{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T06:29:04Z","timestamp":1793946544239,"version":"4.8.0"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T00:00:00Z","timestamp":1689724800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Introduction<\/jats:title><jats:p>Eight members of the International Parkinson\u2019s Disease and Movement Disorders Society Tic and Tourette Syndrome Study Group formed a subcommittee to discuss further barriers to practice guideline implementation. Based on expert opinion and literature review, the consensus was that practice variations continue to be quite broad and that many barriers in different clinical settings might negatively influence the adoption of the American Academy of Neurology and the European Society for the Study of Tourette Syndrome published guidelines.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Objectives<\/jats:title><jats:p>1) To identify how clinical practices diverge from the existing American Academy of Neurology and European Society for the Study of Tourette Syndrome guidelines, and 2) to identify categories of barriers leading to these clinical care gaps.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Methods and analysis<\/jats:title><jats:p>This article presents the methodology of a planned cross-sectional survey amongst healthcare professionals routinely involved in the clinical care of patients with persistent tic disorders, aimed at 1) identifying how practices diverge from the published guidelines; and 2) identifying categories of barriers leading to these clinical care gaps. Purposeful sampling methods are used to identify and recruit critical persistent tic disorders stakeholders. The analysis will use descriptive statistics.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0288408","type":"journal-article","created":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T19:25:27Z","timestamp":1689794727000},"page":"e0288408","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Study protocol: A cross-sectional survey of clinicians to identify barriers to clinical practice guideline implementation in the assessment and treatment of persistent tic disorders"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4919-8850","authenticated-orcid":true,"given":"Jaclyn M.","family":"Martindale","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harini","family":"Sarva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Martino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald L.","family":"Gilbert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Ganos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Pringsheim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6921-9567","authenticated-orcid":true,"given":"Kevin","family":"Black","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene A.","family":"Malaty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"all on behalf of the Movement Disorder Society Tic and Tourette Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,7,19]]},"reference":[{"key":"pone.0288408.ref001","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and statistical manual of mental disorders","author":"American Psychiatric Association","year":"2013"},{"issue":"2","key":"pone.0288408.ref002","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.pediatrneurol.2012.05.002","article-title":"Prevalence of tic disorders: a systematic review and meta-analysis","volume":"47","author":"T Knight","year":"2012","journal-title":"Pediatr Neurol"},{"issue":"5","key":"pone.0288408.ref003","first-page":"701","article-title":"A controlled study of Tourette syndrome. I. Attention-deficit disorder, learning disorders, and school problems","volume":"41","author":"DE Comings","year":"1987","journal-title":"Am J Hum Genet"},{"issue":"4","key":"pone.0288408.ref004","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1001\/jamapsychiatry.2014.2650","article-title":"Lifetime Prevalence, Age of Risk, and Genetic Relationships of Comorbid Psychiatric Disorders in Tourette Syndrome","volume":"72","author":"ME Hirschtritt","year":"2015","journal-title":"JAMA Psychiatry"},{"key":"pone.0288408.ref005","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1016\/bs.irn.2017.05.006","article-title":"Tourette Syndrome and Chronic Tic Disorders: The Clinical Spectrum Beyond Tics","volume":"134","author":"D Martino","year":"2017","journal-title":"Int Rev Neurobiol"},{"issue":"7","key":"pone.0288408.ref006","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1017\/S0012162200000839","article-title":"An international perspective on Tourette syndrome: selected findings from 3500 individuals in 22 countries","volume":"42","author":"RD Freeman","year":"2000","journal-title":"Developmental Medicine and Child Neurology"},{"issue":"1","key":"pone.0288408.ref007","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1176\/jnp.2009.21.1.13","article-title":"The behavioral spectrum of Gilles de la Tourette syndrome","volume":"21","author":"AE Cavanna","year":"2009","journal-title":"J Neuropsychiatry Clin Neurosci"},{"issue":"4","key":"pone.0288408.ref008","article-title":"Tourette syndrome in a longitudinal perspective. Clinical course of tics and comorbidities, coexisting psychopathologies, phenotypes and predictors","volume":"65","author":"C. Groth","year":"2018","journal-title":"Dan Med J"},{"issue":"1","key":"pone.0288408.ref009","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1001\/archpedi.160.1.65","article-title":"Adulthood outcome of tic and obsessive-compulsive symptom severity in children with Tourette syndrome","volume":"160","author":"MH Bloch","year":"2006","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"1","key":"pone.0288408.ref010","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1542\/peds.102.1.14","article-title":"Course of tic severity in Tourette Syndrome: The first two decades","volume":"102","author":"JF Leckman","year":"1998","journal-title":"Pediatrics"},{"issue":"2","key":"pone.0288408.ref011","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s40474-021-00231-3","article-title":"Course of tic disorders over the lifespan","volume":"8","author":"KJ Black","year":"2021","journal-title":"Curr Dev Disord Rep"},{"key":"pone.0288408.ref012","first-page":"7","article-title":"Comorbidities, Social Impact, and Quality of Life in Tourette Syndrome","author":"V Eapen","year":"2016","journal-title":"Frontiers in Psychiatry"},{"issue":"6","key":"pone.0288408.ref013","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1097\/DBP.0000000000000699","article-title":"Tourette Syndrome has Substantial Impact in Childhood and Adulthood As Well","volume":"40","author":"I Malaty","year":"2019","journal-title":"Journal of Developmental & Behavioral Pediatrics"},{"issue":"2","key":"pone.0288408.ref014","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1007\/s10578-010-0211-4","article-title":"Exploring the Impact of Chronic Tic Disorders on Youth: Results from the Tourette Syndrome Impact Survey","volume":"42","author":"CA Conelea","year":"2011","journal-title":"Child Psychiat Hum D"},{"issue":"4","key":"pone.0288408.ref015","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1212\/CON.0000000000000752","article-title":"Tics and Tourette Syndrome","volume":"25","author":"HS Singer","year":"2019","journal-title":"CONTINUUM Lifelong Learning in Neurology"},{"issue":"2","key":"pone.0288408.ref016","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1177\/0883073809336215","article-title":"The presence of attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder worsen psychosocial and educational problems in Tourette syndrome","volume":"25","author":"N Debes","year":"2010","journal-title":"J Child Neurol"},{"issue":"6","key":"pone.0288408.ref017","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1111\/cch.12033","article-title":"\u2019Everybody just thinks I\u2019m weird\u2019: a qualitative exploration of the psychosocial experiences of adolescents with Tourette syndrome","volume":"39","author":"R Wadman","year":"2013","journal-title":"Child Care Health Dev"},{"issue":"1","key":"pone.0288408.ref018","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/s10447-013-9193-9","article-title":"The Impact of Tourette\u2019s Syndrome in the School and the Family: Perspectives from Three Stakeholder Groups","volume":"36","author":"J Rivera-Navarro","year":"2013","journal-title":"International Journal for the Advancement of Counselling"},{"issue":"19","key":"pone.0288408.ref019","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1212\/WNL.0000000000007466","article-title":"Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders","volume":"92","author":"T Pringsheim","year":"2019","journal-title":"Neurology"},{"issue":"3","key":"pone.0288408.ref020","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1007\/s00787-021-01899-z","article-title":"European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part III: pharmacological treatment","volume":"31","author":"V Roessner","year":"2022","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"3","key":"pone.0288408.ref021","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":"KR M\u00fcller-Vahl","year":"2022","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"3","key":"pone.0288408.ref022","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s00787-021-01842-2","article-title":"European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part I: assessment","volume":"31","author":"N Szejko","year":"2022","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"3","key":"pone.0288408.ref023","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s00787-021-01845-z","article-title":"European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part II: psychological interventions","volume":"31","author":"P Andr\u00e9n","year":"2022","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"pone.0288408.ref024","first-page":"11","article-title":"Clinical Practice Patterns in Tic Disorders Among Movement Disorder Society Members","author":"C Ganos","year":"2021","journal-title":"Tremor Other Hyperk"},{"key":"pone.0288408.ref025","first-page":"4","article-title":"Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis","volume":"20","author":"PM Hollis C","year":"2016","journal-title":"Health Tecnol Assess"},{"issue":"3","key":"pone.0288408.ref026","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1176\/jnp.17.3.324","article-title":"Assessment of scientific and ethical issues in two randomized clinical trial designs for patients with Tourette\u2019s syndrome: a model for studies of multiple neuropsychiatric diagnoses","volume":"17","author":"DL Gilbert","year":"2005","journal-title":"J Neuropsychiatry Clin Neurosci"},{"issue":"19","key":"pone.0288408.ref027","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1212\/WNL.0000000000007467","article-title":"Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders","volume":"92","author":"T Pringsheim","year":"2019","journal-title":"Neurology"},{"issue":"3","key":"pone.0288408.ref028","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/s00787-021-01881-9","article-title":"European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part IV: deep brain stimulation","volume":"31","author":"N Szejko","year":"2022","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"2","key":"pone.0288408.ref029","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1055\/s-2008-1081457","article-title":"Limited knowledge of Tourette syndrome causes delay in diagnosis","volume":"39","author":"NMM Mol Debes","year":"2008","journal-title":"Neuropediatrics"},{"key":"pone.0288408.ref030","article-title":"Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders","author":"T. Pringesheim","journal-title":"Neurology"},{"key":"pone.0288408.ref031","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.jpsychires.2013.12.009","article-title":"A meta-analysis of behavior therapy for Tourette Syndrome","volume":"50","author":"JF McGuire","year":"2014","journal-title":"J Psychiatr Res"},{"key":"pone.0288408.ref032","first-page":"12","article-title":"An International Survey of Health Care Services Available to Patients With Tourette Syndrome","author":"T Bhikram","year":"2021","journal-title":"Frontiers in Psychiatry"},{"issue":"4","key":"pone.0288408.ref033","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s00787-011-0163-7","article-title":"European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment","volume":"20","author":"V Roessner","year":"2011","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"1","key":"pone.0288408.ref034","doi-asserted-by":"crossref","DOI":"10.3390\/jcm11010250","article-title":"ONLINE-TICS: Internet-Delivered Behavioral Treatment for Patients with Chronic Tic Disorders","volume":"11","author":"M Haas","year":"2022","journal-title":"J Clin Med"},{"key":"pone.0288408.ref035","doi-asserted-by":"crossref","first-page":"119","DOI":"10.3389\/fpsyt.2016.00119","article-title":"The ONLINE-TICS Study Protocol: A Randomized Observer-Blind Clinical Trial to Demonstrate the Efficacy and Safety of Internet-Delivered Behavioral Treatment for Adults with Chronic Tic Disorders","volume":"7","author":"E Jakubovski","year":"2016","journal-title":"Front Psychiatry"},{"issue":"14","key":"pone.0288408.ref036","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1212\/WNL.0000000000011704","article-title":"The 5 Pillars in Tourette Syndrome Deep Brain Stimulation Patient Selection: Present and Future","volume":"96","author":"D Martino","year":"2021","journal-title":"Neurology"},{"key":"pone.0288408.ref037","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.pnpbp.2016.02.003","article-title":"Treatment-refractory Tourette Syndrome","volume":"70","author":"BM Kious","year":"2016","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry"},{"issue":"2","key":"pone.0288408.ref038","first-page":"225","article-title":"Treatment-refractory Tourette syndrome","volume":"17","author":"M Porta","year":"2011","journal-title":"Italian Journal of Psychopathology"},{"key":"pone.0288408.ref039","doi-asserted-by":"crossref","first-page":"589511","DOI":"10.3389\/fneur.2020.589511","article-title":"Refractory Gilles de la Tourette Syndrome-Many Pieces That Define the Puzzle","volume":"11","author":"N Szejko","year":"2020","journal-title":"Front Neurol"},{"key":"pone.0288408.ref040","article-title":"Treatment failure in persistent tic disorders: an expert clinicians\u2019 consensus-based definition","author":"D Martino","year":"2021","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"pone.0288408.ref041","first-page":"420","volume-title":"Qualitative methods for health research","author":"J Green","year":"2018"},{"issue":"5","key":"pone.0288408.ref042","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s10488-013-0528-y","article-title":"Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research","volume":"42","author":"LA Palinkas","year":"2015","journal-title":"Adm Policy Ment Health"},{"issue":"5","key":"pone.0288408.ref043","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1007\/s10488-014-0596-7","article-title":"Optimal Design and Purposeful Sampling: Complementary Methodologies for Implementation Research","volume":"42","author":"N Duan","year":"2015","journal-title":"Adm Policy Ment Health"},{"key":"pone.0288408.ref044","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: Building an international community of software platform partners","volume":"95","author":"PA Harris","year":"2019","journal-title":"J Biomed Inform"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0288408","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,17]],"date-time":"2023-12-17T09:46:38Z","timestamp":1702806398000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0288408"}},"subtitle":[],"editor":[{"given":"Tarik A.","family":"Rashid","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,7,19]]},"references-count":44,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7,19]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0288408","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,19]]}}}