Improving access to behaviour therapy for young people with Tourette syndrome

Tourette syndrome (TS) and Chronic Tic Disorder (CTD) are childhood-onset neurodevelopmental disorders characterised by motor and vocal tics. Treatment guidelines recommend behaviour therapy (BT) as the first-line treatment for TS/CTD, but availability is generally low. The overall aim of this thesis was to promote the dissemination of BT among young individuals with TS/CTD. Study I was a longitudinal naturalistic study at a paediatric TS/CTD specialist clinic. Seventyfour children and adolescents with TS or CTD were recruited and received regular face-to-face BT at the clinic, either exposure and response prevention (ERP; n=46), habit reversal training (HRT; n=14) or various combinations of psychoeducation, ERP, and HRT (n=14). For the 74 participants, tic severity – as measured by the Total Tic Severity Score (TTSS) of the clinicianrated interview Yale Global Tic Severity Scale (YGTSS) – improved from baseline to the posttreatment assessment point with a large within-group effect size (d=1.03). Thirty-eight participants (57%) were classified as treatment responders at post-treatment. The treatment effects further improved at a 12-month follow-up (12FU). The study concluded that BT for young people with TS/CTD delivered in a naturalistic specialist clinical setting is effective at both short- and long-term, with effects comparable to those in RCTs. Despite the promising results of Study I, few young individuals with TS/CTD have access to such specialised clinical services. To improve accessibility, we developed two therapistsupported, internet-delivered BT programmes based on ERP and HRT (named BIP TIC ERP and BIP TIC HRT, respectively). Next, we evaluated the feasibility, credibility, acceptability, preliminary efficacy, and preliminary durability of the two interventions in a pilot randomised controlled trial (RCT). Twenty-three children and adolescents with TS or CTD were randomised to BIP TIC ERP (n=12) or BIP TIC HRT (n=11). Tic severity, as measured by the primary outcome measure YGTSS-TTSS, improved significantly between baseline and the 3- month follow-up (3FU; the primary endpoint) in the BIP TIC ERP group (d=1.12), but not in the BIP TIC HRT group (d=0.50). Nine participants (75%) in BIP TIC ERP and 6 participants (55%) in BIP TIC HRT were classified as treatment responders at the primary endpoint. The effects of BIP TIC ERP were further maintained at a 12FU. The average therapist support time was 25 minutes per participant and week, compared to 60 minutes in face-to-face BT. Both interventions were concluded as feasible, acceptable, and safe to deliver, but due to its preliminary efficacy, BIP TIC ERP was chosen to be further examined in a larger study. Study III, a fully powered superiority RCT, aimed to evaluate the clinical efficacy of BIP TIC ERP compared with an active control intervention, as well as to conduct a health economic evaluation. Two-hundred and twenty-one children and adolescents with TS or CTD were recruited and randomised to BIP TIC ERP (n=111) or therapist-supported, internet-delivered education (the comparator; n=110). Both groups showed similar tic severity improvements over time, as measured by the primary outcome measure YGTSS-TTSS. No interaction effect of group and time was identified on the YGTSS-TTSS at the primary endpoint (the 3FU), but significantly more participants responded to BIP TIC ERP (n=51; 47%) than to the comparator (n=31; 29%). The average therapist support time per participant and week was 19.05 minutes for the BIP TIC ERP group and 16.55 minutes for the comparator. Overall, the BIP TIC ERP group showed small non-significant gains in quality-adjusted life years (QALYs) at nonsignificantly larger costs. For BIP TIC ERP, the incremental cost per QALY gained was below a willingness-to-pay threshold of 79 000 USD used in Swedish society, at which this intervention had a 66-76% probability of being cost-effective. In this study, both interventions were associated with clinically meaningful tic severity improvements, but BIP TIC ERP showed higher treatment response rates, greater treatment satisfaction, and appears costeffective, indicating that this intervention is more suitable for implementation. The thesis concludes that face-to-face BT for young individuals with TS/CTD can be successfully implemented into a specialist outpatient clinic, with effects comparable to those shown in RCTs. To increase availability further, BT may also be delivered remotely. A dissemination of the BIP TIC ERP intervention into regular healthcare would enable nationwide access to BT for children and adolescents with TS/CTD

Good behavior game – study protocol for a randomized controlled trial of a preventive behavior management program in a Swedish school context

BackgroundEarly conduct problems and school failure are prominent risk factors for several adverse outcomes in later life. With the potential of reaching many children at early stages of their life, school-based interventions constitute a valuable approach to universal prevention. Good behavior game (GBG) is a promising school-based behavior management program, having shown immediate reductions in conduct problems along with several long-term positive effects. Adapting interventions to new contexts may however affect their effectiveness. The current study aims to evaluate the effectiveness of a Swedish adaption of GBG under pragmatic conditions. The intervention is hypothesized to reduce conduct problems in the classroom (primary outcome). Secondary analyses will investigate changes in conduct problems in common school areas, classroom climate, teacher collective efficacy, on-task behavior, as well as investigating behavioral management practices, implementation, and barriers to implementation.MethodsThis is a cluster-randomized trial with two parallel groups. Schools will be randomized (1,1, stratified by their areas sociodemographic index score) to be provided training in GBG or perform business-as-usual. The intervention and data collection lasts for a school year. Data will be collected at three time points: at baseline in the beginning of the school year (prior to training in GBG), after three months, and after nine months (at the end of the school year; primary endpoint). Data consists of teacher-rated measures of conduct problems, classroom climate, teacher collective efficacy, behavior management practices, and implementation factors, along with demographic factors. In addition, data will be collected by independent and blinded observers using corresponding measures in a subset of randomly chosen classrooms. Procedural fidelity will be rated and collected by GBG-trainers during nine observations throughout the school year. Statistical analysis will include frequentist intention-to-treat analysis, and comparisons of estimates with a corresponding Bayesian model using weakly informative priors. The study has currently completed data collection.DiscussionThis study will provide knowledge in universal prevention and school-based interventions with high reach, as well as specific knowledge concerning the effectiveness of an adapted version of GBG under real-world conditions, along with factors affecting its implementation and effects.Clinical trial registrationClinicalTrials.gov, identifier NCT05794893

The Evolution of Contractual Terms in Sovereign Bonds

In reaction to defaults on sovereign debt contracts, issuers and creditors have strengthened the terms in sovereign debt contracts that enable creditors to enforce their debts judicially and that enable sovereigns to restructure their debts. These apparently contradictory approaches reflect attempts to solve an incomplete contracting problem in which debtors need to be forced to repay debts in good states of the world; debtors need to be granted partial relief from debt payments in bad states; debtors may attempt to exploit divisions among creditors in order to opportunistically reduce their debt burden; debtors may engage in excessively risky activities using creditors\u27 money; and debtors and creditors may attempt to externalize costs on the taxpayers of other coun­tries. We support this argument with a statistical study of the development of sovereign bond terms from 1960 to the present

Tourette syndrome research highlights from 2021

We summarize selected research reports from 2021 relevant to Tourette syndrome that the authors consider most important or interesting. The authors welcome article suggestions and thoughtful feedback from readers

The transition of the European Proteomics Association into the future

The following report provides an overview of the discussions and outcome of the EuPA General Council meeting that took place in Estoril 20–21 October 2010. During the annual meeting future policy and action plans in a variety of areas are decided. Several important points were decided upon during this meeting including the expansion of the EuPA Executive Committee by introducing a new EuPA committee – EuPA Developments – that will initially spearhead activities in standardisation, imaging ms and biobanking. The EuPA General Council also invited Russia as its 17th member. More details about these and additional activities are presented in the article

Психологическое влияние рекламы на потребителей славянских государств

Материалы IX Междунар. науч. конф. студентов, аспирантов и молодых ученых, Гомель, 19-20 мая и 7 июня 2016 г

Tourette syndrome research highlights from 2022

This is the ninth yearly article in the Tourette Syndrome Research Highlights series, summarizing selected research reports from 2022 relevant to Tourette syndrome. The authors briefly summarize reports they consider most important or interesting

Effectiveness of multimodal treatment for young people with body dysmorphic disorder in two specialist clinics

Body dysmorphic disorder (BDD) typically originates in adolescence and is associated with considerable adversity. Evidence-based treatments exist but research on clinical outcomes in naturalistic settings is extremely scarce. We evaluated the short- and long-term outcomes of a large cohort of adolescents with BDD receiving specialist multimodal treatment and examined predictors of symptom improvement. We followed 140 young people (age range 10-18) with a diagnosis of BDD treated at two national and specialist outpatient clinics in Stockholm, Sweden (n=96) and London, England (n=44), between January 2015 and April 2021. Participants received multimodal treatment consisting of cognitive behaviour therapy and, in 72% of cases, medication (primarily selective serotonin reuptake inhibitors). Data were collected at baseline, post-treatment, and 3, 6, and 12 months after treatment. The primary outcome measure was the clinician-rated Yale-Brown Obsessive-Compulsive Scale Modified for BDD, Adolescent version (BDD-YBOCS-A). Secondary outcomes included self-reported measures of BDD symptoms, depressive symptoms, and global functioning. Mixed-effects regression models showed that BDD-YBOCS-A scores decreased significantly from baseline to post-treatment (coefficient [95% confidence interval]=-16.33 [-17.90 to -14.76], p<0.001; within-group effect size (Cohen’s d)=2.08 (95% confidence interval, 1.81 to 2.35). At the end of the treatment, 79% of the participants were classified as responders and 59% as full or partial remitters. BDD symptoms continued to improve throughout the follow-up. Improvement was also seen on all secondary outcome measures. Linear regression models identified baseline BDD symptom severity as a predictor of treatment outcome at post-treatment, but no consistent predictors were found at the 12-month follow-up. To conclude, multimodal treatment for adolescent BDD is effective in both the short- and long-term when provided flexibly within a specialist setting. Considering the high personal and societal costs of BDD, specialist care should be made more widely available