{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T14:03:48Z","timestamp":1793109828272,"version":"4.5.0"},"reference-count":24,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T00:00:00Z","timestamp":1730937600000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health Research i4i PDA","award":["NIHR205467"],"award-info":[{"award-number":["NIHR205467"]}]},{"name":"National Institute for Health Research Health Technology Assessment","award":["16\/19\/02"],"award-info":[{"award-number":["16\/19\/02"]}]},{"DOI":"10.13039\/501100020624","name":"NIHR Nottingham Biomedical Research Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100020624","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Ment Health"],"accepted":{"date-parts":[[2024,9,20]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>There are no specific national guidelines in England to guide healthcare professionals in how to assess or treat young people with tic disorders. Access to evidence-based treatment, including behavioural therapy, is of limited availability.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>This study examined the economic impact on services arising from a lack of access to appropriate healthcare services for young people with tic disorders, alongside the impact on school attendance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This study used data from the randomised controlled trial \u2018ORBIT\u2019 (Online Remote Behavioural Intervention for Tics). ORBIT compared online exposure and response prevention behavioural therapy for tics with online psychoeducation and recruited 224 young people aged 9\u201317 years in England. Here, we explore costs of health service use and school absenteeism from children who participated in the ORBIT trial and present these alongside the economic impact of including ORBIT within a tic service. We supplement ORBIT data with findings from two case studies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>The data showed that patients have care from several healthcare professionals and miss school due to accessing care for tics. The case studies suggest that most of these contacts with specialist services are unlikely to be supportive. However, adding ORBIT could save the National Health Service \u00a31 million.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Young people with tic disorders are likely to engage in substantial use of healthcare resources because of inadequate care pathways. The availability of an evidence-based online therapy such as ORBIT could save money to the healthcare system.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical implications<\/jats:title>\n                  <jats:p>There is a need to improve service provision and develop national guidelines for tic disorders.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"ISRCTN70758207\">ISRCTN70758207<\/jats:ext-link>, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT03483493\">NCT03483493<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjment-2024-301241","type":"journal-article","created":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T02:30:11Z","timestamp":1731033011000},"page":"e301241","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Healthcare utilisation and costs associated with poor access to diagnosis and treatment for children and young people with tic disorders"],"prefix":"10.1136","volume":"27","clinical-trial-number":[{"clinical-trial-number":"isrctn70758207","registry":"10.18810\/isrctn"},{"clinical-trial-number":"nct03483493","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"isrctn70758207","registry":"10.18810\/isrctn"},{"clinical-trial-number":"nct03483493","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5412-6165","authenticated-orcid":false,"given":"Charlotte L","family":"Hall","sequence":"first","affiliation":[{"name":"NIHR MindTech MedTech Health Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK"},{"name":"NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham School of Medicine, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Le Novere","sequence":"additional","affiliation":[{"name":"Research Department of Primary Care and Population Health and Priment CTU, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"Murphy","sequence":"additional","affiliation":[{"name":"University College London Great Ormond Street Institute of Child Health, London, UK"},{"name":"Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"McNally","sequence":"additional","affiliation":[{"name":"Tourettes Action, Farnborough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Hollis","sequence":"additional","affiliation":[{"name":"NIHR MindTech MedTech Health Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK"},{"name":"NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham School of Medicine, Nottingham, UK"},{"name":"Child and Adolescent Psychiatry, Queen's Medical Centre, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael","family":"Hunter","sequence":"additional","affiliation":[{"name":"Research Department of Primary Care and Population Health and Priment CTU, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,11,7]]},"reference":[{"key":"2025082701393894000_27.1.e301241.1","unstructured":"American Psychiatric Association . Diagnostic and statistical manual of mental disorders. In: DSM-5. American Psychiatric A, American Psychiatric Association DSMTF. Arlington, VA: American Psychiatric Association, 2013. Available: https:\/\/psychiatryonline.org\/doi\/book\/10.1176\/appi.books.9780890425596"},{"key":"2025082701393894000_27.1.e301241.2","doi-asserted-by":"publisher","DOI":"10.1017\/S0012162200000839"},{"key":"2025082701393894000_27.1.e301241.3","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1007\/s40474-022-00258-0","article-title":"The Developmental Trajectories and Long-Term Outcomes of Childhood Tourette Syndrome: a Systematic Review","volume":"9","author":"Reagan","year":"2022","journal-title":"Curr Dev Disord Rep"},{"key":"2025082701393894000_27.1.e301241.4","first-page":"111","article-title":"Suicide in Tourette\u2019s and Chronic Tic Disorders","volume":"82","author":"Fern\u00e1ndez de la Cruz","year":"2017","journal-title":"Biol Psychiatry Cogn Neurosci Neuroimaging"},{"key":"2025082701393894000_27.1.e301241.5","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2022.914044","article-title":"'I\u2019m in pain and I want help': An online survey investigating the experiences of tic-related pain and use of pain management techniques in people with tics and tic disorders","volume":"13","author":"Taylor","year":"2022","journal-title":"Front Psychiatry"},{"key":"2025082701393894000_27.1.e301241.6","doi-asserted-by":"publisher","DOI":"10.1007\/s00787-011-0165-5"},{"key":"2025082701393894000_27.1.e301241.7","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1111\/bjop.12118","article-title":"The lived experiences of individuals with Tourette syndrome or tic disorders: a meta\u2010synthesis of qualitative studies","volume":"106","author":"Smith","year":"2015","journal-title":"British J of Psychology"},{"key":"2025082701393894000_27.1.e301241.8","doi-asserted-by":"crossref","DOI":"10.3390\/jcm10112479","article-title":"A Comprehensive Review of Tic Disorders in Children","volume":"10","author":"Ueda","year":"2021","journal-title":"J Clin Med"},{"key":"2025082701393894000_27.1.e301241.9","doi-asserted-by":"publisher","DOI":"10.3310\/hta20220"},{"key":"2025082701393894000_27.1.e301241.10","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1007\/s00787-021-01832-4","article-title":"European clinical guidelines for Tourette syndrome and other tic disorders: summary statement","volume":"31","author":"M\u00fcller-Vahl","year":"2022","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"2025082701393894000_27.1.e301241.11","doi-asserted-by":"crossref","unstructured":"Andr\u00e9n P , Jakubovski E , Murphy TL , et al . European clinical guidelines for Tourette syndrome and other tic disorders\u2014version 2.0. Part II: psychological interventions. Eur Child Adolesc Psychiatry 2021;1\u201321.","DOI":"10.1007\/s00787-021-01845-z"},{"key":"2025082701393894000_27.1.e301241.12","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2022.928487","article-title":"Digital and remote behavioral therapies for treating tic disorders: Recent advances and next steps","volume":"13","author":"Khan","year":"2022","journal-title":"Front Psychiatry"},{"key":"2025082701393894000_27.1.e301241.13","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1111\/jcpp.12556","article-title":"Practitioner Review: Treatments for Tourette syndrome in children and young people - a systematic review","volume":"57","author":"Whittington","year":"2016","journal-title":"J Child Psychol Psychiatry"},{"key":"2025082701393894000_27.1.e301241.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-015-0430-0","article-title":"Perceptions of treatment for tics among young people with Tourette syndrome and their parents: a mixed methods study","volume":"15","author":"Cuenca","year":"2015","journal-title":"BMC Psychiatry"},{"key":"2025082701393894000_27.1.e301241.15","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-023-09753-5","article-title":"Patients\u2019 experience of accessing support for tics from primary care in the UK: an online mixed-methods survey","volume":"23","author":"Marino","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"2025082701393894000_27.1.e301241.16","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-027583","article-title":"Investigating a therapist-guided, parent-assisted remote digital behavioural intervention for tics in children and adolescents-\u2019Online Remote Behavioural Intervention for Tics\u2019 (ORBIT) trial: protocol of an internal pilot study and single-blind randomised controlled trial","volume":"9","author":"Hall","year":"2019","journal-title":"BMJ Open"},{"key":"2025082701393894000_27.1.e301241.17","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1016\/S2215-0366(21)00235-2","article-title":"Therapist-supported online remote behavioural intervention for tics in children and adolescents in England (ORBIT): a multicentre, parallel group, single-blind, randomised controlled trial","volume":"8","author":"Hollis","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"2025082701393894000_27.1.e301241.18","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1111\/jcpp.13756","article-title":"Long-term clinical and cost-effectiveness of a therapist-supported online remote behavioural intervention for tics in children and adolescents: extended 12- and 18-month follow-up of a single-blind randomised controlled trial","volume":"64","author":"Hollis","year":"2023","journal-title":"J Child Psychol Psychiatry"},{"key":"2025082701393894000_27.1.e301241.19","doi-asserted-by":"publisher","DOI":"10.3310\/MNJY9014"},{"key":"2025082701393894000_27.1.e301241.20","doi-asserted-by":"crossref","DOI":"10.2196\/25470","article-title":"Fidelity of Delivery and Contextual Factors Influencing Children\u2019s Level of Engagement: Process Evaluation of the Online Remote Behavioral Intervention for Tics Trial","volume":"23","author":"Khan","year":"2021","journal-title":"J Med Internet Res"},{"key":"2025082701393894000_27.1.e301241.21","doi-asserted-by":"publisher","DOI":"10.1097\/00004583-198907000-00015"},{"key":"2025082701393894000_27.1.e301241.22","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.107.038984"},{"key":"2025082701393894000_27.1.e301241.23","unstructured":"Office for National Statistics . Analysis of population estimates tool for UK. 2021. Available: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/populationandmigration\/populationestimates\/datasets\/analysisofpopulationestimatestoolforuk [Accessed 23 May 2024]."},{"key":"2025082701393894000_27.1.e301241.24","unstructured":"Gov.UK . The link between absence and attainment at KS2 and KS4 2013\/14 academic year. 2021. 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