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New online therapy can benefit children with tics

hand holding pen with clipboard in front of video call on computer screen

Published: 07 February 2023

Online behaviour therapy is effective and safe, and could help children with tics, new research shows.

The Online Remote Behavioural Intervention for Tics (ORBIT) trial was funded by the NIHR and led by the University of Nottingham. It looked at online therapy programmes for 9-17 year olds with Tourette’s syndrome or chronic tic disorder. 

Participants tested one of two different behavioural treatments. Both were completed over 10 weeks and featured a number of exercises. 

Different approaches

The first treatment tested Exposure and Response Prevention (ERP). It involved learning to allow the tic to happen, then resisting the urge to tic again for as long as possible. With practise, this technique can increase the time between tics. The second treatment involved learning about tics, rather than how to control them. Participants were supported throughout by an online therapist and their parent or carer.

The new research showed benefits from ERP treatment included reduced scores for low mood and anxiety. It was not only cost effective, but easy for children and young people to access, regardless of where they lived.

Tourette’s syndrome and tics

Around 70,000 children and young people in England have Tourette’s syndrome. Tourette's is the condition most associated with chronic tics. Tic disorders can cause distress in a young person’s school and social life. Despite the impact on those experiencing them, fewer than one in five people living with tics access behavioural therapy. 

Online therapy demonstrates benefits

Dr Charlotte Hall, Principal Research Fellow at the University of Nottingham and ORBIT Trial Manager, said: “These findings are exciting. They are the first to show the long-term benefits of online delivered therapy for tics. We hear a lot from clinicians who want to be able to offer tic therapy but don’t have the skills, money, or resources to offer it. Likewise, we know families who are desperate to access therapy.”

Emma McNally, CEO Tourette’s Action, commented: “I’ve heard from parents who talk of holding their child in their arms in tears, unable to stop motor tics that are so repetitive they become physically painful. Adults who describe muscle spasms so intense and so uncontrollable that they are in extreme pain and yet are unable to stop the tics. The results from this trial are very promising, enabling individuals to access evidence-based treatment to help them better manage and control their tics online. This will be extremely beneficial to individuals who currently have no services local to them. It could potentially improve the lives of so many people.”

Collaborative research

The ORBIT trial has received £1.5m funding from the NIHR through its Health Technology Assessment (HTA) programme. This was a collaborative trial involving:

  • NIHR MindTech
  • The Institute of Mental Health
  • Nottinghamshire Healthcare NHS Foundation Trust
  • Great Ormond Street Hospital 
  • University of Nottingham
  • University College London
  • The Karolinska Institutet.

Researchers also worked closely with the charity Tourette’s Action.

This research is published in the Journal of Child Psychology and Psychiatry.

You may also be interested to read this NIHR Evidence summary which outlines the findings from an earlier stage in the study.


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