Group behavioral interventions for tics and comorbid symptoms in children with chronic tic disorders

Sharon Zimmerman-Brenner, Tammy Pilowsky-Peleg, Lilach Rachamim, Amit Ben-Zvi, Noa Gur, Tara Murphy, Aviva Fattal-Valevski, Michael Rotstein*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Exposure and Response Prevention (ERP), Habit Reversal Training (HRT) and Comprehensive Behavioral Intervention for Tics (CBIT) are effective in reducing tic severity. ERP and HRT have recently gained primary support in a group setting, while CBIT has not been examined similarly. We compared the efficacy of group-CBIT to group-Educational Intervention for Tics (group-EIT) for tics and comorbid symptoms. Children with Tourette Syndrome (TS) or Chronic Tic Disorder (CTD) were randomized to group-CBIT or group-EIT. Tics and comorbid symptoms were assessed in forty-six children pre- and postintervention, and 3-month later. Yale Global Tic Severity Scale (YGTSS) Motor tic severity decreased following both interventions, and was maintained at follow-up for group-CBIT only. The Parent Tic Questionnaire (PTQ) showed significant decrease in total and motor tic severity following group-CBIT only, a gain maintained three months later. YGTSS impairment score decreased following both interventions and was maintained at follow-up. YGTSS vocal tic severity score increased following both interventions, and then decreased significantly at follow up. Co-morbid symptoms including anxiety, behavioral problems, and aggressive behavior decreased following both interventions. Children with behavioral problems benefitted less while children with higher intellectual ability benefit more from intervention. Both group interventions showed efficacy in reducing tic impairment and comorbid symptoms. Group-CBIT was superior to group-EIT in reducing motor tic severity at 3-month follow-up, showing an advantage for tic-focused treatment. Based on the PTQ, group-CBIT was superior to group-EIT in reducing motor, vocal, and total tic scores, a gain maintained three months later. Clinical trial registry information-Group Intervention for Children with Chronic Tics Syndrome: CBIT vs Psychoeducational Intervention URL:, Identifier: NCT02407951,

Original languageEnglish
Pages (from-to)637-648
Number of pages12
JournalEuropean Child and Adolescent Psychiatry
Issue number4
StatePublished - Apr 2022
Externally publishedYes


FundersFunder number
Tourette Syndrome Association in Israel


    • Children
    • Chronic Tic Disorders
    • Comprehensive Behavioral Intervention for Tics
    • Group
    • Tourette Syndrome


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