(PS9-55) Racial and Ethnic Diversity in Comprehensive Behavioral Intervention for Tics Efficacy Research: a Systematic Literature Review.

Abstract Text: Research on the efficacy of Comprehensive Behavioral Intervention for Tics (CBIT) has rapidly increased over the last decade. CBIT is recommended as a first-line treatment for managing tics. However, whether findings regarding the efficacy of CBIT can be generalized to include racial and ethnic minorities is still in question. Given that previous research has shown that culture affects what aspects of CBIT therapist find most beneficial, and racial and ethnic differences are observed in behavioral intervention outcomes for other disorders (Nonaka et al., 2015), it is important to evaluate whether racial and ethnic differences exist in the response to CBIT.

PubMED and PsycInfo were searched using key search terms (i.e., “Tourette” or “chronic tic” or “persistent tic” AND either “Comprehensive Behavioral Intervention for Tics” or “CBIT”). Identified abstracts were reviewed independently by two raters (SR, BCZ) for appropriateness. The references of eligible treatment trials, and review articles were also searched. Identified abstracts/citations were evaluated for the following inclusion criteria: (1) a RCTs, pilot studies, open trials, and case studies; (2) examined the efficacy of CBIT in treating tic disorders (3) available in English. Treatments were classified as CBIT if the studies specifically state that CBIT, based on the CBIT manual (Woods et al., 2008), was administered. To identify relevant studies, we employed specific search criteria. Firstly, we targeted articles published from 2008 onwards, aligning with the release of the CBIT protocol manual by Woods et al. (2008). This timeframe ensures that studies reflect the full implementation of CBIT as intended. Secondly, we included studies utilizing pilot studies, open trials, single-subject designs, or randomized controlled trials (RCTs) to assess the impact of CBIT, with adherence to the Woods et al. (2008) manual. Thirdly, our search encompassed two databases, Pubmed and PsychInfo, to cover medical and psychological research. Articles were screened based on titles and abstracts, with full-length articles reviewed when additional information was necessary for decision-making.

Results showed that 37 out of the 150 (24.7%) included CBIT efficacy studies included information about the racial and ethnic identities of participants, and off these studies, none of them had enough statistical power to make a conclusion about CBITs efficacy in treating non-white individuals.

Due to the lack of statistical power found for racial and ethnic minorities statistical power of research examining the efficacy of CBIT, findings regarding the efficacious nature of CBIT cannot be generalized to include racial and ethnic minorities. Future research should recruit participants from locations with higher racial and ethnic diversity. Furthermore, no research has yet to examine the ways each component of CBIT could be impacted by factors related to individuals with diverse racial/ethnic/cultural backgrounds. Once this research has been conducted, assessing whether culturally responsive adaptations of CBIT are needed can begin.