[version 1; peer review: 1 approved, 1 approved with reservations]
No competing interests were disclosed.
Woods and Himle developed a standardized tic suppression paradigm (TSP) for the experimental setting, to quantify the effects of intentional tic suppression in Tourette syndrome. We previously provided a computer program to facilitate recording tic occurrence and to automate reward delivery during the several experimental conditions of the TSP. The present article describes a web-based program that performs the same functions. Implementing this program on the web allows research sessions to be performed remotely, in tandem with a video calling program. Relevant data for each session, such as the timing of tics and dispensed rewards, are stored in plain text files for later analysis. Expected applications include research on Tourette syndrome and related disorders.
In a previous article
In the course of conducting a longitudinal study of children with Provisional Tic Disorder
Because of enforced social distancing in 2020, the need arose for sessions to be performed remotely. A video calling program allowed us to observe the subjects, but we still needed a way to deliver rewards during the DRO and NCR conditions of the TSP. Previously, we had created a web-based program called TicTrainer for behavioral therapy
TicTimer Web
A new field was added to user accounts so that a research ID (different from the ID used to log on) can be set for research subjects.
Sessions for TicTimer Web use separate but simultaneous connections to a server from a “user” and from a rater. TSP DRO sessions deliver rewards after every 10-s tic-free interval. To deliver rewards at the appropriate times, the user page checks in with the server periodically to see if it has been 10 seconds since the last tic was signaled by the rater. If it has not, the server responds with the time remaining until the next reward is due, and the user page uses that number, adjusted for the lag time of the round trip, to schedule when to check back with the server. Using this method, reward timing is synchronized so that awards are delivered usually within 50 ms of the target time. The previous, in-person version of TicTimer used a token dispenser box to automatically deliver rewards at the appropriate times. In an attempt to approximate the user experience of the physical token dispenser, TicTimer Web delivers rewards by displaying coin images on the subject’s screen along with a chime sound.
At the end of each session, a summary is generated and appended at the bottom of the session log file, which is then archived with the date and time of the session in the filename.
The researcher and subject need only a modern web browser to interface with TicTimer Web once the server is running. The browser must support JavaScript and HTML5. We have tested TicTimer Web with current versions of Chrome and Edge.
To perform sessions with TicTimer Web, the researcher creates a user account if needed, then if desired uses the admin interface to assign the user a research ID number to identify the subject for later data analysis.
During a session, the rater watches the subject. We have used a separate video calling program for this observation, but a video camera or one-way mirror could be used for in-person visits. The rater records any observed tics by immediately pressing the “Tic Detected” button, the spacebar, or the letter “T”. If the session type includes rewards (DRO and NCR), they are dispensed appropriately. The session ends after the predetermined duration, or when the rater presses “End Session,” or when either rater or subject closes their browser window early.
For the NCR condition, the rater first chooses a log file previously created with the current subject, and rewards are delivered to the user at the same times (relative to the session start) that they were delivered in the specified session.
Archived session log files can be downloaded from the admin interface, or they can be copied over directly from the server itself.
The video file (
The TicTimer Web
All data underlying the results are available as part of the article and no additional source data are required.
Zenodo: TicTimer Web: software for measuring tic suppression remotely: Supplementary Files.
This project contains the following extended data:
ttw_demo.mp4. (Supplementary File 1: Video Demonstration of Operation. A video demonstrating how to operate TicTimer Web from the researcher’s perspective.)
au5_20200622-153043_baseline.ttsd. (Supplementary File 2: Sample Log, baseline. Log file for the baseline session performed during the video demonstration.)
au5_20200622-153125_DRZ.ttsd. (Supplementary File 3: Sample Log, DRO. Log file for the DRO session performed during the video demonstration.)
au5_20200622-153214_NCR.ttsd. (Supplementary File 4: Sample Log, NCR. Log file for the NCR session performed during the video demonstration.)
License: MIT License.
The source code for TicTimer Web is available at:
Archived source code at time of publication:
License:
The report describes the development of TicTimer Web, a nifty software that can be used to record tics, tic timings, and distribute reinforcement tokens during online experiments are therapeutic sessions. The authors describe that they adapted the TicTrainer programme to an online version that allows patients to login to a user account and therapists / tic raters to login as administrators. User and rater are then connected to the server simultaneously. The tic rater can record tics via button press and the software stores the timing of that tic. After every tic-free 10 second interval, the software delivers a reward. The software also delivers a summary at the end of the session.
In order for the rater to watch tics, a separate programme, or a webcam can be used. This allows an accurate reward delivery, even remotely.
The source code of TicTimer is available on GitHub, the link is provided in the manuscript. Furthermore, an explanatory video shows how TicTimer can be used. The video is simple and clear and provides step-by-step explanations. Examples of demo files are also provided on Zenodo.
The manuscript is clearly written, the software is demonstrated in a video, examples and the source code are provided.
I have no suggestions for improvement.
Are the conclusions about the tool and its performance adequately supported by the findings presented in the article?
Yes
Is the rationale for developing the new software tool clearly explained?
Yes
Is the description of the software tool technically sound?
Yes
Are sufficient details of the code, methods and analysis (if applicable) provided to allow replication of the software development and its use by others?
Yes
Is sufficient information provided to allow interpretation of the expected output datasets and any results generated using the tool?
Yes
Reviewer Expertise:
Tic disorders.
I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.
We thank Prof. Brandt for her kind comments.
This paper describes a timely and valuable tool for assessing tic suppression remotely in clinical and research settings. This web-based program is based on Woods and Himle’s standardized tic suppression paradigm (TSP) and performs the same function as a computer program previously developed by the authors to record tics and partially automate delivery of rewards. This paper is particularly useful during this time in which remote data collection for research is relevant and necessary, and it provides a helpful overview of a program that can be easily understood by other tic researchers to apply in their own research. The paper could benefit from elaboration in multiple areas to help readers better understand the broader relevance of TSP as well as the research utility of TicTimer Web. Elaboration in the introduction section, as well as a more detailed description of potential applications of this software and how this software helps to overcome previous limitations of the TSP are needed. We recommend that this article be revised and resubmitted. Below are some suggestions for the authors to consider.
Please provide a clearer, more detailed explanation of the broad importance of TSP and related concepts in the introduction section. This will be helpful for readers who are less familiar with tic suppression to understand what insights this paradigm have yielded and how this software program could be beneficial to future investigation. For example, the TSP is described as requiring “substantial investigator effort,” but it is not clear what exactly is entailed. Those who used the old tic-detector boxes know how laborious running a participant was, but those less familiar will not appreciate the leap forward TicTimer Web provides. A short description of the TicTrainer web-based program is also needed in the introduction section. This will be helpful for orienting the reader to the new program that is described in this article, especially considering how similar this older program is to TicTimer Web. In the methods section, there is interchangeable usage of the term “reward” and “award.” The word “awards” in paragraph 3 of the implementation subsection of the methods should be replaced with “rewards.” In the methods section, elaboration is needed on what each experimental condition is (e.g., differential reinforcement of zero-rate ticcing (DRO), noncontingent reinforcement (NCR). Alternatively, this can be elaborated upon in the introduction section as it is also mentioned there. A separate section before the conclusion discussing the strengths and future applications of this software would be useful. This is somewhat addressed in the conclusion section, but further elaboration in a devoted section would do a better job of highlighting the potential of this software program. Next steps: It would be helpful to provide another sentence or two regarding the potential benefits of using artificial intelligence (AI) and machine learning (ML) to do this job as well as barriers to taking this approach.
Overall, this paper provides a concise and useful overview of a web-based program for remote implementation of the TSP. With some clarification in the areas highlighted above, this paper offers a useful contribution to tic research and is especially applicable given the current relevance of remote methods for data collection. We strongly encourage the authors to revise and resubmit this manuscript for consideration.
Are the conclusions about the tool and its performance adequately supported by the findings presented in the article?
Partly
Is the rationale for developing the new software tool clearly explained?
Partly
Is the description of the software tool technically sound?
Yes
Are sufficient details of the code, methods and analysis (if applicable) provided to allow replication of the software development and its use by others?
Yes
Is sufficient information provided to allow interpretation of the expected output datasets and any results generated using the tool?
Partly
Reviewer Expertise:
I have 15 years of research regarding Tourette's disorder and have utilized the tic detector paradigm in my own research.
We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above.
We thank Ms. Schild and Dr. Specht for their thoughtful review, and will edit the report as they suggest.
APPROVED WITH RESERVATIONS
This paper describes a timely and valuable tool for assessing tic suppression remotely in clinical and research settings. This web-based program is based on Woods and Himle’s standardized tic suppression paradigm (TSP) and performs the same function as a computer program previously developed by the authors to record tics and partially automate delivery of rewards. This paper is particularly useful during this time in which remote data collection for research is relevant and necessary, and it provides a helpful overview of a program that can be easily understood by other tic researchers to apply in their own research.
The paper could benefit from elaboration in multiple areas to help readers better understand the broader relevance of TSP as well as the research utility of TicTimer Web. Elaboration in the introduction section, as well as a more detailed description of potential applications of this software and how this software helps to overcome previous limitations of the TSP are needed. We recommend that this article be revised and resubmitted. Below are some suggestions for the authors to consider.
Please provide a clearer, more detailed explanation of the broad importance of TSP and related concepts in the introduction section. This will be helpful for readers who are less familiar with tic suppression to understand what insights this paradigm have yielded and how this software program could be beneficial to future investigation. For example, the TSP is described as requiring “substantial investigator effort,” but it is not clear what exactly is entailed. Those who used the old tic-detector boxes know how laborious running a participant was, but those less familiar will not appreciate the leap forward TicTimer Web provides.
A short description of the TicTrainer web-based program is also needed in the introduction section. This will be helpful for orienting the reader to the new program that is described in this article, especially considering how similar this older program is to TicTimer Web.
In the methods section, there is interchangeable usage of the term “reward” and “award.” The word “awards” in paragraph 3 of the implementation subsection of the methods should be replaced with “rewards.”
In the methods section, elaboration is needed on what each experimental condition is (e.g., differential reinforcement of zero-rate ticcing (DRO), noncontingent reinforcement (NCR). Alternatively, this can be elaborated upon in the introduction section as it is also mentioned there.
A separate section before the conclusion discussing the strengths and future applications of this software would be useful. This is somewhat addressed in the conclusion section, but further elaboration in a devoted section would do a better job of highlighting the potential of this software program.
Next steps: It would be helpful to provide another sentence or two regarding the potential benefits of using artificial intelligence (AI) and machine learning (ML) to do this job as well as barriers to taking this approach.
Overall, this paper provides a concise and useful overview of a web-based program for remote implementation of the TSP. With some clarification in the areas highlighted above, this paper offers a useful contribution to tic research and is especially applicable given the current relevance of remote methods for data collection. We strongly encourage the authors to revise and resubmit this manuscript for consideration.