Abstract Tic disorders are common neurodevelopmental conditions in children and young people. However, although evidence-based support and interventions exist, families often struggle to access these for their children, in part due to a lack of assessment and treatment pathways in UK healthcare services. This article describes a quality improvement project involving the development and implementation of a tics pathway in a generic children and young people’s mental health (CYP MH) service in the UK. This process included building appropriate knowledge, skills and confidence in the team; designing and implementing a pathway, including assessment/diagnosis, provision of psychoeducation/resources, as well as further group and individual treatment where needed; and reflecting on and adapting the process with the support of specialist consultation. The introduction of the tics pathway has resulted in reduced waiting times in all areas of the pathway for those referred to the service, including assessment, diagnosis and the provision of evidence-based support. Feedback from children, young people and families has been very positive. This paper demonstrates that with minimal training and consultation, it is possible for a generic CYP MH service to assess and provide evidence-based resources and support for those referred with tic disorders. It is hoped this paper will provide a model of service delivery that can be utilised by other services, enabling them to support families within their local communities and make a meaningful difference in the lives of children, young people and their families. Key learning aims (1) To raise awareness about the prevalence of tic disorders in children and young people, and the existence of effective evidence-based support and treatment. (2) To highlight challenges faced by families seeking timely and local diagnosis and support. (3) To provide a model of service delivery for the evidence-based assessment and treatment of tic disorders in a generic CYP MH service that can be utilised by other services. (4) To demonstrate that the development and implementation of a tics pathway can be straightforward, cost-effective, and hugely beneficial to children, young people and families. (5) To inspire other CYP MH services to provide support of this kind, thus increasing the provision of timely support for children, young people and families with tic disorders in their local communities.
Abstract Response prevention is an intervention that refers to deliberately abstaining from or blocking a compulsion that is normally performed in response to an obsession. This year marks the 60th anniversary of the publication in which response prevention, a behavioural intervention based on learning theory, was first described by Vic Meyer in 1966. Since then, the theory and practice of the intervention have been incorporated into inhibitory learning theory and cognitive behavioural models of obsessive-compulsive disorder (OCD). The theory and principles of resisting a compulsion by tolerating anxiety or uncertainty and testing expectations are straightforward. However, it may be poorly implemented; for example, it is not merely psychoeducation or encouragement as homework to resist a compulsion, but an active therapeutic intervention conducted collaboratively and testing a client’s predictions (Clark, 2020). Various approaches have been described and adopted by clinicians. However, there is remarkably little literature on the optimum approach to response prevention; for example, how it may differ in physical or mental compulsions, how it may be implemented with doubts, and how it may be conceptualised as habitual behaviour. This paper reviews the historical development of response prevention. This review provides clinical guidance on the theory and implementation of this approach and considers areas that require further research. Key learning aims (1) To understand the phenomenology of compulsions in obsessive-compulsive disorder (OCD). (2) To formulate the function and termination criteria of a compulsion. (3) To understand the learning theory and cognitive models to the maintenance of compulsions. (4) To consider different ways of applying response prevention (response blocking, response reduction, response delay, exposure after a response and habit reversal).
Abstract CBT training programmes increasingly emphasise widening participation and workforce sustainability; however, limited research has explored how neurodivergent trainees and practitioners experience the academic and pedagogical structures through which CBT competence is developed and assessed. This study examined how neurodivergence, specifically the author’s dyslexia and dyspraxia, shaped engagement with CBT training, academic assessment, and pedagogical leadership, and considered implications for inclusive and authentic competence development. A critical autoethnographic approach was employed, drawing on reflective narratives situated within neurodiversity theory, experiential learning models, and Universal Design for Learning (UDL) frameworks. Four interconnected themes emerged: (1) academic norms functioning as structural barriers to competence demonstration; (2) the hidden emotional and cognitive labour of navigating academic systems; (3) neurodivergent strengths within experiential learning and clinical formulation; and (4) transformation of lived experience into inclusive pedagogical redesign within CBT training programmes. The barriers described here reflect systemic misalignment between traditional academic structures and experiential competence development rather than individual deficit; while grounded in dyslexic and dyspraxic experience, they may resonate across neurodivergence. UDL-informed curriculum design and diversified assessment approaches may enhance accessibility, authenticity of competence evaluation, and workforce sustainability within CBT education. Key learning aims (1) To understand how neurodivergent identity shapes experiences of CBT training and academic engagement. (2) To recognise systemic academic barriers affecting neurodivergent CBT trainees and practitioners. (3) To explore the role of experiential learning and inclusive pedagogy in supporting diverse learners. (4) To identify implications for assessment design and curriculum development within CBT training programmes.
Abstract Low-intensity cognitive behavioural therapy (LICBT) services are a key component of mental health provision for children and young people (CYP) in England. Given the elevated prevalence of mental health difficulties among autistic populations, these services are likely to receive referrals for autistic CYP. However, evidence regarding the suitability of LICBT protocols for this group is limited, and little is known about practitioners’ experiences supporting autistic youth. This qualitative study explored LICBT practitioner perspectives on working with autistic CYP, including what helps prepare or support them in this work. Semi-structured interviews were conducted with Children’s Wellbeing Practitioners and Education Mental Health Practitioners ( n = 13) working in LICBT services across England. Data were analysed using reflexive thematic analysis. Two over-arching themes were generated: (1) Delivering LICBT on Unstable Foundations, and (2) Navigating Organisational Challenges. Practitioners described feeling under-prepared by core training and uncertain about the suitability of LICBT interventions for autistic CYP. Successful intervention was perceived to depend on autism-specific adjustments and wider systemic support that were not always available. Organisational pressures, unclear role boundaries, and limited alternative service provision contributed to ethical discomfort and emotional strain. Many practitioners reported independently seeking additional training and informally extending their roles to bridge gaps in care. Findings suggest a misalignment between the LICBT service model and the realities of supporting autistic CYP in practice. Addressing this requires strengthening the evidence for LICBT with autistic populations, closer integration between LICBT and autism-specific services, and flexibility within practitioner workplans to support equitable and appropriate care. Key learning aims (1) To explore Children’s Wellbeing Practitioners’ and Education Mental Health Practitioners’ perspectives and experiences of supporting autistic children and adolescents within low-intensity cognitive behavioural therapy (LICBT) services. (2) To examine what works well and the challenges encountered in practice by these practitioners when supporting autistic children and adolescents. (3) To identify what may be needed to sustainably meet the needs of autistic children and adolescents referred to LICBT services, including factors that may support the accessibility and effectiveness of LICBT for this client group.
