(PS9-53) Investigating the Effect of Tic-Contingent Attention on Tic Frequency

Abstract Text: Persistent tic disorders (PTDs) are a class of childhood onset neurodevelopmental disorders that are defined by the presence of motor and/or vocal tics (rapid, recurrent, non-rhythmic movements or sounds) that persist for more than one year. Research has shown that tic expression (i.e., topography, frequency, and severity) is influenced by contextual factors and behavioral processes. The behavioral model of tics emphasizes two primary functional components: the tic-contingent removal of premonitory urges is hypothesized to negatively reinforce and thus strengthening tics, and that specific contextual factors within an individual’s environment can exert control over tics (i.e., stimulus control).
Comprehensive Behavioral Intervention for Tics (CBIT) is a package of evidence-based intervention strategies that is based on the behavioral model of tics. One primary component of CBIT includes function-based assessment and intervention (FBAI). During FBAI, the clinician works with the client to identify and modify tic-exacerbating antecedents and consequences utilizing a structured function-based assessment protocol. Although FBAI is a primary component of CBIT, research evaluating the relative contribution of the FBAI component of CBIT to treatment outcomes is non-existent. Experimental studies utilizing objective measurement of tic frequency and functional analysis (e.g., systematic manipulation of antecedents and consequences) are needed to determine whether self-reported tic-exacerbating factors are accurate to actual presentation.
The aims of this study were to provide an added demonstration of the behavioral model of tics and evaluate the reliability of the FBAI between self-reported tic-contingent consequences and objective measurement, specific to attention function. This study used a multielement design, during which child participants were exposed to three experimental conditions (attention, extinction, baseline). Each condition lasted 5 minutes and were presented six times in a randomized order. Participants initially completed a baseline observation, diagnostic assessment and a function-based assessment. Six parent-child dyads will be recruited to participate in this study. To date, five parent-child dyads have been recruited and completed the study protocol. Visual data analysis will be used to evaluate an effect of the experimental conditions on tic frequency. These findings will have clinical implications for the treatment of tic disorders, as well as offer possible directions for future research on intervention mechanisms of CBIT.