Tic disorders (TDs) are neurodevelopmental conditions which affect 0.3-0.9% of individuals aged < 18 years. Although tics often improve or resolve spontaneously over time, treatment is often recommended. Pharmacological approaches are widely used as primary interventions. However, their side effects encouraged the development and the interest in nonpharmacological approaches, whose efficacy in pediatric populations remains poorly understood. This systematic review aimed to evaluate the efficacy of nonpharmacological treatments for children and adolescents with TDs. A literature review was performed using PubMed, EBSCOhost, and JABA databases up to 16 May 2024. Eligible articles were randomized controlled trials, written in English and published in peer-reviewed journals, investigating the efficacy of nonpharmacological treatments in pediatric populations diagnosed with TDs. Significant evidence supported the efficacy of behavioral interventions such as the Comprehensive Behavioral Intervention for Tics (CBIT), its reduced version the Habit Reversal Therapy (HRT), and the Exposure and Relapse Prevention (ERP) in reducing tics and tic-related impairment among young people, as assessed through the Yale Global Tic Severity Scale. Behavioral interventions were generally effective in reducing tics, although some studies reported higher effects on motor tics when compared to vocal tics. High level of efficacy was observed for both face-to-face and online treatments. While future studies are needed to improve treatment effects, especially on vocal tics, as well as to have a better understanding of treatment components and modalities, taken together, the present findings support the use of nonpharmacological intervention for TDs in youth.
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