| Objective1.To investigate the clinical effect of the comprehensive behavioral intervention for tics,and the improvement in quality of life for children with tic disorders.2.To investigate the quality of life in children with tic disorders and explore the impact of tic severity and comorbidities on quality of life.Methods1.From December 2017 to October 2018,children with tic disorder were recruited from the pediatrics clinic of Shanghai Mental Health Center and the psychological department of Fudan Pediatrics Hospital,and divided into the CBIT intervention group,the CBIT combined drug group and the drug treatment group,respectively.Assessments was conducted at baseline,four sessions after and eight sessions after respectively,and the clinical effect was assessed by Yale twitch severity scale(YGTSS)and Clinical Global Impression—improvement scale(CGI-I).The adverse effects were scored by TESS.The PedsQL 4.0 was used to compare the quality of life before and after treatment.2.68 pairs of children and their parents,who met the diagnostic criteria of tic disorder in DSM-5,were enrolled in study.Demographic information(including age,gender,education situation,family structure,family income level,parent relationship)was collected by general information questionnaire;Yale comprehensive twitch severity scale(YGTSS)was used to access the severity of tic;the PedsQL 4.0,the mini-CTIM,and GTS-QOL were used to evaluate the quality of life in children with tic.Results1.A total of 37 children with tic disorders were enrolled in this study,including 28 males.The average age was 10.13±2.54,initial YGTSS total tic score was 22.27±6.35,and initial YGTSS function score was 27.84±7.87.There were 12 cases in the CBIT intervention group,10 cases in the CBIT combined drug group and 15 cases in the drug treatment group.The results of one-way anova showed that there was no statistical difference in various variables at the baseline level between the three groups(P>0.05).Four weeks after the end of the four treatments/medication,the total score reduction rate of YGTSS twitches in the CBIT treatment group,the CBIT combined drug treatment group and the drug treatment group was 37.31%,22.73% and 27.26%,respectively,and the functional score reduction rate of YGTSS was 16.67%,15.74% and 4.17%,respectively.At the end of eight treatments/10 weeks after drug administration,the total score reduction rate of YGTSS convulsion in the CBIT treatment group,the CBIT combined drug treatment group and the drug treatment group was 47.49%,39.83% and 56.22%,respectively.The reduction rate of YGTSS functional score was 74.07%,50.00% and 63.54%,respectively.The positive response assessed by CGI-I were 8,4 and 6,respectively.Univariate anova found no statistically significant difference in YGTSS score reduction rates among the three groups(P>0.05).Of the 22 patients treated with CBIT,a total of 12 adverse events were reported during the treatment,two-thirds of which were caused by medication for dyspraxia.A total of 12 adverse events were reported in the drug treatment group,11 of which were related to the use of drugs,and 3 of which were treated with benzodiazepine.By paired sample T test,the quality of life of patients in the CBIT treatment group,the CBIT combined with drug treatment group and the drug treatment group was compared before and after treatment.The CBIT group found in children before treatment self-reported emotional function(69.38±24.85),psychosocial function(80.21±12.16),and parents generation function(87.15±12.64),emotional(66.67±13.46),social psychological function(75.56±7.95),the quality of life scores(78.74±7.69)and after the treatment of children’s self-reported emotional function(80.63±17.00),psychosocial function(85.21±11.32),The differences of physiological function(94.79±4.69),emotional function(82.78±9.72),psychosocial function(86.30±9.12),and total quality of life score(87.32±6.69)were statistically significant(P<0.05).However,there was no statistically significant difference between the children’s self-rated quality of life before treatment and the children’s self-rated quality of life after treatment and the children’s self-rated quality of life and the children’s self-rated quality of life after treatment in the drug treatment group alone(P>0.05).2.The PedsQL 4.0: The internal consistency between pedQL4.0 for children self-evaluation and pedQL4.0 for parents’ evaluation was 0.90 and 0.93,respectively.Between the children comorbid with ADHD or OCD(71.88±17.60)and children no comorbid(83.80±13.21),the quality of life of the parental generation overall level,social function and school differences statistically significant(P<0.05),and evaluation on the physiological function of the parental generation currently in medication of patients(78.88±23.25)and was not associated with(89.12±11.95)differences statistically significant(P<0.05).However,there was no statistically significant difference in the selfassessed quality of life of children with or without comorbidity(P>0.05).The mini-CTIM: The internal consistency of the four CTIM subscales was between 0.63 and 0.88.In terms of school function,there were statistically significant differences between children’s self-assessment(4.19±2.96)and parental assessment(4.90±4.61)in the degree of twitching related damage and children’s self-assessment(5.71±2.99)and parental assessment(6.55±3.48)in the degree of non-twitching related damage(P<0.05).YGTSS twitch severity evaluation and self-evaluation of children and their parents generation function damage person,according to the correlation coefficient of YGTSS voice twitch score(r=0.411,P<0.01)and YGTSS twitch score(r=0.353,P<0.01)associated with the twitch of parental generation evaluation function was positively associated with the degree of damage,statistically significant,and associated with children’s self-reported twitch of associated with the degree of impaired there is no statistical significance(P>0.05)GTS-QOL: The internal consistency of the gts-qol scale cronbach’s alpha coefficient was 0.91.There was no statistically significant difference in gtsqol score and subscales between patients with comorbidity and those without comorbidity(P>0.05).YGTSS total pumping score was positively correlated with physiological subscale(r=0.315),coercive subscale(r=0.471)and gts-qol total score(r=0.298),with statistical significance(P<0.05).Conclusions1.Comprehensive behavioral intervention therapy(CBIT)has a certain clinical effect on the clinical symptoms of children with tic.The incidence of side effects in children with CBIT alone was significantly lower than that of those with medicine.CBIT can help children with tic improve their quality of life and has good acceptability.2.There are some differences between parents’ and children’s evaluation of the quality of life of children.Compared with children,the quality of life was more influenced by objective factors such as the severity of tic,comorbidity.The severity of tic symptoms,especially YGTSS vocal tic score,has a great impact on the quality of life of children.Compared with those without comorbidity,comorbidity patients suffered more serious impairment in school and social functions. |
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