Improving Symptom Trajectories of Tic Disorders and Co-Occurring Diagnoses: The Role of Integrative Intensive Intervention

Tic Disorders (TDs) are neurodevelopmental disorders characterized by involuntary movements or sounds, which can often impact an individual’s quality of life and functioning. Youth with TDs frequently also meet criteria for an additional co-occurring diagnosis (i.e., attention- deficit/hyperactivity disorder (ADHD), anxiety, obsessive-compulsive disorder). Comprehensive Behavioral Intervention for Tics (CBIT) is a well-established and first-line behavioral intervention for youth with TDs, however, despite recent investigation into alternative treatment formats, co-occurring symptoms have not yet been explicitly addressed within the context of CBIT. Intensive intervention formats are well established for co-occurring diagnoses of TDs; however, the literature on the utility, feasibility, and acceptability of intensive interventions for TDs and co-occurring diagnoses is limited. The portfolio of graduate research presented in this dissertation consists of three separate studies of increasing rigor evaluating Taming Tics Together (TTT), which was developed by Chelsea Dale, M.S., and Justin Parent, Ph.D. TTT is a novel, 5-day, videoconference-based intensive intervention to concurrently address TD and co- occurring diagnosis symptoms. The first study (Study 1) uses a case study design, which evaluates the TTT program in an individual format with an 11-year-old biracial male diagnosed with Tourette’s Disorder and ADHD. The second study (Study 2) builds upon family feedback and lessons learned in Study 1 and uses a group-based case series design with three male youth (Mage = 9.67, Range = 9 - 11) and their caregivers. The third study (Study 3) builds upon Study 1 and 2 using a randomized controlled trial design with 21 youth (Mage=12.55, 50% male) and a caregiver (95% female) who were randomly assigned to an immediate treatment group vs. a 1- month waitlist. Primary outcomes across all three studies were TD-related, and secondary outcomes were related to co-occurring diagnostic symptom trajectories. Study 3 also incorporated exploratory outcomes related to caregiver-specific, youth quality of life, and interference outcomes. Satisfaction with treatment and attendance was high across all studies. Overall, results across all studies were promising, suggesting feasibility, acceptability, and preliminary support for TTT to simultaneously address TDs and co-occurring diagnoses. Strengths and limitations of each of the three studies, the clinical implications, and future directions are discussed.

Major Professor: Dr. Jonathan S. Comer