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Practitioner Review: Treatments for Tourette syndrome in children and young people – a systematic review
Author(s) -
Whittington Craig,
Pennant Mary,
Kendall Tim,
Glazebrook Cristine,
Trayner Penny,
Groom Madeleine,
Hedderly Tammy,
Heyman Isobel,
Jackson Georgina,
Jackson Stephen,
Murphy Tara,
Rickards Hugh,
Robertson Mary,
Stern Jeremy,
Hollis Chris
Publication year - 2016
Publication title -
journal of child psychology and psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.652
H-Index - 211
eISSN - 1469-7610
pISSN - 0021-9630
DOI - 10.1111/jcpp.12556
Subject(s) - tics , guanfacine , clonidine , tourette syndrome , placebo , psychology , psychological intervention , randomized controlled trial , clinical trial , psychiatry , physical therapy , medicine , clinical psychology , alternative medicine , pathology
Background Tourette syndrome ( TS ) and chronic tic disorder ( CTD ) affect 1–2% of children and young people, but the most effective treatment is unclear. To establish the current evidence base, we conducted a systematic review of interventions for children and young people. Methods Databases were searched from inception to 1 October 2014 for placebo‐controlled trials of pharmacological, behavioural, physical or alternative interventions for tics in children and young people with TS or CTD . Certainty in the evidence was assessed with the GRADE approach. Results Forty trials were included [pharmacological (32), behavioural (5), physical (2), dietary (1)]. For tics/global score there was evidence favouring the intervention from four trials of α 2‐adrenergic receptor agonists [clonidine and guanfacine, standardised mean difference ( SMD ) = −0.71; 95% CI −1.03, −0.40; N = 164] and two trials of habit reversal training ( HRT )/comprehensive behavioural intervention ( CBIT ) ( SMD = −0.64; 95% CI −0.99, −0.29; N = 133). Certainty in the effect estimates was moderate. A post hoc analysis combining oral clonidine/guanfacine trials with a clonidine patch trial continued to demonstrate benefit ( SMD = −0.54; 95% CI −0.92, −0.16), but statistical heterogeneity was high. Evidence from four trials suggested that antipsychotic drugs improved tic scores ( SMD = −0.74; 95% CI −1.08, −0.40; N = 76), but certainty in the effect estimate was low. The evidence for other interventions was categorised as low or very low quality, or showed no conclusive benefit. Conclusions When medication is considered appropriate for the treatment of tics, the balance of clinical benefits to harm favours α 2‐adrenergic receptor agonists (clonidine and guanfacine) as first‐line agents. Antipsychotics are likely to be useful but carry the risk of harm and so should be reserved for when α 2‐adrenergic receptor agonists are either ineffective or poorly tolerated. There is evidence that HRT / CBIT is effective, but there is no evidence for HRT / CBIT alone relative to combining medication and HRT / CBIT . There is currently no evidence to suggest that the physical and dietary interventions reviewed are sufficiently effective and safe to be considered as treatments.