Michael B. Himle, Susanna Chang, Douglas W. Woods, Amanda Pearlman,
Brian Buzzella, Liviu Bunaciu, & John C. Piacentini. (2006)
Establishing the feasibility of direct observation in the assessment of tics
in children with chronic tic disorders.
Journal of Applied Behavior Analysis,
39, 429-440.
Behavior analysis has been at the forefront in establishing effective treatments
for children and adults with chronic tic disorders. As is customary in behavior
analysis, the efficacy of these treatments has been established using
direct-observation assessment methods. Although behavior-analytic treatments
have enjoyed acceptance and integration into mainstream health care practices
for tic disorders (e.g., psychiatry and neurology), the use of direct observation
as a primary assessment tool has been neglected in favor of less objective methods.
Hesitation to use direct observation appears to stem largely from concerns about
the generalizability of clinic observations to other settings (e.g., home) and a
lack of consensus regarding the most appropriate and feasible techniques for
conducting and scoring direct observation. The purpose of the current study was
to evaluate and establish a reliable, valid, and feasible direct-observation protocol
capable of being transported to research and clinical settings. A total of 43 children
with tic disorders, collected from two outpatient specialty clinics, were assessed
using direct (videotape samples) and indirect (Yale Global Tic Severity Scale; YGTSS)
methods. Videotaped observation samples were collected across 3 consecutive weeks
and two different settings (clinic and home), were scored using both exact frequency
counts and partial-interval coding, and were compared to data from a common indirect
measure of tic severity (the YGTSS). In addition, various lengths of videotaped
segments were scored to determine the optimal observation length. Results show
that (a) clinic-based observations correspond well to home-based observations,
(b) brief direct-observation segments scored with time-sampling methods reliably
quantified tics, and (c) indirect methods did not consistently correspond with the
direct methods.
DESCRIPTORS: tics, Tourette’s syndrome, behavioral assessment, direct observation