Evaluation of feasibility and effectiveness of the Mindgardens Functional Neurological Symptom Disorders (FND) Tic program for children and adolescents.

Mindgardens Functional Neurological Symptom Disorders (FND) Tic program is a new dedicated service designed to provide support to children and adolescents with a diagnosed Tic Disorder. For children and adolescent participants to be allocated into a Stream (either Stream 1 or Stream 2), screening tools will be administered and will be required to be completed before the initial assessment. Stream 1 This stream will include children and adolescents aged between 12-18 years who have a diagnosis of a Functional Tic Disorder (diagnosed by a GP or Specialist such as a Pediatrician, Psychiatrist or Neurologist). Participants will receive 10 x individual sessions over 10 weeks. Each one-on-one session will take approximately 50 minutes and the individual sessions will be run by a registered psychologist who runs each session weekly. Participants will be asked to complete online surveys on four different occasions. This will include completing a set of questionnaires before the completion of the program (4 questionnaires will be completed) and 8 questionnaires on 2 occasions after the child/adolescent completes the program (after the child’s first comprehensive assessment, and at 3 months post-assessment) (9 questionnaires will be completed). There will be 88 participants that will receive one-on-one individual sessions. An attendance checklist will be taken prior to starting each session to monitor adherence to the program. Sessions will be offered to participants either face-to-face or remotely, e.g. via videoconferencing platform. The participant will advise the format as to how they would like to attend these sessions. If the participant chooses to attend sessions remotely via video teleconferencing platform a link to the session will be provided to both the adolescent and the parent/career of the adolescent prior to the session. An interview guide has been developed to support individual sessions with adolescents. The guide provides instructions on how the individual sessions will be run and the types of open-ended questions asked to stimulate discussion in the sessions. Facilitator role The facilitator will: • observe and listen • consider participant availability and the importance of time management (ensuring that each session starts and finishes on time) • ensure all questions are covered • keep the questions on the topic • reassure each participant that their confidentiality will be maintained • providing appropriate feedback to management. The facilitator will adhere to the guidelines outlined in this Individual Session Guide in conducting the proceedings associated with each of the individual sessions. The facilitator will be required to reflect and create their own set of written notes following the completion of each session. Format The psychologist will introduce the individual session’s purpose and expected outcomes. Below will be the suggested format that will be employed for each of the individual sessions: • introductions • confidentiality • questioning (e.g. engagement, exploration, exit questions) • summary of themes • next steps. The final individual session (session 10) will finish with ‘next steps’ as this will be important for participants to understand what happens with their comments and feedback after the final individual session (session number 10), how their comments will be presented and to who, and when they will hear back about a plan of action. Participant guidelines The psychologist will: • ask each participant, prior to the start of each individual session, to switch off or silence their mobile devices • advise participants that there are no right or wrong answers, each view shared will be respected and while it will be appropriate to respectfully disagree, be mindful of the words that they choose to show their disagreement. • encourage participants to rephrase statements using “I” such as “I hear what you are saying, but I think…” instead of “you’re wrong”. Questioning Age-appropriate, simple, and short questions will be the most important tool the psychologistwill employ to engage with this young cohort to ascertain outcomes for the individual session discussions. The psychologist will have a prepared list of open-ended questions. Examples of questions will include: • Have you had motor tics (e.g. facial twitch, blinking, jerking parts of the body) or other unusual movements or habits? • If YES, how old were you when your motor tics began? • Have you ever found yourself involuntarily making noises or voices (e.g. grunting, throat clearing, coughing, sniffing)? • What was the first tic, habit or mannerism you developed? • Can you tell me about your current tic(s), habit or manerisms? • Did you feel worried or upset about anything around the time your tics started/got worse? o Home/family? o School? o Friends? Exit questions will ensure that the psychologist will not have missed important issues to discuss and to assist with making sure that the participant has had their say: • Do you have anything else that they would like to tell me about your experiences, you’re your tics? Have I missed anything that you might want to tell me? The psychologist will be mindful that the following questions below will not be encouraged to give the desired answer. • So, do you agree that…? • How bad was it that…? • Your doctor did…, didn’t they? • Would you say that…?