This Phase I SBIR proposes to develop and demonstrate the feasibility of an innovative computer-based treatment-delivery product for children with Chronic Tic Disorders (CTD;including Tourette's Disorder) and their families. CTD represents a class of neuropsychiatric disorders, occurring in 1-3 percent of school-aged children that can lead to significant impairments in physical, social, academic, and interpersonal functioning and reduced quality of life. There is currently no cure for CTD, however in large-scale randomized controlled trials;a non- pharmacological treatment known as Comprehensive Behavioral Interventions for Tics (CBIT) has been shown to reduce tics without the adverse side effects associated with pharmacotherapy. A therapist-guided, empirically validated CBIT protocol is available;however the vast majority of individuals who desire CBIT do not have access to therapists trained in the delivery of this intervention. Given the NEED for nonpharmacological treatment options for children with CTD, a desire for such treatments by potential end- users, and the absence of practitioners adequately trained in the treatment, there is a clear NEED for innovative modes of dissemination. The current proposal partners two of the primary developers of the CBIT intervention with PsycTech Ltd., a company that specializes in developing effective computer-based, self-administered treatment delivery products for repetitive behavior disorders. This Phase I project proposes to adapt three core components of the CBIT treatment protocol for self-administration via an interactive web-based computer platform. The resulting product (Computerized Comprehensive Behavioral Intervention for Tics;C-CBIT) will be tested for feasibility, usability, and end-user satisfaction. This Phase I project ill accomplish three aims: (1) to adapt three core components of the therapist-guided CBIT protocol (psychoeducation about tics, self- monitoring, and habit reversal training) into a self-administered format that is appropriate for use with children and their families, (2) Integrate these self-administered CBIT components into an interactive, online computer delivery platform, and (3) establish the feasibility, usability, and acceptability of the preliminary C-CBIT intervention with experts as well as children (ages 8-18) with a CTD and their families.
Chronic tic disorders (CTD) occur in 1-3 percent of school-aged children and are often associated with significantly diminished quality of life and impairments in physical, social, academic, and interpersonal functioning. There is currently no cure for CTD and they are often managed with pharmacotherapies which, although moderately effective for reducing tics in some individuals, have high rates of adverse side effects which limi their use and often result in poor adherence and discontinuation. A non-pharmacological treatment, known as Comprehensive Behavioral Interventions for Tics (CBIT), has shown results similar to those achieved with pharmacotherapy. However, it is not widely available to those who want it. Surveys of families with CTD show that only 6 percent of treatment-seeking children/families and 4 percent of treatment seeking adults had received CBIT. While most respondents desired CBIT, several barriers were identified that restricted access to care including a LACK of providers (especially in underserved areas) and the costs associated with weekly therapy. Clearly there is a NEED for novel dissemination strategies capable of reaching more people and lowering costs associated with treatment. The proposed program, C-CBIT, will offer a novel dissemination strategy that will address treatment barriers. In addition to being universally available to anyone with Internet access, C-CBIT has the potential to significantly lower the cost of treatment. An average course of face-to-face treatment lasts 8-12 sessions and costs $120 - $150 per session with totals exceeding $2,000. In comparison, computerized products for managing other repetitive behavior problems are marketed at $29.95 per month with subscriptions averaging 5 months of use for a total cost of treatment of $150;roughly the cost of a single face-to-face treatment session. As such, the proposed program, C-CBIT, has the potential to address known accessibility problems by offering a novel dissemination strategy that will increase accessibility, reduce delivery burden, and lower the cost of treatment.