1) To evaluate whether comorbidities influence Comprehensive Behavioral Intervention for Tics (CBIT) response.

CBIT has been shown in multiple randomized controlled trials to significantly improve motor and vocal tic control in patients with Tourette syndrome (TS). While attention problems are frequently hypothesized to impair tic suppression therapies, the results have been inconclusive. A differential response to CBIT by tic phenotype and location also has not been extensively investigated. These issues, if better understood, could help inform more optimal candidates for CBIT.

A retrospective real-world analysis of a single Tourette Association of America (TAA) Center of Excellence tertiary referral center was undertaken. Excluded were patients with two or less CBIT therapy visits. The patient and/or the parent completed a tic hierarchy questionnaire at the initial therapy visit and final visit (target was 10 therapies).

There were 48 patients (77.1% males) with a mean age of 16.3±10.8 years and a mean number of visits of 5.9±2.2. Twenty-eight patients (58.3%) responded completely (n=16) or partially (n=12) to CBIT, while 20 patients (41.7%) did not meet pre-established therapy goals. Baseline clinical characteristics and comorbidities were similar between groups with the exception of more attention deficit hyperactivity disorder (ADHD) in the partial response subgroup (p=0.048). Tic phenotypes were assessed. Darting eyes, facial grimace, head forward, throwing head back, shrugging shoulders, quick flexion/extension of arms and stimulus-dependent tics revealed statistically significant improvements with CBIT (p<0.05).

This single center experience suggests that ADHD and tic phenotype may influence CBIT outcome in clinical practice.  This small cohort revealed a more positive effect on tics including head and neck and/or proximal upper extremity involvement. Larger and prospective studies will be needed to fully characterize CBIT response in real-world conditions.