Case Report
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2014; 2(10): 569-577
Published online Oct 16, 2014. doi: 10.12998/wjcc.v2.i10.569
Intensive outpatient comprehensive behavioral intervention for tics: A case series
Tabatha H Blount, Ann-Louise T Lockhart, Rocio V Garcia, Jeslina J Raj, Alan L Peterson
Tabatha H Blount, Jeslina J Raj, Alan L Peterson, Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, United States
Ann-Louise T Lockhart, Rocio V Garcia, Child and Adolescent Psychology, San Antonio Military Medical Center, Joint Base San Antonio, Ft. Sam Houston, TX 78234, United States
Author contributions: Blount TH and Lockhart AT made equal contributions to the manuscript; Peterson AL designed the report; Blount TH collected patient data and wrote Introduction, Patient A, and assisted with overall editing; Lockhart AT and Garcia RV collected clinical data and wrote Patient B and Discussion; Raj JJ helped write introduction and methods for Patient A.
Correspondence to: Alan L Peterson, Professor, Department of Psychiatry, The University of Texas Health Science Center at San Antonio, 7550 IH-10 West, Suite 1325, San Antonio, TX 78229, United States. petersona3@uthscsa.edu
Telephone: +1-210-5677000
Received: April 22, 2014
Revised: May 29, 2014
Accepted: August 27, 2014
Published online: October 16, 2014
Processing time: 176 Days and 17.1 Hours
Abstract

Recent randomized clinical trials have established the efficacy of Comprehensive Behavioral Intervention for Tics (CBIT) in treating children and adults with Tourette syndrome and persistent tic disorders. However, the standard CBIT protocol uses a weekly outpatient treatment format (i.e., 8 sessions over 10 wk), which may be inconvenient or impractical for some patients, particularly patients, who are required to travel long distances in order to receive care. In contrast, an intensive outpatient program may increase accessibility to evidence-based behavioral treatments for Tourette syndrome and other persistent tic disorders by eliminating the necessity of repeated travel. This case series evaluated the use of an intensive outpatient program CBIT (IOP CBIT) for the treatment of 2 preadolescent males (ages 10 and 14 years) with Tourette syndrome. The IOP CBIT treatment protocol included several hours of daily treatment over a 4-d period. Both children evidenced notable reductions in their tics and maintained treatment gains at follow-up. Moreover, both patients and their parents expressed treatment satisfaction with the IOP CBIT format. This case series addresses an important research gap in the behavioral treatment of tic disorders literature. The patients’ treatment outcomes indicate that IOP CBIT is a promising treatment that warrants more systematic investigation.

Keywords: Tourette syndrome; Tics; Habit reversal; Intensive outpatient; Behavior therapy

Core tip: Comprehensive Behavioral Intervention for Tics (CBIT) is an empirically supported treatment for individuals with Tourette syndrome. However, the standard, weekly outpatient format of CBIT may preclude some from receiving care. This is the first case series to examine the treatment outcomes of intensive outpatient CBIT (Intensive Outpatient Program CBIT) in children. Despite marked differences between the two boy’s presentations, outcomes for both cases were positive.