Working…
ClinicalTrials.gov
ClinicalTrials.gov Menu

Modified Comprehensive Behavioral Intervention for Tics (M_CBIT) (M_CBIT)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02900144
Recruitment Status : Active, not recruiting
First Posted : September 14, 2016
Last Update Posted : June 3, 2019
Sponsor:
Information provided by (Responsible Party):
Erica Greenberg, Massachusetts General Hospital

Brief Summary:

The main purpose of this trial is to develop and investigate the effects of a modified comprehensive behavioral intervention for tics (CBIT) protocol for children and adolescents with chronic tic disorders and ADHD.

CBIT is a first-line behavioral treatment for individuals with tic disorders. However, the benefit of CBIT is mitigated in those with co-occurring ADHD, as ADHD is negatively associated with effect size in behavioral treatments for tics. Additionally, while tic disorders are associated with reduced quality of life measures, CBIT is 'tic-specific.' Despite improving tics, measures do not show associated improved quality of life. Currently, there are no standardized behavioral treatments for tics that account for ADHD symptoms and/or addresses the impact that tics and ADHD symptoms have on quality of life.

The first aim is to develop a treatment protocol that combines elements from CBIT, Cognitive Behavioral Therapy (CBT) for ADHD and factors targeting psychosocial impairment.

The second aim is to determine the treatment feasibility and acceptability (e.g. retention, reasons for treatment refusal and dropout, and motivation) of this modified CBIT treatment. The investigators will evaluate and assess the randomization process, the treatment modules, and the expectations and satisfaction of the participants and their parents.

The final aim is to use a pilot randomized control trial (RCT) design to evaluate improvement using measures including tic, ADHD and quality of life scales as rated by a blinded clinician. Though the investigators will evaluate efficacy of the modified protocol, the primary purpose will remain feasibility. The hope is to use this study to develop larger trials in the future.


Condition or disease Intervention/treatment Phase
Tourette Syndrome ADHD Behavioral: Modified Comprehensive Behavioral Intervention for Tics Behavioral: Comprehensive Behavioral Intervention for Tics Not Applicable

  Show Detailed Description

Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 20 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Modified Comprehensive Behavioral Intervention for Tics: Treating Children With Tic Disorders, Co-occurring ADHD and Psychosocial Impairment
Study Start Date : September 2016
Estimated Primary Completion Date : March 2020
Estimated Study Completion Date : March 2020

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Modified CBIT Treatment Arm
In this arm, participants will receive the modified CBIT protocol. In addition to addressing tics, the treatment in this arm will also directly address ADHD symptoms using CBT for ADHD techniques, and quality of life concerns. The treatment itself will be modified to be more accessible to an ADHD population. The treatment will consist of twelve 50-min sessions: ten weekly and then two every other week for relapse prevention.
Behavioral: Modified Comprehensive Behavioral Intervention for Tics
In this arm, participants will receive the modified CBIT protocol. In addition to addressing tics, the treatment in this arm will also directly address ADHD symptoms using CBT for ADHD techniques, and quality of life concerns. The treatment itself will be modified to be more accessible to an ADHD population. The treatment will consist of twelve 50-min sessions: ten weekly and then two every other week for relapse prevention.

Active Comparator: Standard CBIT Treatment Arm
In this arm, participants will receive the standard CBIT intervention (Piacentini et al 2010). The primary components of CBIT are habit reversal training, relaxation training and a functional interventional to assess the environment for situations/factors that exacerbate or sustain tics. The treatment will consist of twelve 50-min sessions: ten weekly and then two every other week for relapse prevention.
Behavioral: Comprehensive Behavioral Intervention for Tics
In this arm, participants will receive the standard CBIT intervention (Piacentini et al 2010). The primary components of CBIT are habit reversal training, relaxation training and a functional interventional to assess the environment for situations/factors that exacerbate or sustain tics. The treatment will consist of twelve 50-min sessions: ten weekly and then two every other week for relapse prevention.




Primary Outcome Measures :
  1. Patient Satisfaction Questionnaire [ Time Frame: 26 weeks ]
    Scale that measures the subject's satisfaction with the treatment

  2. Expectancy Therapy Evaluation Form [ Time Frame: Baseline ]
    Rates subject's expectations about effectiveness of the treatment

  3. Satisfaction Scale for Module 1 [ Time Frame: 1 week ]
    Brief Likert scale/multiple choice questions assessing the satisfaction/effectiveness of each session.

  4. Expectancy Therapy Evaluation Form [ Time Frame: 6 weeks ]
    Rates subject's expectations about effectiveness of the treatment

  5. Satisfaction Scale for Module 2 [ Time Frame: 2 weeks ]
    Brief Likert scale/multiple choice questions assessing the satisfaction/effectiveness of each session.

  6. Satisfaction Scale for Module 3 [ Time Frame: 3 weeks ]
    Brief Likert scale/multiple choice questions assessing the satisfaction/effectiveness of each session.

  7. Satisfaction Scale for Module 4 [ Time Frame: 4 weeks ]
    Brief Likert scale/multiple choice questions assessing the satisfaction/effectiveness of each session.

  8. Satisfaction Scale for Module 5 [ Time Frame: 5 weeks ]
    Brief Likert scale/multiple choice questions assessing the satisfaction/effectiveness of each session.

  9. Satisfaction Scale for Module 6 [ Time Frame: 6 weeks ]
    Brief Likert scale/multiple choice questions assessing the satisfaction/effectiveness of each session.

  10. Satisfaction Scale for Module 7 [ Time Frame: 7 weeks ]
    Brief Likert scale/multiple choice questions assessing the satisfaction/effectiveness of each session.

  11. Satisfaction Scale for Module 8 [ Time Frame: 8 weeks ]
    Brief Likert scale/multiple choice questions assessing the satisfaction/effectiveness of each session.

  12. Satisfaction Scale for Module 9 [ Time Frame: 9 weeks ]
    Brief Likert scale/multiple choice questions assessing the satisfaction/effectiveness of each session.

  13. Satisfaction Scale for Module 10 [ Time Frame: 10 weeks ]
    Brief Likert scale/multiple choice questions assessing the satisfaction/effectiveness of each session.

  14. Satisfaction Scale for Module 11 [ Time Frame: 12 weeks ]
    Brief Likert scale/multiple choice questions assessing the satisfaction/effectiveness of each session.

  15. Satisfaction Scale for Module 12 [ Time Frame: 14 weeks ]
    Brief Likert scale/multiple choice questions assessing the satisfaction/effectiveness of each session.

  16. Patient Satisfaction Questionnaire [ Time Frame: 6 weeks ]
    Scale that measures the patient's satisfaction with the treatment

  17. Patient Satisfaction Questionnaire [ Time Frame: 14 weeks ]
    Scale that measures the patient's satisfaction with the treatment


Secondary Outcome Measures :
  1. Yale Global Tic Severity Scale [ Time Frame: Change from baseline to mid-point (6 weeks) ]
    Measures tic symptom severity and impairment

  2. Yale Global Tic Severity Scale [ Time Frame: Change from baseline to end-point (14 weeks) ]
    Measures tic symptom severity and impairment

  3. Yale Global Tic Severity Scale [ Time Frame: Change from baseline to 3months following end-point (26 weeks) ]
    Measures tic symptom severity and impairment

  4. Vanderbilt Assessment Scale - ADHD [ Time Frame: Change from baseline to mid-point (6 weeks) ]
    Measures DSM-IV ADHD and other externalizing behaviors

  5. Vanderbilt Assessment Scale - ADHD [ Time Frame: Change from baseline to end-point (14 weeks) ]
    Measures DSM-IV ADHD and other externalizing behaviors

  6. Vanderbilt Assessment Scale - ADHD [ Time Frame: Change from baseline to 3months following end-point (26 weeks) ]
    Measures DSM-IV ADHD and other externalizing behaviors

  7. Clinical Global Impression - Improvement Scale [ Time Frame: Change from baseline to one week ]
    Measures improvement on a Likert scale

  8. Clinical Global Impression - Severity Scale [ Time Frame: Change from baseline to one week ]
    Measures severity of illness on a Likert scale

  9. Clinical Global Impression - Improvement Scale [ Time Frame: Change from baseline to two weeks ]
    Measures improvement on a Likert scale

  10. Clinical Global Impression - Severity Scale [ Time Frame: Change from baseline to two weeks ]
    Measures severity of illness on a Likert scale

  11. Clinical Global Impression - Improvement Scale [ Time Frame: Change from baseline to three weeks ]
    Measures improvement on a Likert scale

  12. Clinical Global Impression - Severity Scale [ Time Frame: Change from baseline to three weeks ]
    Measures severity of illness on a Likert scale

  13. Clinical Global Impression - Improvement Scale [ Time Frame: Change from baseline to four weeks ]
    Measures improvement on a Likert scale

  14. Clinical Global Impression - Severity Scale [ Time Frame: Change from baseline to four weeks ]
    Measures severity of illness on a Likert scale

  15. Clinical Global Impression - Improvement Scale [ Time Frame: Change from baseline to five weeks ]
    Measures improvement on a Likert scale

  16. Clinical Global Impression - Severity Scale [ Time Frame: Change from baseline to five weeks ]
    Measures severity of illness on a Likert scale

  17. Clinical Global Impression - Improvement Scale [ Time Frame: Change from baseline to six weeks (mid-point) ]
    Measures improvement on a Likert scale

  18. Clinical Global Impression - Severity Scale [ Time Frame: Change from baseline to six weeks (mid-point) ]
    Measures severity of illness on a Likert scale

  19. Clinical Global Impression - Improvement Scale [ Time Frame: Change from baseline to seven weeks ]
    Measures improvement on a Likert scale

  20. Clinical Global Impression - Severity Scale [ Time Frame: Change from baseline to seven weeks ]
    Measures severity of illness on a Likert scale

  21. Clinical Global Impression - Improvement Scale [ Time Frame: Change from baseline to eight weeks ]
    Measures improvement on a Likert scale

  22. Clinical Global Impression - Severity Scale [ Time Frame: Change from baseline to eight weeks ]
    Measures severity of illness on a Likert scale

  23. Clinical Global Impression - Improvement Scale [ Time Frame: Change from baseline to nine weeks ]
    Measures improvement on a Likert scale

  24. Clinical Global Impression - Severity Scale [ Time Frame: Change from baseline to nine weeks ]
    Measures severity of illness on a Likert scale

  25. Clinical Global Impression - Improvement Scale [ Time Frame: Change from baseline to ten weeks ]
    Measures improvement on a Likert scale

  26. Clinical Global Impression - Severity Scale [ Time Frame: Change from baseline to ten weeks ]
    Measures severity of illness on a Likert scale

  27. Clinical Global Impression - Improvement Scale [ Time Frame: Change from baseline to twelve weeks (session 11) ]
    Measures improvement on a Likert scale

  28. Clinical Global Impression - Severity Scale [ Time Frame: Change from baseline to twelve weeks (session 11) ]
    Measures severity of illness on a Likert scale

  29. Clinical Global Impression - Improvement Scale [ Time Frame: Change from baseline to fourteen weeks (session 12) ]
    Measures improvement on a Likert scale

  30. Clinical Global Impression - Severity Scale [ Time Frame: Change from baseline to fourteen weeks (session 12) ]
    Measures severity of illness on a Likert scale

  31. Clinical Global Impression - Improvement Scale [ Time Frame: Change from baseline to 3months after end-point (26 weeks) ]
    Measures improvement on a Likert scale

  32. Clinical Global Impression - Severity Scale [ Time Frame: Change from baseline to 3months after end-point (26 weeks) ]
    Measures severity of illness on a Likert scale

  33. Pediatric Quality of Life Inventory (PedsQL)-Child Version [ Time Frame: Change from baseline to mid-point (6 weeks) ]
    Assesses pediatric population subject's quality of life on a scale of 0-100, with higher scores indicating a better quality of life.

  34. Pediatric Quality of Life Inventory (PedsQL)-Child Version [ Time Frame: Change from baseline to end-point (14 weeks) ]
    Assesses pediatric population subject's quality of life on a scale of 0-100, with higher scores indicating a better quality of life.

  35. Pediatric Quality of Life Inventory (PedsQL)-Child Version [ Time Frame: Change from baseline to 3months following end-point (26 weeks) ]
    Assesses pediatric population subject's quality of life on a scale of 0-100, with higher scores indicating a better quality of life.

  36. Parent Tic Questionnaire (PTQ) [ Time Frame: Mid-point (6 weeks) ]
    Measures severity of specific motor and vocal tics in terms of their frequency and intensity on a scale of 1-4, with higher scores indicating greater frequency and intensity.

  37. Parent Tic Questionnaire (PTQ) [ Time Frame: End-point (14 weeks) ]
    Measures severity of specific motor and vocal tics in terms of their frequency and intensity on a scale of 1-4, with higher scores indicating greater frequency and intensity.

  38. Parent Tic Questionnaire (PTQ) [ Time Frame: 3months following end-point (26 weeks) ]
    Measures severity of specific motor and vocal tics in terms of their frequency and intensity on a scale of 1-4, with higher scores indicating greater frequency and intensity.

  39. ADHD - Self-report [ Time Frame: Change from baseline to mid-point (6 weeks) ]
    Self-report of ADHD symptoms

  40. ADHD - Self-report [ Time Frame: Change from baseline to end-point (14 weeks) ]
    Self-report of ADHD symptoms

  41. ADHD - Self-report [ Time Frame: Change from baseline to 3months following end-point (26 weeks) ]
    Self-report of ADHD symptoms


Other Outcome Measures:
  1. Children's Yale-Brown Obsessive Compulsive Scale [ Time Frame: Change from baseline to mid-point (6 weeks) ]
    Assesses severity of obsessive-compulsive symptoms in the last week

  2. Children's Yale-Brown Obsessive Compulsive Scale [ Time Frame: Change from baseline to end-point (14 weeks) ]
    Assesses severity of obsessive-compulsive symptoms in the last week

  3. Children's Yale-Brown Obsessive Compulsive Scale [ Time Frame: Change from baseline to 3months following end-point (26 weeks) ]
    Assesses severity of obsessive-compulsive symptoms in the last week

  4. Children's Depression Inventory [ Time Frame: Change from baseline to mid-point (6 weeks) ]
    Assesses depressive symptoms in children

  5. Children's Depression Inventory [ Time Frame: Change from baseline to end-point (14 weeks) ]
    Assesses depressive symptoms in children

  6. Children's Depression Inventory [ Time Frame: Change from baseline to 3months following end-point (26 weeks) ]
    Assesses depressive symptoms in children

  7. Emotion Regulation Questionnaire [ Time Frame: Change from baseline to mid-point (6 weeks) ]
    Measures emotion regulation strategies

  8. Emotion Regulation Questionnaire [ Time Frame: Change from baseline to end-point (14 weeks) ]
    Measures emotion regulation strategies

  9. Emotion Regulation Questionnaire [ Time Frame: Change from baseline to 3months following end-point (26 weeks) ]
    Measures emotion regulation strategies

  10. Concomitant Medication and Therapy Questionnaire [ Time Frame: 1 week ]
    Tracks whether there are any concurrent therapy and/or medication changes

  11. Concomitant Medication and Therapy Questionnaire [ Time Frame: 2 weeks ]
    Tracks whether there are any concurrent therapy and/or medication changes

  12. Concomitant Medication and Therapy Questionnaire [ Time Frame: 3 weeks ]
    Tracks whether there are any concurrent therapy and/or medication changes

  13. Concomitant Medication and Therapy Questionnaire [ Time Frame: 4 weeks ]
    Tracks whether there are any concurrent therapy and/or medication changes

  14. Concomitant Medication and Therapy Questionnaire [ Time Frame: 5 weeks ]
    Tracks whether there are any concurrent therapy and/or medication changes

  15. Concomitant Medication and Therapy Questionnaire [ Time Frame: 6 weeks ]
    Tracks whether there are any concurrent therapy and/or medication changes

  16. Concomitant Medication and Therapy Questionnaire [ Time Frame: 7 weeks ]
    Tracks whether there are any concurrent therapy and/or medication changes

  17. Concomitant Medication and Therapy Questionnaire [ Time Frame: 8 weeks ]
    Tracks whether there are any concurrent therapy and/or medication changes

  18. Concomitant Medication and Therapy Questionnaire [ Time Frame: 9 weeks ]
    Tracks whether there are any concurrent therapy and/or medication changes

  19. Concomitant Medication and Therapy Questionnaire [ Time Frame: 10 weeks ]
    Tracks whether there are any concurrent therapy and/or medication changes

  20. Concomitant Medication and Therapy Questionnaire [ Time Frame: 12 weeks ]
    Tracks whether there are any concurrent therapy and/or medication changes

  21. Concomitant Medication and Therapy Questionnaire [ Time Frame: 14 weeks ]
    Tracks whether there are any concurrent therapy and/or medication changes

  22. The Caregiver Strain Questionnaire [ Time Frame: Change from baseline to mid-point (6 weeks) ]
    Assesses the extent to which the subject's condition has negatively affected the family

  23. The Caregiver Strain Questionnaire [ Time Frame: Change from baseline to end-point (14 weeks) ]
    Assesses the extent to which the subject's condition has negatively affected the family

  24. The Caregiver Strain Questionnaire [ Time Frame: Change from baseline to 3months following end-point (26 weeks) ]
    Assesses the extent to which the subject's condition has negatively affected the family

  25. Child Tourette's Syndrome Impairment Scale [ Time Frame: Change from baseline to mid-point (6 weeks) ]
    Assesses the impact that tics have on school, home, and social activities

  26. Child Tourette's Syndrome Impairment Scale [ Time Frame: Change from baseline to end-point (14 weeks) ]
    Assesses the impact that tics have on school, home, and social activities

  27. Child Tourette's Syndrome Impairment Scale [ Time Frame: Change from baseline to 3months following end-point (26 weeks) ]
    Assesses the impact that tics have on school, home, and social activities



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


Layout table for eligibility information
Ages Eligible for Study:   10 Years to 17 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Have a DSM-5-based diagnosis of Tourette Syndrome or Persistent Motor or Vocal Tic Disorder
  2. Have a diagnosis of ADHD by DSM-5 standards, or a previous diagnosis of ADHD where there are some residual symptoms (at least 7/18) but does not currently meet diagnostic criteria due to current medications.
  3. Tic disorder is the most problematic psychiatric disorder and the primary reason for seeking treatment
  4. Have a current total tic severity score of >13 (or >9 if CTD) on the Yale Global Tic Severity Score (YGTSS), and a current total impairment score of >19 on the YGTSS
  5. Be male or female and between 10-17 years of age at the start of the treatment, inclusive
  6. Be able to communicate meaningfully with the investigators and be competent to provide written assent; both parental informed consent and adolescent assent must be obtained
  7. Be English speaking

Exclusion Criteria:

  1. Comorbid psychiatric diagnoses including: alcohol or substance abuse or dependence within the past 3 months, psychosis, organic mental disorder, current mania, developmental delay, estimated IQ <80 on the Wechsler Abbreviated Scale of Intelligence (WASI), other cognitive impairment that would interfere with ability to engage in CBT, or other developmental/cognitive impairment that precludes the participant from being able to communicate meaningfully with the treater
  2. Those deemed to pose a serious suicidal or homicidal threat (e.g., suicide attempt within past 6 months and/or endorsement of "I want to kill myself" on the Children's Depression Inventory (CDI)).
  3. Current illness (tics or otherwise) so severe that an immediate psychopharmacological evaluation is warranted
  4. Any clinical features requiring a higher level of care than outpatient (as determined by evaluator).
  5. Intent to travel for a period longer than two weeks (such that three sessions would be missed) during the proposed time-frame of the study. However, this criterion may be waived as per the discretion of the Principal investigator.
  6. In general, the participant cannot be engaged in concurrent psychotherapy - if they are, they would need to stop (no lag time required between stopping current therapy and beginning this intervention). Decisions can be made on a case by case basis if the therapy is for a concern/disorder separate from mood, anxiety or OCD-spectrum disorders (e.g. gender dysphoria).
  7. Four or more sessions of previous CBT treatment similar to the current treatment (CBIT and/or CBT for ADHD) within the last five years
  8. Participants can be receiving psychotropic medication, but they must be on a stable dose for four weeks prior to the study baseline assessment and maintain this dosage throughout the course of the study. If a potential participant is taking psychotropic medication at the time of the phone evaluation or the first in-person study assessment and wishes to discontinue this medication to enter the trial, the participant will be asked to discuss this option with their prescribing physician to determine whether medication discontinuation would be safe and in the participant's best interest. We will not influence the decision or procedures participants choose with their prescribing physician. If the participant decides to discontinue treatment with the psychotropic medication, he/she must wait for four weeks before receiving a baseline assessment.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02900144


Locations
Layout table for location information
United States, Massachusetts
Massachusetts General Hospital
Boston, Massachusetts, United States, 02114
Sponsors and Collaborators
Massachusetts General Hospital

Publications:
Achenbach, T. M. (1991). Manual for the child behavior checklist/4-18 and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry.
"Attention Deficit Hyperactivity Disorder (ADHD)." Centers for Disease Control and Prevention - National Center for Health Statistics. 2015
Barkley, R.A. (1990). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York, NY: Guilford Press.
Borkovec TD, Nau SD: Credibility for analogue therapy rationales. J Behav Ther Exp Psychiatry 1972; 3:257-260
Brannan AM, Heflinger CA, Bickman L. The Caregiver Strain Questionnaire: measuring the impact on the family of living with a child with serious emotional disturbance. J Emot Behav Disord. 1997;5(4):212-222
Chang S, Himle M, Tucker B, Woods D, Piacentini J. Initial psychometric properties of a brief parent- report instrument for assessing tic severity in children with chronic tic disorders. Child Fam Behav Ther. 2009; 31(3):181-191.
DuPaul, G.J., Power, T.J., Anastopoulos, A.D., & Reid, R. (1998). ADHD rating scale-IV: Checklists, norms, and clinical interpretations. New York, NY: Guilford Press
Guy W. ECDEU Assessment Manual for Psychopharmacology. Washington, DC, US Department of HEW Publications, 1976
Rapee, R. M., Wignall, A., Hudson, J. L., & Schniering, C. A. (2000). Treating anxious children and adolescents: An evidence-based approach. Oakland, CA: New Harbringer
Storch EA, Morgan JE, Caporino NE, Brauer L, Lewin AB, Piacentini J. Psychosocial Treatment to Improve Resilience and Reduce Impairment in Youth With Tics: An Intervention Case Series of Eight Youth. Journal of Cognitive Psychotherapy 2012; 26(1):57-70
U.S. Census Bureau
Kovacs M. Children's Depression Inventory (CDI). Toronto, Ontario, Canada: Multi-Health System. Inc; 1992.
Vanderbilt Assessment Scale. American Academy of Pediatrics and National Initiative for Children's Healthcare Quality. McNeil, 2002
Wechsler D. (1999). Wechsler Abbreviated Scale of Intelligence (WASI). San Antonio, TX: Psychological Corporation.
World Health Organization. Childhood ADHD Symptoms Scale Self-Report.

Layout table for additonal information
Responsible Party: Erica Greenberg, M.D., Massachusetts General Hospital
ClinicalTrials.gov Identifier: NCT02900144     History of Changes
Other Study ID Numbers: 2016P001396
First Posted: September 14, 2016    Key Record Dates
Last Update Posted: June 3, 2019
Last Verified: May 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Additional relevant MeSH terms:
Layout table for MeSH terms
Tourette Syndrome
Basal Ganglia Diseases
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Tic Disorders
Movement Disorders
Heredodegenerative Disorders, Nervous System
Neurodegenerative Diseases
Genetic Diseases, Inborn
Neurodevelopmental Disorders
Mental Disorders