Tics clinical outcomes

Clinical outcomes are measurable changes in health, function or quality of life that result from our care. Constant review of our clinical outcomes establishes standards against which to continuously improve all aspects of our practice.

We are a national service specialising in the assessment, diagnosis and treatment of children and young people with tic disorders. Tics are fast, repetitive muscle movements that result in sudden body jolts or sounds that are difficult to control.

Our multidisciplinary team includes psychologists and psychiatrists. We work closely with referring teams to understand and offer joined up care. The clinic provides care for children and young people with complex tics aged 3-17 years. Young people are most often referred to the Tics Service if they have additional co-occurring difficulties and where there is a question about the diagnosis or advice on treatment is required.

We provide a ‘stepped care’ approach to treatment, meaning that the child’s treatment will be matched to their needs. We aim to offer all interventions in collaboration with the child’s local child and adolescent mental health team (CAMHS) or paediatrician. Depending on the specific needs identified at the assessment, interventions may include psychological treatment or medication.

The table below outlines the numbers of patients offered intervention or further assessment by our service at the initial assessment between March 2022 and March 2023.

We have delivered group-based interventions for children with tics in our clinics since the late 1990s. We noticed that meeting other children with tics helped children feel more comfortable with their tics and be more knowledgeable about tics generally. They also made friends with other young people with tics and their parents also found new friends who had children with tics.

We initially carried out a study that offered Habit Reversal Training in a group intervention, which was found to be effective. After a few years, we then adapted our individual exposure and response prevention (ERP) therapy to a group therapy approach. This facilitated young people meeting one another and also enabled the team to work through our waiting list efficiently.

The group therapy was delivered once per week over a period of eight weeks. We now collect Goal Based Outcomes (GBOs) before and after each eight-week group. GBOs measure progress towards a goal that a young person or their family may have chosen to work on. It is rated on a 0-10 scale (0 rated as not yet begun to achieve goal and 10 rated as goal achieved). The bar graph below shows the average GBOs before and after the group. These are based on 44 goals collected from 24 young people between January 2021 and December 2022. It is clear that following the group, participants made progress towards achieving their goals.

Feedback from patients and families is important as it helps us to understand what works well and how to improve our interventions. The word cloud below highlights key words in family’s feedback about the remote ERP treatment group.

Functional tics are involuntary physical movements that can be anxiety-driven and are more common in teenage adolescents. A high proportion of the young people we see with functional tics also have undiagnosed neurodevelopmental disorders such as ADHD and Autism.

We run a group psychoeducation session on tic attacks, functional tics and tic-like movements. The aim of this session is for parents and young people to learn more about functional tics and how to cope with them.

We evaluated the group with GBOs to find out how useful it is for young people and parents. The bar chart below shows the average GBO rating before and after the functional tics group. These are based on 50 goals collected from 33 young people between May 2021 and June 2022. The data indicates the participants made progress towards achieving their goals.

We wanted to learn more about attendee’s experiences of the functional tics group. Young people, their parents/carers and local professionals were asked to rate their opinion to statements about the group. The bar graphs below show outcomes from the perspective of young people, their parents/carers and allocated local professional based on 32 service evaluation forms collected between May 2021 and June 2022.

Since the COVID – 19 pandemic we now deliver many group interventions remotely, in agreement with our patients. Through collecting outcome data about our groups, we have been better able to tailor the delivery of groups to meet the needs of our service users.

For example, the Exposure with Response Prevention (ERP) behavioural tic treatment group was initially offered in an ‘intensive’ format remotely over two consecutive days. After gathering feedback, we learnt that there was a patient preference for shorter sessions which led to our service changing the format to be remotely delivered weekly over 8 consecutive shorter sessions.

Current feedback from the group indicates a preference for a face-to-face element within the groups, which we are developing and plan to integrate in the coming months.

This information was published in November 2023.