Effects of a Board Game on Tic Management and Psychosocial Functioning in Adolescents With Tourette Syndrome: Randomized Controlled Trial (Preprint)

<sec> <title>BACKGROUND</title> Tics and comorbidities significantly impact the social interactions and mental health of adolescents with Tourette syndrome (TS). Psychoeducation is an initial intervention for TS. Gamification is a common psychoeducational intervention for youths with chronic conditions. However, the effectiveness of board games in improving tic severity and mental health in adolescents with TS remains underexplored. </sec> <sec> <title>OBJECTIVE</title> We developed a serious board game to investigate its effects on tic severity, mental health, social adjustment, and depression in adolescents with TS. </sec> <sec> <title>METHODS</title> A single-blinded, 2-arm, parallel randomized controlled study was conducted. From September 2022 to July 2024, participants were recruited from a medical center in northern Taiwan. Seventy-nine adolescents with TS aged 12 to 18 years were randomly assigned to either a control group (n=39) or an intervention group (n=40). Both groups received care as usual (daily pyridoxine [50 mg] and psychoeducation), while the intervention group additionally participated in a weekly 60-minute board game session over a 4-week period. Outcome measures included the Yale Global Tic Severity Scale, Positive Mental Health Scale, Social Adjustment Scale for Adolescents with TS, and Beck Youth Inventory II – Depression scale. </sec> <sec> <title>RESULTS</title> Generalized estimation equation results showed that, compared to the control group, the intervention group demonstrated significant improvements in positive mental health at the postintervention (β=5.19, 95% CI 0.36 to 10.02, &lt;i&gt;P&lt;/i&gt;=.04) and follow-up (β=7.14, 95% CI 2.15 to 12.14, &lt;i&gt;P&lt;/i&gt;=.005), with time-dependent effects. The intervention group also showed significant improvements in social adjustment (β=4.24, 95% CI 1.79 to 6.69, &lt;i&gt;P&lt;/i&gt;&amp;lt;.001) and depression (β=–3.06, 95% CI –6.04 to –0.11, &lt;i&gt;P&lt;/i&gt;=.04) at follow-up. No significant differences were observed between the 2 groups in tic severity. </sec> <sec> <title>CONCLUSIONS</title> The serious board game developed in this study significantly enhanced psychosocial functioning in adolescents with TS. As an alternative to verbal and written health communication, the board game serves as an innovative psychoeducational instrument for health care professionals to help adolescents with TS in tic management and mental health promotion. Future studies can develop and validate the feasibility of a digital version of the board game. </sec> <sec> <title>CLINICALTRIAL</title> ClinicalTrials.gov NCT05566236; https://clinicaltrials.gov/study/NCT05566236 </sec>