{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T12:01:41Z","timestamp":1773921701136,"version":"3.50.1"},"reference-count":40,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,6,16]],"date-time":"2024-06-16T00:00:00Z","timestamp":1718496000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008771","name":"Tourette Association of America","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008771","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disorders"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p><jats:italic>Gamification<\/jats:italic> of behavioral intervention for tic disorders (TDs) potentially enhances compliance and offers key clinical advantages. By delivering immediate positive feedback upon tic\u2010suppression, games may counteract negative reinforcement, which presumably contribute to tic consolidation by relieving uncomfortable premonitory urges.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We developed a gamified protocol (XTics), which leverages this potential by combining gamified tic\u2010triggering with immediate feedback, and evaluated its clinical value in enhancing tic suppression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>XTics encompasses two conditions: <jats:italic>Immediate and Contingent Reward<\/jats:italic> (ICR), where game progression is contingent upon successful tic suppression, and <jats:italic>Delayed Reward<\/jats:italic> (DR), where game events' outcomes are random. Employing a randomized crossover design, 35 participants (aged 7\u201315\u2009years) underwent daily gaming sessions over a week per condition. Improvements in our primary measures, including the inter\u2010tic interval (ITI) and tic severity assessment by blinded evaluators (Yale Global Tic Severity\u2010Total Tic Score [YGTSS\u2010TTS], Rush), and parents (Parent Tic Questionnaire [PTQ]), were compared between ICR and DR, and assessed across conditions for the 4\u2010week protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>No participant voluntarily left the study before completing its two\u2010phase protocol. As expected, ITI showed significantly larger improvement (Z\u2009=\u20094.19, <jats:italic>P<\/jats:italic>\u2009=\u20092.85\u2009\u00d7\u200910\u20135) after ICR (1442\u2009\u00b1\u20092250%) versus DR (242\u2009\u00b1\u2009493%) training, increasing at a higher pace (t(67)\u2009=\u20093.15, <jats:italic>P<\/jats:italic>\u2009=\u20090.0025). Similarly, Rush tic severity scores reduced more post\u2010ICR versus DR (t(47)\u2009=\u20093.47, <jats:italic>P<\/jats:italic>\u2009=\u20090.002). We observed a clinically significant reduction of 25.69\u2009\u00b1\u200923.39% in YGTSS\u2010TTS following a f4\u2010week protocol including both conditions. Parent\u2010reported tic severity decreased by 42.99\u2009\u00b1\u200931.69% from baseline to 3\u2009months post\u2010treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The combination of gamified tic\u2010triggering with immediate and contingent rewards demonstrates a promising approach for enhancing treatment efficacy in TDs, boosting traditional therapeutic methods. \u00a9 2024 The Author(s). <jats:italic>Movement Disorders<\/jats:italic> published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mds.29875","type":"journal-article","created":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T02:34:38Z","timestamp":1718591678000},"page":"1310-1322","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Gamified Closed\u2010Loop Intervention Enhances Tic Suppression in Children: A Randomized 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