Computerized Self Administered Behavioral Intervention for Tics in Children

描述（由申请人提供）：本I期SBIR旨在开发和证明一种创新的基于计算机的治疗递送产品的可行性，用于慢性抽动障碍（CTD，包括图雷特病）儿童及其家庭。CTD代表了一类神经精神疾病，发生在1- 3%的学龄儿童中，可导致身体、社会、学术和人际功能的严重损害，并降低生活质量。然而，在大规模的随机对照试验中，目前还没有治愈CTD的方法；一种被称为抽动症综合行为干预（CBIT）的非药物治疗已被证明可以减少抽动症，而且没有与药物治疗相关的不良副作用。治疗师指导，经验验证的CBIT协议是可用的；然而，绝大多数渴望CBIT的人没有机会接触到受过这种干预训练的治疗师。考虑到对CTD儿童非药物治疗方案的需求，潜在最终用户对此类治疗的渴望，以及缺乏在治疗方面受过充分培训的从业人员，显然需要创新的传播模式。目前的提议是将CBIT干预的两个主要开发者与PsycTech Ltd.合作，PsycTech Ltd.是一家专门开发有效的基于计算机的、自我管理的重复性行为障碍治疗产品的公司。这个第一阶段的项目建议调整CBIT治疗方案的三个核心组成部分，通过一个交互式的基于web的计算机平台进行自我管理。最终的产品（计算机综合行为干预抽搐；C-CBIT）将被测试的可行性，可用性和最终用户满意度。第一期项目将实现三个目标：(1)将治疗师指导的CBIT协议的三个核心组成部分（抽搐心理教育、自我监控和习惯逆转训练）改编成适合儿童及其家庭使用的自我管理的形式；(2)将这些自我管理的CBIT组成部分整合到一个交互式的在线计算机交付平台中；专家以及患有CTD的儿童（8-18岁）及其家人对初步C-CBIT干预的接受程度。

DESCRIPTION (provided by APPLICANT): This Phase I SBIR proposes to develop and demonstrate the feasibility of an innovative computer-based treatment-delivery product for children with Chronic Tic Disorders (CTD; including Tourette's Disorder) and their families. CTD represents a class of neuropsychiatric disorders, occurring in 1-3 percent of school-aged children that can lead to significant impairments in physical, social, academic, and interpersonal functioning and reduced quality of life. There is currently no cure for CTD, however in large-scale randomized controlled trials; a non- pharmacological treatment known as Comprehensive Behavioral Interventions for Tics (CBIT) has been shown to reduce tics without the adverse side effects associated with pharmacotherapy. A therapist-guided, empirically validated CBIT protocol is available; however the vast majority of individuals who desire CBIT do not have access to therapists trained in the delivery of this intervention. Given the NEED for nonpharmacological treatment options for children with CTD, a desire for such treatments by potential end- users, and the absence of practitioners adequately trained in the treatment, there is a clear NEED for innovative modes of dissemination. The current proposal partners two of the primary developers of the CBIT intervention with PsycTech Ltd., a company that specializes in developing effective computer-based, self-administered treatment delivery products for repetitive behavior disorders. This Phase I project proposes to adapt three core components of the CBIT treatment protocol for self-administration via an interactive web-based computer platform. The resulting product (Computerized Comprehensive Behavioral Intervention for Tics; C-CBIT) will be tested for feasibility, usability, and end-user satisfaction. This Phase I project ill accomplish three aims: (1) to adapt three core components of the therapist-guided CBIT protocol (psychoeducation about tics, self- monitoring, and habit reversal training) into a self-administered format that is appropriate for use with children and their families, (2) Integrate these self-administered CBIT components into an interactive, online computer delivery platform, and (3) establish the feasibility, usability, and acceptability of the preliminary C-CBIT intervention with experts as well as children (ages 8-18) with a CTD and their families. PUBLIC HEALTH RELEVANCE: Chronic tic disorders (CTD) occur in 1-3 percent of school-aged children and are often associated with significantly diminished quality of life and impairments in physical, social, academic, and interpersonal functioning. There is currently no cure for CTD and they are often managed with pharmacotherapies which, although moderately effective for reducing tics in some individuals, have high rates of adverse side effects which limi their use and often result in poor adherence and discontinuation. A non-pharmacological treatment, known as Comprehensive Behavioral Interventions for Tics (CBIT), has shown results similar to those achieved with pharmacotherapy. However, it is not widely available to those who want it. Surveys of families with CTD show that only 6 percent of treatment-seeking children/families and 4 percent of treatment seeking adults had received CBIT. While most respondents desired CBIT, several barriers were identified that restricted access to care including a LACK of providers (especially in underserved areas) and the costs associated with weekly therapy. Clearly there is a NEED for novel dissemination strategies capable of reaching more people and lowering costs associated with treatment. The proposed program, C-CBIT, will offer a novel dissemination strategy that will address treatment barriers. In addition to being universally available to anyone with Internet access, C-CBIT has the potential to significantly lower the cost of treatment. An average course of face-to-face treatment lasts 8-12 sessions and costs $120 - $150 per session with totals exceeding $2,000. In comparison, computerized products for managing other repetitive behavior problems are marketed at $29.95 per month with subscriptions averaging 5 months of use for a total cost of treatment of $150; roughly the cost of a single face-to-face treatment session. As such, the proposed program, C-CBIT, has the potential to address known accessibility problems by offering a novel dissemination strategy that will increase accessibility, reduce delivery burden, and lower the cost of treatment.