Practitioner review: Treatments for Tourette syndrome in children and young people: a systematic review
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 w...
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| Format: | Article |
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Wiley
2016
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| Online Access: | https://eprints.nottingham.ac.uk/33043/ |
| _version_ | 1848794545935876096 |
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| author | Whittington, Craig Pennant, Mary Kendall, Tim Glazebrook, Cris Trayner, Penny Groom, Madeleine J. Hedderly, Tammy Heyman, Isobel Jackson, Georgina M. Murphy, Tara Rickards, Hugh Robertson, Mary Stern, Jeremy Hollis, Chris |
| author_facet | Whittington, Craig Pennant, Mary Kendall, Tim Glazebrook, Cris Trayner, Penny Groom, Madeleine J. Hedderly, Tammy Heyman, Isobel Jackson, Georgina M. Murphy, Tara Rickards, Hugh Robertson, Mary Stern, Jeremy Hollis, Chris |
| author_sort | Whittington, Craig |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | 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 a2-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 a2-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 a2-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. |
| first_indexed | 2025-11-14T19:17:54Z |
| format | Article |
| id | nottingham-33043 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:17:54Z |
| publishDate | 2016 |
| publisher | Wiley |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-330432020-05-04T17:53:29Z https://eprints.nottingham.ac.uk/33043/ Practitioner review: Treatments for Tourette syndrome in children and young people: a systematic review Whittington, Craig Pennant, Mary Kendall, Tim Glazebrook, Cris Trayner, Penny Groom, Madeleine J. Hedderly, Tammy Heyman, Isobel Jackson, Georgina M. Murphy, Tara Rickards, Hugh Robertson, Mary Stern, Jeremy Hollis, Chris 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 a2-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 a2-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 a2-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. Wiley 2016-05-02 Article PeerReviewed Whittington, Craig, Pennant, Mary, Kendall, Tim, Glazebrook, Cris, Trayner, Penny, Groom, Madeleine J., Hedderly, Tammy, Heyman, Isobel, Jackson, Georgina M., Murphy, Tara, Rickards, Hugh, Robertson, Mary, Stern, Jeremy and Hollis, Chris (2016) Practitioner review: Treatments for Tourette syndrome in children and young people: a systematic review. Journal of Child Psychology and Psychiatry . ISSN 0021-9630 Paediatrics; Tourette syndrome; therapy; tics http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12556/abstract doi:10.1111/jcpp.12556 doi:10.1111/jcpp.12556 |
| spellingShingle | Paediatrics; Tourette syndrome; therapy; tics Whittington, Craig Pennant, Mary Kendall, Tim Glazebrook, Cris Trayner, Penny Groom, Madeleine J. Hedderly, Tammy Heyman, Isobel Jackson, Georgina M. Murphy, Tara Rickards, Hugh Robertson, Mary Stern, Jeremy Hollis, Chris Practitioner review: Treatments for Tourette syndrome in children and young people: a systematic review |
| title | Practitioner review: Treatments for Tourette syndrome in children and young people: a systematic review |
| title_full | Practitioner review: Treatments for Tourette syndrome in children and young people: a systematic review |
| title_fullStr | Practitioner review: Treatments for Tourette syndrome in children and young people: a systematic review |
| title_full_unstemmed | Practitioner review: Treatments for Tourette syndrome in children and young people: a systematic review |
| title_short | Practitioner review: Treatments for Tourette syndrome in children and young people: a systematic review |
| title_sort | practitioner review: treatments for tourette syndrome in children and young people: a systematic review |
| topic | Paediatrics; Tourette syndrome; therapy; tics |
| url | https://eprints.nottingham.ac.uk/33043/ https://eprints.nottingham.ac.uk/33043/ https://eprints.nottingham.ac.uk/33043/ |