptability, usability, and feasibility of the VoIP-modified version of CBIT, and establish the preliminary efficacy of VoIP-modified CBIT for reducing tics in children with TS compared to a waitlist control condition. As an exploratory aim, the current study will investigate potential correlates of treatment outcome, including home computer equipment available (i.e., web camera type, microphone type, internet upload speed, and type of internet connection), prior computer experience, and comfort with study computer equipment. The original CBIT manual will be adapted for use with VoIP. The VoIP-modified treatment will then be pilot tested with 4 children to determine initial effectiveness, and whether further modifications are needed. Prior to the trial, the cross-modality reliability of the primary outcome measure, the Yale Global Tic Severity Scale, will be assessed. To test preliminary efficacy of the intervention, 20 children (ages 9-17) with TS or Chronic Tic Disorder as a primary diagnosis will be recruited for a randomized, observer-blind, waitlist controlled trial of VoIP-delivered CBI. Participants will be randomly assigned to 8 weekly sessions of CBIT-VoIP through Skype(c) over a 10- week acute treatment period, or waitlist control condition. The proposed research is consistent with the areas of high priority outlined by the NIMH Division of Services and Intervention Research, as the proposed research seeks to adapt a treatment for use in an innovative service delivery modality, and test the intervention through both effectiveness research and a preliminary efficacy trial.