Impact of Cognitive Behavioural Intervention for Tic Disorders in Children

Abstract

Tic disorders are one of the most prevalent neurodevelopmental disorders and if unattended, can have other psychological impact. It can present as poor academic performance, poor concentration, low confidence, anxiety, depression and many others. This case series is about seven children diagnosed with tic disorder, as per Diagnostic and Statistical Manual (DSM) 5 criteria. These children underwent standard behavioural training module comprising of behavioural rewards, Habit Reversal Training (HRT), relaxation training, identification and management of emotions and social skills training; which was planned following case conceptualisation. Yale Global Tic Severity Scale (YGTSS) was used before starting therapy and while completing the therapy. Considering the severity of symptoms and distress caused by them, three children were started on medicine (clonidine) along with therapy. Same therapy module was provided online for those children (three) who were not able to come for direct training due to geographic distance and Coronavirus disease-2019 (COVID-2019) pandemic restrictions. All the seven children showed favourable improvement in terms of severity and improvement in the co-morbid conditions. All of them responded to the individualised treatment protocol and showed difference in pre (mean=38) and post (mean=12) total tic severity score suggesting response to treatment. Among them, two children scored zero. This case series demonstrates the application of behavioural therapy including varied strategies as per the individual case conceptualisation.