| Summary: | Background: Tic disorder is a highly debilitating condition that is more common in children and young people (CYP) than adults. A parent and therapist-supported intervention called Online Remote Behavioural Intervention for Tics (ORBIT) was developed to meet the demand for behavioural therapy for CYP with tic disorders. Whilst a randomised controlled trial (RCT) assesses overall efficacy, a process evaluation is necessary to establish how and for whom an intervention works.
Methods: First, a systematic review and meta-analysis was conducted to assess the overall effectiveness of online interventions delivered to CYP with neurodevelopmental disorders (NDDs). Following this, the Medical Research Council’s (MRC) 2015 guidelines were used for this two-part mixed-methods process evaluation. This involved analysing quantitative data, such as participants’ usage of the intervention and baseline demographics as well as purposively sampled, semi-structured interviews. The first part explored the implementation and contextual factors of engagement whilst the second part analysed the mechanisms of impact underpinning the ORBIT intervention.
Results: A systematic review of 10 trials found that six (two aimed at tic disorders) were effective in improving outcomes in CYP. Part one of the process evaluation found the intervention was implemented with high fidelity, and participants deemed the intervention acceptable and satisfactory. Engagement was high with child participants completing an average of 7.5/10 chapters and 99/112 (88.4%) participants completing the minimum of first four chapters: the pre-defined threshold for effective dose. Parental engagement was the only significant independent predictor of child engagement. Part two demonstrated reduced tic severity post intervention and 36% of CYP had their overall clinical condition rated as being very much or much improved post-treatment. Improvement was not moderated by the relationship between demographic or baseline clinical factors and engagement and no mediators were found. However, level of parental engagement was associated with overall clinical improvement and this relationship was illuminated by the qualitative data.
Conclusions: The findings provide promising evidence that an online behavioural intervention is acceptable and accessible amongst CYP with tic disorders, and engaging parents is the key to effective implementation and positive outcomes whilst highlighting that there is no particular subgroup that is more or less likely to engage or to find this treatment beneficial.
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