Pilot Open Case Series of Voice over Internet Protocol-Delivered Assessment and Behavior Therapy for Chronic Tic Disorders

Comprehensive Behavioral Intervention for Tics (CBIT) is an efficacious treatment for children with chronic tic disorders (CTDs). Nevertheless, many families of children with CTDs are unable to access CBIT due to a lack of adequately trained treatment providers, time commitment, and travel distance. This study established the interrater reliability between in-person and Voice over Internet Protocol (VoIP) administrations of the Yale Global Tic Severity Scale (YGTSS), and examined the preliminary efficacy, feasibility, and acceptability of VoIP-delivered CBIT for reducing tics in children with CTDs in an open case series. Across in-person and VoIP administrations of the YGTSS, results showed mean agreement of 91%, 96%, and 95% for motor, phonic, and total tic severity subscales. In the pilot feasibility study, 4 children received 8 weekly sessions of CBIT via VoIP and were assessed at pre- and posttreatment by an independent evaluator. Results showed a 29.44% decrease in clinician-rated tic severity from pre- to posttreatment on the YGTSS. Two of the 4 patients were considered treatment responders at posttreatment, using Clinical Global Impressions–Improvement ratings. Therapeutic alliance, parent and child treatment satisfaction, and videoconferencing satisfaction ratings were high. CBIT was considered feasible to implement via VoIP, although further testing is recommended

HEART RATE VARIABILITY AND ANXIETY IN CHILDREN: TONIC CHARACTERISTICS AND REACTIVITY

AN ABSTRACT OF THE THESIS OF DAGONG RAN, for the MASTER OF ARTS degree in PSYCHOLOGY, presented on JULY 5, 2016, at Southern Illinois University Carbondale. TITLE: HEART RATE VARIABILITY IN CHILDREN: TONIC CHARACTERISTICS AND REACTIVITY MAJOR PROFESSOR: Dr. Sarah Kertz This study investigated tonic heart rate variability (HRV) and heart rate variability reactivity in response to stress in children with anxiety and worry symptoms. Twenty-nine children age 8 to 12 from a rural Midwestern region completed the study and were included in the data analyses. Participants completed an artificial auditioning task in which they were asked to sing in front of a video camera. Electrocardiogram were recorded prior, during, and after the task. Frequency and time domain analyses of HRV were conducted. Neither parent-report or child self-report anxiety/worry symptom levels were associated with baseline frequency domain and time domain HRV. All participants showed similar HRV reactivity in response to the stress task. Specifically, high frequency HRV was higher during baseline than during stress task, and low frequency HRV was higher during baseline than both during stress task and recovery. These findings contradicted with previous literature results. More studies are needed to examine the association between anxiety and HRV in children

A Randomized Waitlist-controlled Pilot Trial of Voice Over Internet Protocol-delivered Behavior Therapy for Youth with Chronic Tic Disorders

Introduction Comprehensive Behavioral Intervention for Tics (CBIT) has been shown to be efficacious for chronic tic disorders (CTDs), but utilization is limited by a lack of treatment providers and perceived financial and time burden of commuting to treatment. A promising alternative to in-person delivery is voice over Internet protocol (VoIP), allowing for remote, real-time treatment delivery to patients’ homes. However, little is known about the effectiveness of VoIP for CTDs. Therefore, the present study examined the preliminary efficacy, feasibility, and acceptability of VoIP-delivered CBIT (CBIT-VoIP). Methods Twenty youth (8–16 years) with CTDs participated in a randomized, waitlist-controlled pilot trial of CBIT-VoIP. The main outcome was pre- to post-treatment change in clinician-rated tic severity (Yale Global Tic Severity Scale). The secondary outcome was clinical responder rate (Clinical Global Impressions – Improvement Scale), assessed using ratings of ‘very much improved’ or ‘much improved’ indicating positive treatment response. Results Intention-to-treat analyses with the last observation carried forward were performed. At post-treatment (10-weeks), significantly greater reductions in clinician-rated, (F(1,18) = 3.05, p \u3c 0.05, partial η2 = 0.15), and parent-reported tic severity, (F(1,18) = 6.37, p \u3c 0.05, partial η2 = 0.26) were found in CBIT-VoIP relative to waitlist. One-third (n = 4) of those in CBIT-VoIP were considered treatment responders. Treatment satisfaction and therapeutic alliance were high. Discussion CBIT can be delivered via VoIP with high patient satisfaction, using accessible, low-cost equipment. CBIT-VoIP was generally feasible to implement, with some audio and visual challenges. Modifications to enhance treatment delivery are suggested