Multimodal Profiling of Response to Pediatric Comprehensive Behavioral Intervention for Tics

Inclusion Criteria:

• Age 10-17 years at time of enrollment.

• Current chronic motor and/or vocal tics, defined as tics for at least 1 year withouta tic-free period of more than 3 consecutive months. Tics must not be due to amedical condition or the direct physiological effects of a substance.

• At least moderate tic severity, defined as a Yale Global Tic Severity Scale totalscore ≥14 (≥9 for those with motor or vocal tics only).

• Full scale IQ greater than 70.

• Child participant required to have English fluency to ensure comprehension of studymeasures and instructions.

• To increase external validity of findings, we will include participants takingpsychotropic medications that have been stable for 6 weeks and expect to remainstable for the study period. Individuals receiving non-tic related psychotherapyinvolving procedures that overlap with CBIT can be eligible to participate if theyrefrain from receiving treatment once enrolled through the post-treatmentassessment. All concurrent treatments will be monitored.

Exclusion Criteria:

• Inability to undergo MRI (e.g., metal in body, claustrophobia, orthodontia) and/orEEG.

• Active suicidality Previous diagnosis of psychosis, cognitive disability, orstructural brain disease that in the investigator opinion would impedeparticipation.

• History of seizure disorder

• Active substance abuse or dependence.

• Presence of another psychiatric or medical condition requiring immediate treatmentand/or for which delay of treatment to focus on tics would be clinicallyinappropriate. Participants will not be excluded for comorbidities that commonlyoccur with TS (e.g., ADHD, OCD, anxiety) provided that this criterion is met, asonly 10-15% of patients with TS have no comorbidities.

• Concurrent psychotherapy focused on tics and/or involving procedures that overlapwith CBIT (e.g., habit reversal therapy, exposure therapy targeting repetitivebehaviors).

• Psychotropic medication changes in the past 6 weeks and/or plans to changemedication during the study period through post-treatment assessment.

• ≥ 4 previous sessions of CBIT.