Michael Himle Receives a Tourette Association of America Grant
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Michael Himle, |
Awarded from: The Tourette Association of America
Grant title: "Investigating the feasibility, acceptability and initial efficacy of a comprehensive transdiagnostic treatment for complex comorbidity in Tourette Disorder"
Most children with TD meet criteria for >1 one comorbid psychiatric diagnosis [TD+] – even more have impairing symptoms that do not meet full diagnostic criteria but are nonetheless problematic. Comorbid symptoms can be internalizing and/or externalizing and often contribute to functional impairment, family problems, and decreased quality of life beyond that attributable to the tics – further, these symptoms interfere with effective non-drug treatments for tics. Current best practice guidelines for psychosocial management of comorbidity in TD are based on empirically supported intervention (ESI) protocols developed and tested in isolation for single diagnoses.
For children with TD+, especially those with multiple comorbidities, sequential administration of ESIs based on specific diagnoses has several limitations. First, it is difficult to determine which symptoms to prioritize, resulting in delaying intervention for impairing problems. Second, symptoms of one problem (e.g., defiance) can interfere with treatment of another (e.g., OCD). Sequentially administering ESIs fails to adequately address these additive and interactive elements. Transdiagnostic approaches to treatment may overcome limitations of sequential approaches, yet remain untested in TD.
Rather than splitting disorders based on categorical classification, the transdiagnosic approach draws from a unifying theoretical model (that explains disparate conditions via shared mechanisms); it targets shared cognitive, behavioral, emotional, and interpersonal processes that unify or explain varied clinical phenomena. It assumes that these factors are causally interrelated such that altering one aspect of the system will have effects on the other features. Our study aims to (1) test the acceptability and feasibility of a transdiagnostic protocol in a small pilot sample of children with TD+ and refine the protocol based on therapist and patient feedback followed by (2) testing the efficacy of the revised transdiagnostic treatment for reducing internalizing and externalizing symptoms in an open trial of children with TD+.