1
|
Barber KE, Pitts BX, Stiede JT, Espil FM, Woods DW, Specht MW, Bennett SM, Walkup JT, Ricketts EJ, McGuire JF, Peterson AL, Compton SN, Wilhelm S, Scahill L, Piacentini JC. Perceived Negative Effects of Tic Management Strategies in Adults With Tic Disorders. Behav Modif 2024; 48:449-470. [PMID: 38557310 PMCID: PMC11179959 DOI: 10.1177/01454455241236446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Behavior therapy is a well-established and empirically supported treatment for tic disorders (TDs). However, concerns have been expressed about the negative effects of behavioral interventions, such as tic worsening, tic substitution, and excessive effort. This study explored perceived negative effects of tic management strategies in adults with TDs and predictors of these experiences. Participants (N = 72) completed semi-structured interviews 11 years after receiving behavior therapy or supportive therapy in a randomized clinical trial. We examined responses to interview questions about managing tics and predictors of reported negative effects. Most participants did not experience tic worsening (84%) or tic substitution (75%) from tic management strategies. The majority felt they could manage tics while participating in their environment (87%) and did not report life interference from tic management (77%). About half (45%) felt less present when managing tics. Treatment non-responders in the original trial were more likely to report negative effects of tic management strategies. No differences in reported negative consequences were found between those who received behavior therapy versus supportive therapy, suggesting that behavior therapy specifically does not lead to such adverse effects. These findings could reduce misconceptions about behavior therapy for TDs and enhance its acceptability and utilization.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - John T Walkup
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Emily J Ricketts
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | | | - Alan L Peterson
- The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | | | | | - Lawrence Scahill
- Emory University School of Medicine Marcus Center, Atlanta, GA, USA
| | - John C Piacentini
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| |
Collapse
|
2
|
Mazur-Lainé E, Soubata H, Leclerc JB, Blanchet PJ, O’Connor KP, Lavoie ME. Impacts of ADHD Symptomatology on the Response to Cognitive-Behavioural Therapy with Gilles de la Tourette Syndrome Patients. J Clin Med 2024; 13:2975. [PMID: 38792517 PMCID: PMC11122476 DOI: 10.3390/jcm13102975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
(1) Background: Gilles de la Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by motor and vocal tics. Attention deficit and hyperactivity disorder (ADHD) is a common comorbidity of TS that adds further impairment. Cognitive-behavioural therapy (CBT) has shown efficacy in treating tics, yet its effectiveness in individuals with TS and comorbid ADHD remains unclear. Also, it is suggested that ADHD characteristics like executive dysfunction and inattention could hinder the response to CBT. This study aims to compare the response to CBT for tics and its maintenance six months post-therapy among TS individuals with and without ADHD symptoms. (2) Methods: In this study, 55 TS participants who completed 14-week CBT for tics were split into high (TS+) or low (TS-) ADHD symptomatology groups. Outcomes were evaluated using the Yale Global Tic Severity Scale (YGTSS) regarding global tic severity and motor and vocal tic frequency post-CBT and at a 6-month follow-up. (3) Results: No significant group difference was found regarding improvements post-CBT (n = 55), nor the maintenance six months later (n = 45). (4) Conclusions: ADHD symptoms may not hinder the response to CBT or its maintenance, suggesting that TS individuals with ADHD symptoms may not require specialized CBT interventions.
Collapse
Affiliation(s)
- Emmanuelle Mazur-Lainé
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3V2, Canada; (E.M.-L.); (H.S.); (J.B.L.); (P.J.B.); (K.P.O.)
- Département de Psychologie, Université de Montréal, Montréal, QC H2V 2S9, Canada
| | - Houda Soubata
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3V2, Canada; (E.M.-L.); (H.S.); (J.B.L.); (P.J.B.); (K.P.O.)
- Département de Psychologie, Université de Montréal, Montréal, QC H2V 2S9, Canada
| | - Julie B. Leclerc
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3V2, Canada; (E.M.-L.); (H.S.); (J.B.L.); (P.J.B.); (K.P.O.)
- Département de Psychologie, Université du Québec à Montréal, Montréal, QC H2X 3P2, Canada
- Groupe d’étude sur les Troubles Tic, d’Accumulation Compulsive et Obsessionnel-Compulsif (GE-tic-tac-toc), Montréal, QC H1N 3V2, Canada
- Centre de Recherche du CIUSSS du Nord-de-l’Île-de-Montréal, Montréal, QC H4J 1C5, Canada
| | - Pierre J. Blanchet
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3V2, Canada; (E.M.-L.); (H.S.); (J.B.L.); (P.J.B.); (K.P.O.)
- Faculté de Médecine Dentaire, Département de Stomatologie, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Kieron P. O’Connor
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3V2, Canada; (E.M.-L.); (H.S.); (J.B.L.); (P.J.B.); (K.P.O.)
- Groupe d’étude sur les Troubles Tic, d’Accumulation Compulsive et Obsessionnel-Compulsif (GE-tic-tac-toc), Montréal, QC H1N 3V2, Canada
- Département de Psychiatrie et Addictologie, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Marc E. Lavoie
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3V2, Canada; (E.M.-L.); (H.S.); (J.B.L.); (P.J.B.); (K.P.O.)
- Groupe d’étude sur les Troubles Tic, d’Accumulation Compulsive et Obsessionnel-Compulsif (GE-tic-tac-toc), Montréal, QC H1N 3V2, Canada
- Département de Psychiatrie et Addictologie, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Département de Sciences Humaines, Lettres et Communication, Université TÉLUQ, Quebec, QC G1K 9H6, Canada
| |
Collapse
|
3
|
Mohamed ZA, Xue Y, Bai M, Dong H, Jia F. Efficacy of differential reinforcement of other behaviors therapy for tic disorder: a meta-analysis. BMC Neurol 2024; 24:3. [PMID: 38166709 PMCID: PMC10759470 DOI: 10.1186/s12883-023-03501-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Recently, studies on behavioral tic suppression techniques have gained popularity as opposed to pharmacological alternatives that often have potentially dangerous side effects. Differential Reinforcement of Other Behaviors therapy (DRO) is one such behavioral technique whose efficacy in tic suppression has been experimentally demonstrated albeit in studies with very few patients, and lacking statistical power. Here, we conducted a meta-analysis of these studies to improve their overall power and explore whether DRO intervention is really effective for tic suppression. MATERIALS AND METHODS PubMed, Embase, PsycINFO, and Cochrane Library were searched from inception to August 30, 2023. Only original interventional studies that examined the efficacy of DRO for tic suppression were included. RESULTS A total of 8 no control interventional studies involving 79 children with tic disorders were recruited. Most of the children had moderate tic severity. The pooled mean Yale Global Tic Severity Scale (YGTSS) score was 24.64 (95% CI: 21.99 - 30.12, p = < 0.00001, I2 = 87%). In terms of efficacy of the DRO technique for tic suppression, the results showed that DRO was effective in reducing tic frequency among the children. The pooled standardized mean difference (SMD) was -10.25 (95% CI: -14.71 - -5.79, p = < 0.00001) with I2 = 94%. CONCLUSION In conclusion, this study revealed that DRO is potentially an effective tic suppression technique for temporarily managing tic disorder. It also showed that DRO could be employed for both moderate and severe tic disorders. However, the technique bears crucial limitations that limit its implementation outside of experimental settings. More studies are needed to address these limitations and improve its applicability in the real world.
Collapse
Affiliation(s)
- Zakaria Ahmed Mohamed
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Yang Xue
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Miaoshui Bai
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Hanyu Dong
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Feiyong Jia
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, China.
| |
Collapse
|
4
|
Conelea C, Greene DJ, Alexander J, Houlihan K, Hodapp S, Wellen B, Francis S, Mueller B, Hendrickson T, Tseng A, Chen M, Fiecas M, Lim K, Opitz A, Jacob S. The CBIT + TMS trial: study protocol for a two-phase randomized controlled trial testing neuromodulation to augment behavior therapy for youth with chronic tics. Trials 2023; 24:439. [PMID: 37400828 PMCID: PMC10316640 DOI: 10.1186/s13063-023-07455-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/13/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Comprehensive Behavioral Intervention for Tics (CBIT) is a first-line treatment for tic disorders that aims to improve controllability over tics that an individual finds distressing or impairing. However, it is only effective for approximately half of patients. Supplementary motor area (SMA)-directed neurocircuitry plays a strong role in motor inhibition, and activity in this region is thought to contribute to tic expression. Targeted modulation of SMA using transcranial magnetic stimulation (TMS) may increase CBIT efficacy by improving patients' ability to implement tic controllability behaviors. METHODS The CBIT + TMS trial is a two-phase, milestone-driven early-stage randomized controlled trial. The trial will test whether augmenting CBIT with inhibitory, non-invasive stimulation of SMA with TMS modifies activity in SMA-mediated circuits and enhances tic controllability in youth ages 12-21 years with chronic tics. Phase 1 will directly compare two rTMS augmentation strategies (1 Hz rTMS vs. cTBS) vs. sham in N = 60 participants. Quantifiable, a priori "Go/No Go Criteria" guide the decision to proceed to phase 2 and the selection of the optimal TMS regimen. Phase 2 will compare the optimal regimen vs. sham and test the link between neural target engagement and clinical outcomes in a new sample of N = 60 participants. DISCUSSION This clinical trial is one of few to date testing TMS augmentation of therapy in a pediatric sample. The results will provide insight into whether TMS is a potentially viable strategy for enhancing CBIT efficacy and reveal potential neural and behavioral mechanisms of change. TRIAL REGISTRATION ClinicalTrials.gov NCT04578912 . Registered on October 8, 2020.
Collapse
Affiliation(s)
- Christine Conelea
- Department of Psychiatry and Behavioral Sciences, Masonic Institute for the Developing Brain, University of Minnesota, 2025 E. River Parkway, Minneapolis, MN, 55414, USA.
| | - Deanna J Greene
- Department of Cognitive Science, University of California San Diego, San Diego, USA
| | - Jennifer Alexander
- Department of Psychiatry and Behavioral Sciences, Masonic Institute for the Developing Brain, University of Minnesota, 2025 E. River Parkway, Minneapolis, MN, 55414, USA
| | - Kerry Houlihan
- Department of Psychiatry and Behavioral Sciences, Masonic Institute for the Developing Brain, University of Minnesota, 2025 E. River Parkway, Minneapolis, MN, 55414, USA
| | - Sarah Hodapp
- Department of Psychiatry and Behavioral Sciences, Masonic Institute for the Developing Brain, University of Minnesota, 2025 E. River Parkway, Minneapolis, MN, 55414, USA
| | - Brianna Wellen
- Department of Psychiatry and Behavioral Sciences, Masonic Institute for the Developing Brain, University of Minnesota, 2025 E. River Parkway, Minneapolis, MN, 55414, USA
| | - Sunday Francis
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA
| | - Bryon Mueller
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA
| | - Tim Hendrickson
- Masonic Institute for the Developing Brain, University of Minnesota Informatics Institute, Minneapolis, USA
| | - Angela Tseng
- Department of Psychiatry and Behavioral Sciences, Masonic Institute for the Developing Brain, University of Minnesota, 2025 E. River Parkway, Minneapolis, MN, 55414, USA
| | - Mo Chen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA
- Non-Invasive Neuromodulation Lab, Brain Conditions, MnDRIVE Initiative, University of Minnesota, Minneapolis, USA
- Neuroscience Program, Research Department, Gillette Children's Specialty Healthcare, Saint Paul, USA
| | - Mark Fiecas
- School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, USA
| | - Kelvin Lim
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA
| | - Alexander Opitz
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA
| | - Suma Jacob
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA
| |
Collapse
|
5
|
Conelea C, Greene D, Alexander J, Houlihan K, Hodapp S, Wellen B, Francis S, Mueller B, Hendrickson T, Tseng A, Chen M, Fiecas M, Lim K, Opitz A, Jacob S. The CBIT+TMS Trial: study protocol for a two-phase randomized controlled trial testing neuromodulation to augment behavior therapy for youth with chronic tics. RESEARCH SQUARE 2023:rs.3.rs-2949388. [PMID: 37398344 PMCID: PMC10312978 DOI: 10.21203/rs.3.rs-2949388/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background Comprehensive Behavioral Intervention for Tics (CBIT) is a first-line treatment for tic disorders that aims to improve controllability over tics that an individual finds distressing or impairing. However, it is only effective for approximately half of patients. Supplementary motor area (SMA)-directed neurocircuitry plays a strong role in motor inhibition, and activity in this region is thought to contribute to tic expression. Targeted modulation of SMA using transcranial magnetic stimulation (TMS) may increase CBIT efficacy by improving patient ability to implement tic controllability behaviors. Methods The CBIT+TMS trial is a two-phase, milestone driven early-stage randomized controlled trial. The trial will test whether augmenting CBIT with inhibitory, noninvasive stimulation of SMA with TMS modifies activity in SMA-mediated circuits and enhances tic controllability in youth ages 12-21 years with chronic tics. Phase 1 will directly compare two rTMS augmentation strategies (1Hz rTMS vs. cTBS) vs. sham in N = 60 participants. Quantifiable, a priori "Go/No Go Criteria" guide the decision to proceed to Phase 2 and selection of the optimal TMS regimen. Phase 2 will compare the optimal regimen vs. sham and test the link between neural target engagement and clinical outcomes in a new sample of N = 60 participants. Discussion This clinical trial is one of few to date testing TMS augmentation of therapy in a pediatric sample. Results will provide insight into whether TMS is a potentially viable strategy for enhancing CBIT efficacy and reveal potential neural and behavioral mechanisms of change. Trial registration ClinicalTrials.gov Identifier: NCT04578912.
Collapse
Affiliation(s)
- Christine Conelea
- Department of Psychiatry and Behavioral Sciences, Masonic Institute for the Developing Brain, University of Minnesota, USA
| | - Deanna Greene
- Department of Cognitive Science, University of California San Diego, USA
| | - Jennifer Alexander
- Department of Psychiatry and Behavioral Sciences, Masonic Institute for the Developing Brain, University of Minnesota, USA
| | - Kerry Houlihan
- Department of Psychiatry and Behavioral Sciences, Masonic Institute for the Developing Brain, University of Minnesota, USA
| | - Sarah Hodapp
- Department of Psychiatry and Behavioral Sciences, Masonic Institute for the Developing Brain, University of Minnesota, USA
| | - Brianna Wellen
- Department of Psychiatry and Behavioral Sciences, Masonic Institute for the Developing Brain, University of Minnesota, USA
| | - Sunday Francis
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, USA
| | - Bryon Mueller
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, USA
| | - Timothy Hendrickson
- University of Minnesota Informatics Institute, Masonic Institute for the Developing Brain, USA
| | - Angela Tseng
- Department of Psychiatry and Behavioral Sciences, Masonic Institute for the Developing Brain, University of Minnesota, USA
| | - Mo Chen
- Non-invasive Neuromodulation Lab, Brain Conditions, MnDRIVE Initiative, University of Minnesota, USA; Department of Psychiatry and Behavioral Sciences, University of Minnesota, USA; Neuroscience Program, Research Department, Gillette Children's Specialty Healthcare, USA
| | - Mark Fiecas
- School of Public Health, Division of Biostatistics, University of Minnesota, USA
| | - Kelvin Lim
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, USA
| | - Alexander Opitz
- Department of Biomedical Engineering, University of Minnesota, USA
| | - Suma Jacob
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, USA
| |
Collapse
|
6
|
Woods DW, Himle MB, Stiede JT, Pitts BX. Behavioral Interventions for Children and Adults with Tic Disorder. Annu Rev Clin Psychol 2023; 19:233-260. [PMID: 37159286 DOI: 10.1146/annurev-clinpsy-080921-074307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Over the past decade, behavioral interventions have become increasingly recognized and recommended as effective first-line therapies for treating individuals with tic disorders. In this article, we describe a basic theoretical and conceptual framework through which the reader can understand the application of these interventions for treating tics. The three primary behavioral interventions for tics with the strongest empirical support (habit reversal, Comprehensive Behavioral Intervention for Tics, and exposure and response prevention) are described. Research on the efficacy and effectiveness of these treatments is summarized along with a discussion of the research evaluating the delivery of these treatments in different formats and modalities. The article closes with a review of the possible mechanisms of change underlying behavioral interventions for tics and areas for future research.
Collapse
Affiliation(s)
- Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
| | - Michael B Himle
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Jordan T Stiede
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Brandon X Pitts
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
| |
Collapse
|
7
|
Hartmann A, Andrén P, Atkinson-Clement C, Czernecki V, Delorme C, Debes NM, Szejko N, Ueda K, Black K. Tourette syndrome research highlights from 2021. F1000Res 2022; 11:716. [PMID: 35923292 PMCID: PMC9315233 DOI: 10.12688/f1000research.122708.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/05/2022] Open
Abstract
We summarize selected research reports from 2021 relevant to Tourette syndrome that the authors consider most important or interesting. The authors welcome article suggestions and thoughtful feedback from readers.
Collapse
Affiliation(s)
- Andreas Hartmann
- Department of Neurology, APHP, Sorbonne University, Hôpital de la Pitié-Salpêtrière, Paris, 75013, France,
| | - Per Andrén
- Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
| | - Cyril Atkinson-Clement
- Paris Brain Institute (ICM), Sorbonne Université, Inserm, CNRS, APHP, Paris, 75013, France
| | - Virginie Czernecki
- Department of Neurology, APHP, Sorbonne University, Hôpital de la Pitié-Salpêtrière, Paris, 75013, France
| | - Cécile Delorme
- Department of Neurology, APHP, Sorbonne University, Hôpital de la Pitié-Salpêtrière, Paris, 75013, France
| | | | - Natalia Szejko
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Keisuke Ueda
- Department of Psychiatry, Neurology, Radiology and Neuroscience, Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Kevin Black
- Department of Psychiatry, Neurology, Radiology and Neuroscience, Washington University in St. Louis, Saint Louis, Missouri, USA
| |
Collapse
|
8
|
McGuire JF, Strum A, Ricketts EJ, Montalbano GE, Chang S, Loo SK, Woods DW, McCracken J, Piacentini J. Cognitive control processes in behavior therapy for youth with Tourette's disorder. J Child Psychol Psychiatry 2022; 63:296-304. [PMID: 34155637 PMCID: PMC10696898 DOI: 10.1111/jcpp.13470] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cognitive control processes are implicated in the behavioral treatment of Tourette's disorder (TD). However, the influence of these processes on treatment outcomes has received minimal attention. This study examined whether cognitive control processes and/or tic suppression predicted reductions in tic severity and treatment response to behavior therapy. METHOD Fifty-three youth with TD or a pervasive tic disorder participated in a randomized wait list-controlled trial of behavior therapy. Following a baseline assessment to evaluate psychiatric diagnoses, tic severity, and cognitive control processes (e.g., response selection, inhibition, and suppression), youth were randomly assigned to receive eight sessions of behavior therapy (n = 23) or a wait list of equal duration (n = 28). Youth receiving immediate treatment completed a post-treatment assessment to determine improvement in tic severity. Meanwhile, youth in the wait list condition completed another assessment to re-evaluate tic severity and cognitive control processes, and subsequently received 8 sessions of behavior therapy followed by a post-treatment assessment to determine improvement. RESULTS A multiple linear regression model found that pretreatment inhibition/switching on the Delis-Kaplan Executive Function System Color-Word Interference Test predicted reductions in tic severity after behavior therapy (β = -.36, t = -2.35, p = .025, ƞ2 = .15). However, other cognitive control processes and tic suppression did not predict treatment response and/or reductions in tic severity. Small nonsignificant effects were observed in cognitive control processes after behavior therapy. CONCLUSION Cognitive control processes may influence tic severity reductions in behavior therapy. Notably, even when other cognitive control processes are impaired and youth are initially unable to voluntarily suppress their tics, youth with TD can still benefit from behavior therapy. Findings offer implications for clinical practice and research for TD.
Collapse
Affiliation(s)
- Joseph F. McGuire
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Alexandra Strum
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
- Department of Psychology, Loyola Marymount University
| | - Emily J. Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | | | - Susanna Chang
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Sandra K. Loo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | | | - James McCracken
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| |
Collapse
|
9
|
Bamigbade SE, Rogers SL, Wills W, Ludlow AK. Mothers' accounts of mealtime and feeding challenges for children with Tourette syndrome or persistent tic disorders. Front Psychiatry 2022; 13:936796. [PMID: 35978849 PMCID: PMC9377638 DOI: 10.3389/fpsyt.2022.936796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/05/2022] [Indexed: 12/02/2022] Open
Abstract
Parenting a young person with a tic disorder can present daily challenges to families struggling to manage their child's tics and establish routines. Research recognises that tics can be problematic to everyday activities, however no attention has been given to mealtimes, arguably an important family activity closely related to quality of life of the family. The current qualitative study aimed to investigate the mealtime experiences of families with a child with a tic disorder from the perspective of mothers, looking at mealtime challenges, their impact and how these challenges are navigated. Seventeen mothers with children diagnosed with Tourette Syndrome (TS) or a Persistent Tic Disorder (PTD) (aged 3-14) took part in semi-structured interviews. Interpretative phenomenological analysis of 17 semi-structured interviews resulted in seven subthemes which were grouped under two superordinate themes: (1) tics as a barrier to positive mealtime experiences and (2) eating behaviours and other mealtime challenges. The findings highlight tics to create functional mealtime challenges, affecting a young person's ability to eat, drink and be seated, with mothers noting the family dynamic was often intensified and compounded by additional challenges related to their child's tics and comorbidities. Tics also have the power to disrupt the conviviality of mealtimes. For example, eating out-of-home can be especially challenging, with restaurants being high-pressure environments for young people with tics and their families. The cumulative effect of dissatisfaction, stress and additional foodwork can have a diminishing effect on maternal and familial resilience and wellbeing. Mealtime-related interventions need to be considered to help increase confidence and skills in managing mealtimes.
Collapse
Affiliation(s)
- Sandra-Eve Bamigbade
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, United Kingdom.,NIHR Applied Research Collaboration, Cambridge, United Kingdom
| | - Samantha L Rogers
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, United Kingdom
| | - Wendy Wills
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, United Kingdom.,NIHR Applied Research Collaboration, Cambridge, United Kingdom
| | - Amanda K Ludlow
- Department of Psychology and Sports Sciences, University of Hertfordshire, Hatfield, United Kingdom
| |
Collapse
|
10
|
Olvera C, Stebbins GT, Goetz CG, Kompoliti K. TikTok Tics: A Pandemic Within a Pandemic. Mov Disord Clin Pract 2021; 8:1200-1205. [PMID: 34765687 PMCID: PMC8564823 DOI: 10.1002/mdc3.13316] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND TikTok is a social media platform where users create and share videos. During the COVID-19 pandemic, the use of this site greatly expanded. Tic and Tourette syndrome content also increased dramatically along with the number of patients with tics in neurology clinics. OBJECTIVES We compared the phenomenology of "TikTok tics" to typical tic disorders. We chose to analyze the most widely viewed videos and therefore focused on the most popular content creators. METHODS Videos with the keywords "tic," "Tourette," or "tourettes" were reviewed to identify content creators between March 11, 2020 and March 30, 2021. We performed a quantitative assessment of TikTok tics as well as a descriptive analysis of the entire series of videos of each content creator. RESULTS The mean age of the cohort was 18.8 years old, and the majority were women. Unlike the predominance of facial movements in typical tics, arm movements were most frequent. Average tics per minute was 29, and almost all recorded TikTok tics were severe, causing significant disability. Whereas coprolalia and self-injurious behavior are only infrequently encountered in typical tic disorders, they were present in the overwhelming majority of TikTok subjects. CONCLUSIONS TikTok tics are distinct from what is typically seen in patients with Tourette syndrome, although share many characteristics with functional tics. We believe this to be an example of mass sociogenic illness, which involves behaviors, emotions, or conditions spreading spontaneously through a group. A modern clinician needs to remain abreast of social media sources as knowledge of media content is essential in managing patients in the current environment.
Collapse
Affiliation(s)
- Caroline Olvera
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Glenn T. Stebbins
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Christopher G. Goetz
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Katie Kompoliti
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
| |
Collapse
|
11
|
Sturm A, Ricketts EJ, McGuire JF, Lerner J, Lee S, Loo SK, McGough JJ, Chang S, Woods DW, McCracken J, Piacentini J. Inhibitory control in youth with Tourette's Disorder, attention-deficit/hyperactivity disorder and their combination and predictors of objective tic suppressibility. Psychiatry Res 2021; 304:114163. [PMID: 34411767 PMCID: PMC8809367 DOI: 10.1016/j.psychres.2021.114163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
The present study investigated inhibitory control deficits in Tourette's Disorder (TD)-only, Attention Deficit/Hyperactivity Disorder (ADHD)-only, and TD+ADHD and explored the degree to which measures of inhibitory control, and tic and ADHD severity predicted objective tic suppressibility. Participants were youth ages 9 to 14 (M = 11.15) with TD-only (n = 24), TD+ADHD (n = 19), ADHD-only (n = 139), and typically-developing controls (n = 59) drawn from a larger study. Groups were compared on computer-based and paper and pencil neurocognitive inhibitory control tasks. Among youth with TD, neurocognitive measures of inhibitory control, subjective tic-suppressibility (Premonitory Urge for Tics Scale, item 10), and ADHD symptom severity were evaluated as predictors of objective tic suppressibility (i.e., laboratory-based tic suppression task), controlling for total tic severity. There were significant group differences on Color-Word inhibition/switching performance, though post-hoc comparisons yielded no significant pairwise group contrasts. Subjective tic suppressibility was the only significant predictor of objective tic suppressibility. The evident intact neurocognitive inhibitory control among youth with TD suggests that individuals with TD may use compensatory neural mechanisms to support typical speed and accuracy of response. The role of cognitive flexibility in mechanisms of tic suppression should also be further explored.
Collapse
Affiliation(s)
- Alexandra Sturm
- Psychology Department, Loyola Marymount University, One LMU Drive, Suite 4700, Los Angeles, CA 90045, United States.
| | - Emily J. Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095
| | - Joseph F. McGuire
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21205
| | - Juliette Lerner
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095
| | - SoJeong Lee
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095
| | - Sandra K. Loo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095
| | - James J. McGough
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095
| | - Susanna Chang
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095
| | - Douglas W. Woods
- Department of Psychology, Marquette University, Milwaukee, WI, 53233
| | - James McCracken
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095
| |
Collapse
|
12
|
Ueda K, Kim S, Greene DJ, Black KJ. Correlates and clinical implications of tic suppressibility. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2021; 8:112-120. [PMID: 34178574 DOI: 10.1007/s40474-021-00230-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of review Tic disorders are common in the pediatric population and are differentiated from other movement disorders by tic suppressibility. Understanding the mechanism of tic suppression may provide new insights to the pathophysiology of tic disorders. This article highlights clinical phenomenology and neuronal correlates of tic suppressibility. Recent findings Recent studies suggest that tic suppressibility exists in children shortly after onset of their tics. Moreover, those who are better able to suppress their tics have better tic outcomes. Interoceptive awareness and automatic action inhibition may be involved in tic suppression. Summary We illustrate a possible underlying mechanism of tic suppressibility and its clinical correlations and implications. New concepts such as interoceptive awareness and action inhibition may help explain tic disorders. Further study will be useful to fill remaining knowledge gaps.
Collapse
Affiliation(s)
- Keisuke Ueda
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Soyoung Kim
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Deanna J Greene
- Department of Cognitive Science, University of California San Diego, La Jolla, CA, USA
| | - Kevin J Black
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA.,Department of Radiology, Washington University School of Medicine, St Louis, MO, USA.,Department of Neuroscience, Washington University School of Medicine, St Louis, MO, USA
| |
Collapse
|
13
|
|
14
|
Abstract
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.
Collapse
Affiliation(s)
- Jonathan K. Black
- Department of Mechanical Engineering, Brigham Young University, Provo, Utah, 84602, USA
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
| | - Kevin J. Black
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
- Department of Neuroscience, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
| |
Collapse
|
15
|
Black JK, Koller JM, Black KJ. TicTimer Web: software for measuring tic suppression remotely. F1000Res 2020; 9:1264. [PMID: 33824720 PMCID: PMC7993402 DOI: 10.12688/f1000research.26347.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 04/01/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Jonathan K. Black
- Department of Mechanical Engineering, Brigham Young University, Provo, Utah, 84602, USA
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
| | - Kevin J. Black
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
- Department of Neuroscience, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
| |
Collapse
|
16
|
Stiede JT, Woods DW. Pediatric Prevention: Tic Disorders. Pediatr Clin North Am 2020; 67:547-557. [PMID: 32443993 DOI: 10.1016/j.pcl.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
It is not clear whether the development of tics can be prevented. Contextual variables can impact tic expression; therefore, shifting attention to behaviors that reduce tics is an important part of decreasing tic severity. Several medications are effective in reducing tic severity, but side effects restrict their use. Behavioral treatment is the gold standard psychotherapy intervention for tic disorders, with Comprehensive Behavioral Intervention for Tics being the most well-supported nonpharmacological treatment. Although children may be unable to prevent the development of tics, they can still use several strategies to reduce tic severity and impairment.
Collapse
Affiliation(s)
- Jordan T Stiede
- Psychology Department, Marquette University, Cramer Hall, 307, PO Box 1881, Milwaukee, WI 53201-1881, USA
| | - Douglas W Woods
- Marquette University, Holthusen Hall, 305, PO Box 1881, Milwaukee, WI 5320-1881, USA.
| |
Collapse
|
17
|
Yadegar M, Guo S, Ricketts EJ, Zinner SH. Assessment and Management of Tic Disorders in Pediatric Primary Care Settings. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2020; 6:159-172. [PMID: 32467820 DOI: 10.1007/s40474-019-00168-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose of Review Pediatricians and other primary care providers are often the first and sole healthcare clinicians of patients who present with tics. However, limited primary care pediatric training in neuropsychiatric concerns, as well as perceived lack of comfort and preparation, make it challenging for these clinicians to confidently identify and manage tic disorders. Recent Findings Current empirical findings of tic disorder management relevant to pediatric physicians, including assessment, psychoeducation, behavioral interventions, psychotropic medications, and alternative treatments are reviewed. Summary This article discusses neuropsychiatric and medical complexities of tic disorder assessment, with particular emphasis on differential and comorbid diagnoses. Tiered referral recommendations, based on symptom severity, impairment, and consideration of comorbid conditions, are provided. Future directions for tic management, including dissemination of evidence-based treatments of tic disorders and multidisciplinary teams within pediatric primary care settings, are included.
Collapse
Affiliation(s)
- Mina Yadegar
- Univeristy of California, Los Angeles.,Boston Child Study Center - Los Angeles.,Behavioral Associates Los Angeles
| | - Sisi Guo
- Univeristy of California, Los Angeles
| | | | - Samuel H Zinner
- University of Washington School of Medicine.,Seattle Children's Hospital
| |
Collapse
|
18
|
Kim S, Greene DJ, Robichaux-Viehoever A, Bihun EC, Koller JM, Acevedo H, Schlaggar BL, Black KJ. Tic Suppression in Children With Recent-Onset Tics Predicts 1-Year Tic Outcome. J Child Neurol 2019; 34:757-764. [PMID: 31241402 PMCID: PMC6733613 DOI: 10.1177/0883073819855531] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Successful voluntary tic suppression is a key component of the behavioral interventions that are used to treat tic disorders. This study aimed to examine tic suppression in children with recent-onset tics and determine whether the capacity to suppress tics predicts future tic severity. We tested 45 children (30 male, mean age 7.74 years) with recent-onset tics (mean 3.47 months prior to the first study visit; baseline) and re-examined each child at the 12-month anniversary of the first recognized tic (follow-up). At the baseline visit, children performed a tic suppression task with several conditions: tic freely, inhibit tics given a verbal request, and inhibit tics in the presence of a reward. At the baseline visit, children with tics for only a few months could suppress their tics, and tic suppression was especially successful when they received an immediate and contingent reward. Additionally, the ability to suppress tics in the presence of a reward predicted tic severity at follow-up. These findings suggest that better inhibitory control of tics within months of tic onset may be an important predictor of future tic symptom outcome.
Collapse
Affiliation(s)
- Soyoung Kim
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Deanna J. Greene
- Department of Psychiatry, Washington University School of Medicine, United States
- Department of Radiology, Washington University School of Medicine, United States
| | | | - Emily C. Bihun
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Haley Acevedo
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Bradley L. Schlaggar
- Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kevin J. Black
- Department of Psychiatry, Washington University School of Medicine, United States
- Department of Radiology, Washington University School of Medicine, United States
- Department of Neurology, Washington University School of Medicine, United States
- Department of Neuroscience, Washington University School of Medicine, United States
| |
Collapse
|
19
|
Maigaard K, Nejad AB, Andersen KW, Herz DM, Hagstrøm J, Pagsberg AK, Skov L, Siebner HR, Plessen KJ. A superior ability to suppress fast inappropriate responses in children with Tourette syndrome is further improved by prospect of reward. Neuropsychologia 2019; 131:342-352. [PMID: 31103639 DOI: 10.1016/j.neuropsychologia.2019.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 12/31/2022]
Abstract
In children with Tourette syndrome (TS), tics are often attributed to deficient self-control by health-care professionals, parents, and peers. In this behavioural study, we examined response inhibition in TS using a modified Simon task which probes the ability to solve the response conflict between a new non-spatial rule and a highly-overlearned spatial stimulus-response mapping rule. We applied a distributional analysis to the behavioural data, which grouped the trials according to the individual distribution of reaction times in four time bins. Distributional analyses enabled us to probe the children's ability to control fast, impulsive, responses, which corresponded to the trials in the fastest time bin. Additionally, we tested whether the ability to suppress inappropriate action tendencies can be improved further by the prospect of a reward. Forty-one clinically well-characterized medication-naïve children with TS, 20 children with attention-deficit/hyperactivity disorder (ADHD), and 43 typically developing children performed a Simon task during alternating epochs with and without a prospect of reward. We applied repeated measures ANCOVAs to estimate how the prospect of reward modulated reaction times and response accuracy, while taking into account the distribution of the reaction times across trials. We found between-group differences in accuracy when subjects responded relatively fast. The TS group responded more accurately than typically developing control children when resolving the response conflict introduced by the Simon task. The opposite pattern was found in children with ADHD. Prospect of reward improved accuracy rates in all groups. Although the Tourette group performed with superior accuracy in the fast trials, it was still possible for them to benefit from prospect of reward in fast trials. The findings corroborate the notion that children with TS have an enhanced capacity to inhibit fast inappropriate response tendencies. This ability can be improved further by offering a prospect of reward which might be useful during non-pharmacological therapeutic interventions.
Collapse
Affiliation(s)
- Katrine Maigaard
- Child and Adolescent Mental Health Centre, Mental Health Services Capital Region Copenhagen, University of Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark.
| | - Ayna Baladi Nejad
- Child and Adolescent Mental Health Centre, Mental Health Services Capital Region Copenhagen, University of Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark
| | - Kasper Winther Andersen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark
| | - Damian Marc Herz
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark; The Department of Neurology, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Julie Hagstrøm
- Child and Adolescent Mental Health Centre, Mental Health Services Capital Region Copenhagen, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Centre, Mental Health Services Capital Region Copenhagen, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Liselotte Skov
- The Department of Paediatrics, Herlev Hospital, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark; The Department of Neurology, Bispebjerg Hospital, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Centre, Mental Health Services Capital Region Copenhagen, University of Copenhagen, Denmark; Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
20
|
Gagné JP. The psychology of Tourette disorder: Revisiting the past and moving toward a cognitively-oriented future. Clin Psychol Rev 2018; 67:11-21. [PMID: 30292438 DOI: 10.1016/j.cpr.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/15/2018] [Accepted: 09/21/2018] [Indexed: 01/04/2023]
Abstract
Tourette syndrome is a neurodevelopmental disorder characterized by chronic tics (i.e., repetitive and stereotyped movements and vocalizations) and premonitory urges (i.e., aversive sensations preceding tics that are alleviated once a tic is performed). Research supports that dysfunctional neurobiological and psychological processes interact and contribute to the development and maintenance of tics. However, psychological theories of Tourette syndrome and accompanying research have mainly focused on the emotional states (e.g., anxiety and frustration) and behavioural principles (i.e., operant conditioning) that play a role in tic exacerbation. This selective review summarizes key discoveries pertaining to the emotional and behavioural aspects of Tourette syndrome but also proposes a more comprehensive, cognitively-oriented conceptualization of the disorder. Specifically, it is proposed that maladaptive beliefs about discomfort and about one's ability to cope with discomfort underlie negative appraisals of unpleasant sensory experiences in individuals with Tourette syndrome. It is further suggested that these beliefs lead individuals to perceive premonitory urges in a catastrophic manner and thereby enhance tic frequency. Concrete research avenues to empirically examine these hypotheses are outlined and clinical implications for the field of cognitive-behaviour therapy are discussed.
Collapse
Affiliation(s)
- Jean-Philippe Gagné
- Department of Psychology, Concordia University, 7141 Sherbrooke St. West, Montreal, QC H4B 1R6, Canada.
| |
Collapse
|
21
|
Conelea CA, Wellen B, Woods DW, Greene DJ, Black KJ, Specht M, Himle MB, Lee HJ, Capriotti M. Patterns and Predictors of Tic Suppressibility in Youth With Tic Disorders. Front Psychiatry 2018; 9:188. [PMID: 29875706 PMCID: PMC5974106 DOI: 10.3389/fpsyt.2018.00188] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/23/2018] [Indexed: 12/02/2022] Open
Abstract
Tic suppression is the primary target of tic disorder treatment, but factors that influence voluntary tic inhibition are not well understood. Several studies using the Tic Suppression Task have demonstrated significant inter-individual variability in tic suppressibility but have individually been underpowered to address correlates of tic suppression. The present study explored patterns and clinical correlates of reward-enhanced tic suppression in youth with tic disorders using a large, pooled dataset. Individual-level data from nine studies using the Tic Suppression Task were pooled, yielding a sample of 99 youth with tic disorders. Analyses examined patterns of tic suppressibility and the relationship between tic suppressibility and demographic and clinical characteristics. A large majority of youth demonstrated a high degree of tic suppression, but heterogeneous patterns of tic suppressibility were also observed. Better tic suppressibility was related to older age and more frequent tics but unrelated to other clinical variables, including presence of psychiatric comorbidity, psychotropic medication status, tic and premonitory urge severity, and self-rated tic suppressibility. The mechanisms underlying the observed heterogeneity in reward-enhanced tic suppressibility warrant further investigation. The Tic Suppression Task is a promising method for testing mechanistic hypotheses related to tic suppression.
Collapse
Affiliation(s)
- Christine A. Conelea
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Brianna Wellen
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Douglas W. Woods
- Department of Psychology, Marquette University, Milwaukee, WI, United States
| | - Deanna J. Greene
- Departments of Psychiatry and Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University School of Medicine, St. Louis, MO, United States
| | - Matthew Specht
- Weill Cornell Medical College, New York-Presbyterian Hospital-Westchester, New York, NY, United States
| | - Michael B. Himle
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Han-Joo Lee
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Matthew Capriotti
- Department of Psychology, San Jose State University, San Jose, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
22
|
Chang SW, McGuire JF, Walkup JT, Woods DW, Scahill L, Wilhelm S, Peterson AL, Dziura J, Piacentini J. Neurocognitive correlates of treatment response in children with Tourette's Disorder. Psychiatry Res 2018; 261:464-472. [PMID: 29407718 PMCID: PMC5809184 DOI: 10.1016/j.psychres.2017.12.066] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 12/15/2017] [Accepted: 12/30/2017] [Indexed: 01/24/2023]
Abstract
This paper examined neurocognitive functioning and its relationship to behavior treatment response among youth with Tourette's Disorder (TD) in a large randomized controlled trial. Participants diagnosed with TD completed a brief neurocognitive battery assessing inhibitory functions, working memory, and habit learning pre- and post-treatment with behavior therapy (CBIT, Comprehensive Behavioral Intervention for Tics) or psychoeducation plus supportive therapy (PST). At baseline, youth with tics and Attention Deficit Hyperactivity Disorder (ADHD) exhibited some evidence of impaired working memory and simple motor inhibition relative to youth with tics without ADHD. Additionally, a small negative association was found between antipsychotic medications and youth's performance speed. Across treatment groups, greater baseline working memory and aspects of inhibitory functioning were associated with a positive treatment response; no between-group differences in neurocognitive functioning at post-treatment were identified. Within the behavior therapy group, pre-treatment neurocognitive status did not predict outcome, nor was behavior therapy associated significant change in neurocognitive functioning post-treatment. Findings suggest that co-occurring ADHD is associated with some impairments in neurocognitive functioning in youth with Tourette's Disorder. While neurocognitive predictors of behavior therapy were not found, participants who received behavior therapy exhibited significantly reduced tic severity without diminished cognitive functioning.
Collapse
Affiliation(s)
- Susanna W. Chang
- Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA,Corresponding author: Susanna Chang, Ph.D.; UCLA Semel Institute, 760 Westwood Plaza, rm 67-463, Los Angeles, CA 90024; ; telephone: 310.206.1040; fax: 310.267.4925
| | - Joseph F. McGuire
- Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA,Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - John T. Walkup
- Department of Psychiatry, Weill Cornell Medical College, Cornell University, Ithaca, New York, USA
| | - Douglas W. Woods
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Lawrence Scahill
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Cambridge, MA, USA
| | - Alan L. Peterson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - John Piacentini
- Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| |
Collapse
|
23
|
Brandt VC, Herrmann K, Kerner auch Koerner J, Münchau A. Perceived and real tic suppression ability and its relation to impulsivity. Mov Disord 2017; 32:1795-1796. [DOI: 10.1002/mds.27202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
- Valerie C. Brandt
- Department of Psychology, Centre for Innovation in Mental Health; University of Southampton; Southampton United Kingdom
| | - Katja Herrmann
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Center for Brain, Behavior and Metabolism; University of Lübeck; Lübeck Germany
| | - Julia Kerner auch Koerner
- Helmut-Schmidt University; Hamburg Germany
- Center for Research on Individual Development and Adaptive Education of Children at Risk (IDeA); Frankfurt Germany
| | - Alexander Münchau
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Center for Brain, Behavior and Metabolism; University of Lübeck; Lübeck Germany
| |
Collapse
|
24
|
Abstract
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. The present article describes a Java program that automates record keeping and reward dispensing during the several experimental conditions of the TSP. The software can optionally be connected to a commercial reward token dispenser to further automate reward delivery to the participant. The timing of all tics, 10-second tic-free intervals, and dispensed rewards is recorded in plain text files for later analysis. Expected applications include research on Tourette syndrome and related disorders.
Collapse
Affiliation(s)
- Jonathan K. Black
- Ira A. Fulton College of Engineering and Technology, Brigham Young University, Provo, Utah, 84602, USA
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University School of Medicine , St. Louis , Missouri, 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, 63110, USA
| | - Kevin J. Black
- Department of Psychiatry, Washington University School of Medicine , St. Louis , Missouri, 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, 63110, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri, 63110, USA
| |
Collapse
|
25
|
Abstract
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. The present article describes a Java program that automates record keeping and reward dispensing during the several experimental conditions of the TSP. The software can optionally be connected to a commercial reward token dispenser to further automate reward delivery to the participant. The timing of all tics, 10-second tic-free intervals, and dispensed rewards is recorded in plain text files for later analysis. Expected applications include research on Tourette syndrome and related disorders.
Collapse
Affiliation(s)
- Jonathan K Black
- Ira A. Fulton College of Engineering and Technology, Brigham Young University, Provo, Utah, 84602, USA
| | - Jonathan M Koller
- Department of Psychiatry, Washington University School of Medicine , St. Louis , Missouri, 63110, USA.,Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, 63110, USA
| | - Kevin J Black
- Department of Psychiatry, Washington University School of Medicine , St. Louis , Missouri, 63110, USA.,Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, 63110, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, 63110, USA.,Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri, 63110, USA
| |
Collapse
|
26
|
Lee MS, Park SB, Kim GM, Kim HJ, Park S, Kim Y, Lee YS, Kweon YS, Shin D. The Revised Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder (II) - Diagnosis and Assessment -. Soa Chongsonyon Chongsin Uihak 2017. [DOI: 10.5765/jkacap.2017.28.2.58] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Moon-Soo Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Su-Bin Park
- National Center of Mental Health, Seoul, Korea
| | - Gyung-Mee Kim
- Department of Psychiatry, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Hyun-Jin Kim
- Department of Psychiatry, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Sangwon Park
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Yunsin Kim
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Young Sik Lee
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yong-sil Kweon
- Department of Psychiatry, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Dongwon Shin
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| |
Collapse
|
27
|
Lee S, Choi JW, Kim KM, Kim JW, Kim S, Kang T, Kim JI, Lee YS, Kim B, Han DH, Cheong JH, Lee SI, Hyun GJ, Kim BN. The Guideline of Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder: Developed by ADHD Translational Research Center. Soa Chongsonyon Chongsin Uihak 2016. [DOI: 10.5765/jkacap.2016.27.4.236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Sumin Lee
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Won Choi
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung-Min Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Jun Won Kim
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sooyeon Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | | | - Johanna Inhyang Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Young Sik Lee
- Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Bongseog Kim
- Department of Psychiatry, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jae Hoon Cheong
- Uimyung Research Institute for Neuroscience, Sahmyook University, Seoul, Korea
| | - Soyoung Irene Lee
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Gi Jung Hyun
- Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Bung-Nyun Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
28
|
Capriotti MR, Turkel JE, Johnson RA, Espil FM, Woods DW. Comparing fixed-amount and progressive-amount DRO Schedules for tic suppression in youth with chronic tic disorders. J Appl Behav Anal 2016; 50:106-120. [PMID: 27734468 DOI: 10.1002/jaba.360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/07/2016] [Accepted: 04/01/2016] [Indexed: 11/12/2022]
Abstract
Chronic tic disorders (CTDs) involve motor and/or vocal tics that often cause substantial distress and impairment. Differential reinforcement of other behavior (DRO) schedules of reinforcement produce robust, but incomplete, reductions in tic frequency in youth with CTDs; however, a more robust reduction may be needed to affect durable clinical change. Standard, fixed-amount DRO schedules have not commonly yielded such reductions, so we evaluated a novel, progressive-amount DRO schedule, based on its ability to facilitate sustained abstinence from functionally similar behaviors. Five youth with CTDs were exposed to periods of baseline, fixed-amount DRO (DRO-F), and progressive-amount DRO (DRO-P). Both DRO schedules produced decreases in tic rate and increases in intertic interval duration, but no systematic differences were seen between the two schedules on any dimension of tic occurrence. The DRO-F schedule was generally preferred to the DRO-P schedule. Possible procedural improvements and other future directions are discussed.
Collapse
Affiliation(s)
- Matthew R Capriotti
- San José State University, University of California San Francisco, University of Wisconsin-Milwaukee
| | | | | | - Flint M Espil
- Stanford University School of Medicine, University of Wisconsin-Milwaukee
| | | |
Collapse
|
29
|
Abstract
Objective To demonstrate the usefulness of neurophysiological evaluation to distinguish simple motor tics and functional myoclonus. Methods Careful clinical assessments, multichannel surface EMG, and EEG-EMG jerk-locked back-averaging were performed. Results Urge to move and ability to voluntarily suppress the movement were reported. EMG bursts showed variable duration and triphasic pattern of the antagonist muscles mimicking voluntary movements. Only the late component of the Bereitschaftspotential (BP2) was present prior to the involuntary movement onset. Conclusion Combination of the isolated late BP, premonitory urge, and suppressibility leads to the diagnosis of simple motor tics rather than functional myoclonus. Significance The physiological approach in addition to careful clinical assessment is helpful to support the diagnosis of tic.
Collapse
Affiliation(s)
- Pattamon Panyakaew
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA, 20892; Department of Medicine, Faculty of Medicine, Chulalongkorn Center of Excellence on Parkinson Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand 10330
| | - Hyun Joo Cho
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA, 20892
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA, 20892
| |
Collapse
|
30
|
Buse J, Enghardt S, Kirschbaum C, Ehrlich S, Roessner V. Tic Frequency Decreases during Short-term Psychosocial Stress - An Experimental Study on Children with Tic Disorders. Front Psychiatry 2016; 7:84. [PMID: 27242554 PMCID: PMC4868996 DOI: 10.3389/fpsyt.2016.00084] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/29/2016] [Indexed: 11/16/2022] Open
Abstract
It has been suggested that psychosocial stress influences situational fluctuations of tic frequency. However, evidence from experimental studies is lacking. The current study investigated the effects of the Trier Social Stress Test (TSST-C) on tic frequency in 31 children and adolescents with tic disorders. A relaxation and a concentration situation served as control conditions. Patients were asked either to suppress their tics or to "tic freely." Physiological measures of stress were measured throughout the experiment. The TSST-C elicited a clear stress response with elevated levels of saliva cortisol, increased heart rate, and a larger number of skin conductance responses. During relaxation and concentration, the instruction to suppress tics reduced the number of tics, whereas during stress, the number of tics was low, regardless of the given instruction. Our study suggests that the stress might result in a situational decrease of tic frequency.
Collapse
Affiliation(s)
- Judith Buse
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden , Dresden , Germany
| | - Stephanie Enghardt
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden , Dresden , Germany
| | - Clemens Kirschbaum
- Department of Psychology, Technische Universität Dresden , Dresden , Germany
| | - Stefan Ehrlich
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden , Dresden , Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden , Dresden , Germany
| |
Collapse
|
31
|
Yael D, Vinner E, Bar-Gad I. Pathophysiology of tic disorders. Mov Disord 2015; 30:1171-8. [PMID: 26179434 DOI: 10.1002/mds.26304] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/12/2015] [Accepted: 05/20/2015] [Indexed: 12/15/2022] Open
Abstract
Tics are the defining symptom of Tourette syndrome and other tic disorders (TDs); however, they form only a part of their overall symptoms. The recent surge of studies addressing the underlying pathophysiology of tics has revealed an intricate picture involving multiple brain areas and complex pathways. The myriad of pathophysiological findings stem, at least partially, from the multifaceted properties of tics and the disorders that express them. Distinct brain pathways mediate the expression of tics, whereas others are involved in the generation of the premonitory urge, associated comorbidities, and other changes in brain state. Expression of these symptoms is controlled by additional networks underlying voluntary suppression by the patient or those reflecting overall behavioral state. This review aims to simplify the complex picture of tic pathophysiology by dividing it into these key components based on converging data from human and animal model studies. Thus, involvement of the corticobasal ganglia pathway and its interaction with motor, sensory, limbic, and executive networks in each of the components as well as their control by different neuromodulators is described. This division enables a focused definition of the neuronal systems involved in each of these processes and allows a better understanding of the pathophysiology of TDs as a whole.
Collapse
Affiliation(s)
- Dorin Yael
- The Leslie & Susan Goldschmied (Gonda) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Esther Vinner
- The Leslie & Susan Goldschmied (Gonda) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Izhar Bar-Gad
- The Leslie & Susan Goldschmied (Gonda) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| |
Collapse
|
32
|
Capriotti MR, Piacentini JC, Himle MB, Ricketts EJ, Espil FM, Lee HJ, Turkel JE, Woods DW. Assessing Environmental Consequences of Ticcing in Youth with Chronic Tic Disorders: The Tic Accommodation and Reactions Scale. CHILDRENS HEALTH CARE 2014; 44:205-220. [PMID: 27076696 DOI: 10.1080/02739615.2014.948164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Tics associated with Tourette syndrome and other chronic tic disorders (CTDs) often draw social reactions and disrupt ongoing behavior. In some cases, such tic-related consequences may function to alter moment-to-moment and future tic severity. These observations have been incorporated into contemporary biopsychosocial models of CTD phenomenology, but systematic research detailing the nature of the relationship between environmental consequences and ticcing remains scarce. This study describes the development of the Tic Accommodation and Reactions Scale (TARS), a measure of the number and frequency of immediate consequences for ticcing experienced by youth with CTDs. Thirty eight youth with CTDs and their parents completed the TARS as part of a broader assessment of CTD symptoms and psychosocial functioning. The TARS demonstrated good psychometric properties (i.e., internal consistency, parent-child agreement, convergent validity, discriminant validity). Differences between parent-reported and child-reported data indicated that children may provide more valid reports of tic-contingent consequences than parents. Although preliminary, results of this study suggest that the TARS is a psychometrically sound measure of tic-related consequences suited for future research in youth with CTDs.
Collapse
Affiliation(s)
| | | | | | - Emily J Ricketts
- University of Wisconsin-Milwaukee; Western Psychiatric Institute and Clinic/University of Pittsburgh Medical Center
| | | | | | | | | |
Collapse
|
33
|
Abstract
Tourette syndrome (TS) is a neuropsychiatric condition associated with substantial distress and functional impairment. Pharmacotherapy has traditionally been considered the first-line intervention for this condition, but there is strong evidence that behavior therapy is a comparably effective treatment option. Here we review empirically supported behavior therapy protocols for treating TS and the evidence associated with each. Potential mechanisms through which behavior therapy operates and concerns surrounding the utilization of behavioral interventions are also discussed.
Collapse
|
34
|
Abstract
Cognitive behavior therapy (CBT) is considered a first-line intervention for obsessive-compulsive disorder (OCD) across the lifespan. Efficacy studies of CBT with exposure and response prevention suggest robust symptom reduction, often with sustained remission. Acceptability of CBT is high, and the treatment is devoid of adverse side effects. The primary mechanism of CBT is based on operant principles, specifically extinction learning. The efficacy of extinction-based treatments such as CBT is being shown for other obsessive-compulsive spectrum disorders. This article reviews the theoretic basis, clinical application, and relevant treatment outcome research for CBT and related therapies for several obsessive-compulsive spectrum disorders.
Collapse
|
35
|
Greene DJ, Koller JM, Robichaux-Viehoever A, Bihun EC, Schlaggar BL, Black KJ. Reward enhances tic suppression in children within months of tic disorder onset. Dev Cogn Neurosci 2014; 11:65-74. [PMID: 25220075 PMCID: PMC4323948 DOI: 10.1016/j.dcn.2014.08.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/31/2014] [Accepted: 08/11/2014] [Indexed: 11/12/2022] Open
Abstract
We examine a common, yet rarely studied, population: children with recent-onset tics. The ability to suppress tics is present within months of tic onset. Immediate, contingent reward enhances these children's ability to suppress tics.
Tic disorders are childhood onset neuropsychiatric disorders characterized by motor and/or vocal tics. Research has demonstrated that children with chronic tics (including Tourette syndrome and Chronic Tic Disorder: TS/CTD) can suppress tics, particularly when an immediate, contingent reward is given for successful tic suppression. As a diagnosis of TS/CTD requires tics to be present for at least one year, children in these tic suppression studies had been living with tics for quite some time. Thus, it is unclear whether the ability to inhibit tics is learned over time or present at tic onset. Resolving that issue would inform theories of how tics develop and how behavior therapy for tics works. We investigated tic suppression in school-age children as close to the time of tic onset as possible, and no later than six months after onset. Children were asked to suppress their tics both in the presence and absence of a contingent reward. Results demonstrated that these children, like children with TS/CTD, have some capacity to suppress tics, and that immediate reward enhances that capacity. These findings demonstrate that the modulating effect of reward on inhibitory control of tics is present within months of tic onset, before tics have become chronic.
Collapse
Affiliation(s)
- Deanna J Greene
- Department of Radiology, Washington University School of Medicine, United States; Department of Psychiatry, Washington University School of Medicine, United States.
| | - Jonathan M Koller
- Department of Psychiatry, Washington University School of Medicine, United States
| | | | - Emily C Bihun
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Bradley L Schlaggar
- Department of Radiology, Washington University School of Medicine, United States; Department of Neurology, Washington University School of Medicine, United States; Department of Anatomy & Neurobiology, Washington University School of Medicine, United States; Department of Pediatrics, Washington University School of Medicine, United States
| | - Kevin J Black
- Department of Radiology, Washington University School of Medicine, United States; Department of Psychiatry, Washington University School of Medicine, United States; Department of Neurology, Washington University School of Medicine, United States; Department of Anatomy & Neurobiology, Washington University School of Medicine, United States
| |
Collapse
|
36
|
Müller-Vahl KR, Riemann L, Bokemeyer S. Tourette patients' misbelief of a tic rebound is due to overall difficulties in reliable tic rating. J Psychosom Res 2014; 76:472-6. [PMID: 24840142 DOI: 10.1016/j.jpsychores.2014.03.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 03/13/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE While in clinical interviews the vast majority of patients with Tourette syndrome (TS) report about a tic rebound after voluntary tic suppression, in recent studies in children no paradoxical tic increase could be found. We hypothesized that in adult patients there is a tic rebound after tic suppression. METHODS We investigated the tic severity, premonitory urges and influence of attention deficit hyperactivity disorder (ADHD) before, during and after tic suppression in 22 adult patients with TS using both an objective video tic rating and subjective patient ratings for tics and premonitory urges. RESULTS According to the video rating, tic suppression resulted in a significant tic reduction, but no rebound. Patients also reported no tic rebound. They erroneously believed in an absolute tic reduction 20 and 30 min after suppression, but paradoxically felt no relative tic change. Premonitory urges remained unchanged. There was no correlation between premonitory urges and tic severity. The potency for tic inhibition did not correlate with premonitory urges and tic severity. ADHD did not influence tic inhibition. CONCLUSION In adults with TS, there is no tic rebound after voluntary tic suppression. Patients also reported no rebound, but erroneously felt a tic reduction in the later course of the study. This misjudgement as well as patients' often reported (mis-)belief of a tic rebound may be caused by overall difficulties in reliable tic rating. Premonitory urges remained unchanged during tic suppression. Tic suppression was not influenced by attention deficits. Premonitory urges are no prerequisite of tic suppression.
Collapse
Affiliation(s)
- Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Germany.
| | - Laura Riemann
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Germany
| | - Stefanie Bokemeyer
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Germany
| |
Collapse
|
37
|
Himle MB, Capriotti MR, Hayes LP, Ramanujam K, Scahill L, Sukhodolsky DG, Wilhelm S, Deckersbach T, Peterson AL, Specht MW, Walkup JT, Chang S, Piacentini J. Variables Associated With Tic Exacerbation in Children With Chronic Tic Disorders. Behav Modif 2014; 38:163-83. [PMID: 24778433 DOI: 10.1177/0145445514531016] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research has shown that motor and vocal tics fluctuate in frequency, intensity, and form in response to environmental and contextual cues. Behavioral models have proposed that some of the variation in tics may reflect context-dependent interactive learning processes such that once tics are performed, they are influenced by environmental contingencies. The current study describes the results of a function-based assessment of tics (FBAT) from a recently completed study comparing Comprehensive Behavioral Intervention for Tics (CBIT) with supportive psychotherapy. The current study describes the frequency with which antecedent and consequence variables were reported to exacerbate tics and the relationships between these functional variables and sample baseline characteristics, comorbidities, and measures of tic severity. Results showed that tic-exacerbating antecedents and consequences were nearly ubiquitous in a sample of children with chronic tic disorder. In addition, functional variables were related to baseline measures of comorbid internalizing symptoms and specific measures of tic severity.
Collapse
Affiliation(s)
| | | | | | | | - Lawrence Scahill
- Emory University School of Medicine, Atlanta, GA, USA Yale University School of Medicine, New Haven, CT, USA
| | | | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Thilo Deckersbach
- Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Alan L Peterson
- The University of Texas Health Science Center at San Antonio, USA
| | - Matt W Specht
- Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - John T Walkup
- Johns Hopkins Medical Institutions, Baltimore, MD, USA Weill Cornell Medical College, New York, NY, USA
| | | | | |
Collapse
|
38
|
Nixon E, Glazebrook C, Hollis C, Jackson GM. Reduced Tic Symptomatology in Tourette Syndrome After an Acute Bout of Exercise: An Observational Study. Behav Modif 2014; 38:235-63. [PMID: 24778432 DOI: 10.1177/0145445514532127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In light of descriptive accounts of attenuating effects of physical activity on tics, we used an experimental design to assess the impact of an acute bout of aerobic exercise on tic expression in young people (N = 18) with Tourette Syndrome (TS). We compared video-based tic frequency estimates obtained during an exercise session with tic rates obtained during pre-exercise (baseline) and post-exercise interview-based sessions. Results showed significantly reduced tic rates during the exercise session compared with baseline, suggesting that acute exercise has an attenuating effect on tics. Tic rates also remained reduced relative to baseline during the post-exercise session, likely reflecting a sustained effect of exercise on tic reduction. Parallel to the observed tic attenuation, exercise also had a beneficial impact on self-reported anxiety and mood levels. The present findings provide novel empirical evidence for the beneficial effect of exercise on TS symptomatology bearing important research and clinical implications.
Collapse
|
39
|
Eddy CM, Rickards HE, Cavanna AE. Physiological Awareness Is Negatively Related to Inhibitory Functioning in Tourette Syndrome. Behav Modif 2013; 38:319-35. [DOI: 10.1177/0145445513504431] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Tourette syndrome (TS), tics are characteristically preceded by subjective bodily experiences referred to as premonitory sensations. Premonitory sensory phenomena play a key role in behavior therapy for tics, the success of which has also been suggested to be related to inhibitory functioning. We investigated whether TS was associated with altered internal physiological awareness and how this may interact with the neuropsychological characteristics of TS. We compared the awareness of bodily sensations and inhibitory functioning in 18 adult patients with uncomplicated TS and 18 healthy controls. We also explored relationships between these factors, tic severity, and premonitory sensations. Patients with TS exhibited significantly higher scores on the Private Body Consciousness (PBC) scale and inhibitory deficits on traditional and emotional Stroop tests. PBC scores were not correlated with premonitory sensations or tic severity. However, inhibitory functioning was negatively related to PBC scores and premonitory sensations. Relationships between inhibitory performance and tic severity were complex. In conclusion, patients with TS exhibit increased PBC in addition to inhibitory deficits. Aspects of inhibitory functioning are related to PBC, premonitory sensations, and tic severity. Complex interplay between neuropsychological and neurophysiological mechanisms could therefore determine tic severity and the success of behavioral treatments.
Collapse
Affiliation(s)
- Clare M. Eddy
- Birmingham and Solihull Mental Health NHS Foundation Trust, The Barberry National Centre for Mental Health, Birmingham, UK
- University of Birmingham, UK
| | - Hugh E. Rickards
- Birmingham and Solihull Mental Health NHS Foundation Trust, The Barberry National Centre for Mental Health, Birmingham, UK
- University of Birmingham, UK
| | - Andrea E. Cavanna
- Birmingham and Solihull Mental Health NHS Foundation Trust, The Barberry National Centre for Mental Health, Birmingham, UK
- University of Birmingham, UK
- University College London Institute of Neurology, UK
| |
Collapse
|
40
|
van de Griendt J, Verdellen C, van Dijk M, Verbraak M. Behavioural treatment of tics: Habit reversal and exposure with response prevention. Neurosci Biobehav Rev 2013; 37:1172-7. [DOI: 10.1016/j.neubiorev.2012.10.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 10/04/2012] [Accepted: 10/11/2012] [Indexed: 12/31/2022]
|
41
|
Capriotti MR, Brandt BC, Ricketts EJ, Espil FM, Woods DW. Comparing the effects of differential reinforcement of other behavior and response-cost contingencies on tics in youth with Tourette syndrome. J Appl Behav Anal 2013; 45:251-63. [PMID: 22844135 DOI: 10.1901/jaba.2012.45-251] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 12/05/2011] [Indexed: 10/27/2022]
Abstract
Tics are rapid, repetitive, stereotyped movements or vocalizations that arise from neurobiological dysfunction and are influenced by environmental factors. Although persons with tic disorders often experience aversive social reactions in response to tics, little is known about the behavioral effects of such consequences. Along several dimensions, the present study compared the effects of two treatments on tics: response cost (RC) and differential reinforcement of other behavior (DRO). Four children with Tourette syndrome were exposed to free-to-tic baseline, DRO, RC, and quasibaseline rebound evaluation conditions using an alternating treatments design. Both DRO and RC produced substantial decreases in tics from baseline levels. No differential effects of DRO and RC contingencies were seen on self-reported stress or in the strength of the reflexive motivating operation (i.e., premonitory urge) believed to trigger tics, and neither condition produced tic-rebound effects. Implications of these findings and directions for future research are discussed.
Collapse
|
42
|
Specht MW, Woods DW, Nicotra CM, Kelly LM, Ricketts EJ, Conelea CA, Grados MA, Ostrander RS, Walkup JT. Effects of tic suppression: Ability to suppress, rebound, negative reinforcement, and habituation to the premonitory urge. Behav Res Ther 2013; 51:24-30. [DOI: 10.1016/j.brat.2012.09.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 09/06/2012] [Accepted: 09/23/2012] [Indexed: 11/28/2022]
|
43
|
Abstract
Tourette syndrome (TS) is a neuropsychiatric disorder involving multiple motor and phonic tics. Tics, which usually begin between the ages of 6 and 8, are sudden, rapid, stereotyped, and apparently purposeless movements or sounds that involve discrete muscle groups. Individuals with TS experience a variety of different sensory phenomena, including premonitory urges prior to tics and somatic hypersensitivity due to impaired sensorimotor gating. In addition to other conditions, stress, anxiety, fatigue, or other heightened emotional states tend to exacerbate tics, while relaxation, playing sports, and focused concentration on a specific task tend to alleviate tic symptoms. Ninety percent of children with TS also have comorbid conditions, such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), or an impulse control disorder. These disorders often cause more problems for the child both at home and at school than tics do alone. Proper diagnosis and treatment of TS involves appropriate evaluation and recognition, not only of tics, but also of these associated conditions.
Collapse
|
44
|
Wilhelm S, Peterson AL, Piacentini J, Woods DW, Deckersbach T, Sukhodolsky DG, Chang S, Liu H, Dziura J, Walkup JT, Scahill L. Randomized trial of behavior therapy for adults with Tourette syndrome. ARCHIVES OF GENERAL PSYCHIATRY 2012. [PMID: 22868933 DOI: 10.1001/archgenpsychiatry.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Tics in Tourette syndrome begin in childhood, peak in early adolescence, and often decrease by early adulthood. However, some adult patients continue to have impairing tics. Medications for tics are often effective but can cause adverse effects. Behavior therapy may offer an alternative but has not been examined in a large-scale controlled trial in adults. OBJECTIVE To test the efficacy of a comprehensive behavioral intervention for tics in adults with Tourette syndrome of at least moderate severity. DESIGN A randomized controlled trial with posttreatment evaluations at 3 and 6 months for positive responders. SETTING Three outpatient research clinics. PATIENTS Patients (N = 122; 78 males; age range, 16-69 years) with Tourette syndrome or chronic tic disorder were recruited between December 27, 2005, and May 21, 2009. INTERVENTIONS Patients received 8 sessions of comprehensive behavioral intervention for tics or 8 sessions of supportive treatment for 10 weeks. Patients with a positive response were given 3 monthly booster sessions. MAIN OUTCOME MEASURES Total tic score on the Yale Global Tic Severity Scale and the Clinical Global Impression-Improvement scale rated by a clinician masked to treatment assignment. RESULTS Behavior therapy was associated with a significantly greater mean (SD) decrease on the Yale Global Tic Severity Scale (24.0 [6.47] to 17.8 [7.32]) from baseline to end point compared with the control treatment (21.8 [6.59] to 19.3 [7.40]) (P < .001; effect size = 0.57). Twenty-four of 63 patients (38.1%) were rated as much improved or very much improved on the Clinical Global Impression-Improvement scale compared with 4 of 63 (6.4%) in the control group (P < .001). Attrition was 13.9%, with no difference across groups. Patients receiving behavior therapy who were available for assessment at 6 months after treatment showed continued benefit. CONCLUSION Comprehensive behavior therapy is a safe and effective intervention for adults with Tourette syndrome. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00231985.
Collapse
Affiliation(s)
- Sabine Wilhelm
- Massachusetts General Hospital/Harvard Medical School, Boston, 02114, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Wilhelm S, Peterson AL, Piacentini J, Woods DW, Deckersbach T, Sukhodolsky DG, Chang S, Liu H, Dziura J, Walkup JT, Scahill L. Randomized trial of behavior therapy for adults with Tourette syndrome. ARCHIVES OF GENERAL PSYCHIATRY 2012; 69:795-803. [PMID: 22868933 PMCID: PMC3772729 DOI: 10.1001/archgenpsychiatry.2011.1528] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
CONTEXT Tics in Tourette syndrome begin in childhood, peak in early adolescence, and often decrease by early adulthood. However, some adult patients continue to have impairing tics. Medications for tics are often effective but can cause adverse effects. Behavior therapy may offer an alternative but has not been examined in a large-scale controlled trial in adults. OBJECTIVE To test the efficacy of a comprehensive behavioral intervention for tics in adults with Tourette syndrome of at least moderate severity. DESIGN A randomized controlled trial with posttreatment evaluations at 3 and 6 months for positive responders. SETTING Three outpatient research clinics. PATIENTS Patients (N = 122; 78 males; age range, 16-69 years) with Tourette syndrome or chronic tic disorder were recruited between December 27, 2005, and May 21, 2009. INTERVENTIONS Patients received 8 sessions of comprehensive behavioral intervention for tics or 8 sessions of supportive treatment for 10 weeks. Patients with a positive response were given 3 monthly booster sessions. MAIN OUTCOME MEASURES Total tic score on the Yale Global Tic Severity Scale and the Clinical Global Impression-Improvement scale rated by a clinician masked to treatment assignment. RESULTS Behavior therapy was associated with a significantly greater mean (SD) decrease on the Yale Global Tic Severity Scale (24.0 [6.47] to 17.8 [7.32]) from baseline to end point compared with the control treatment (21.8 [6.59] to 19.3 [7.40]) (P < .001; effect size = 0.57). Twenty-four of 63 patients (38.1%) were rated as much improved or very much improved on the Clinical Global Impression-Improvement scale compared with 4 of 63 (6.4%) in the control group (P < .001). Attrition was 13.9%, with no difference across groups. Patients receiving behavior therapy who were available for assessment at 6 months after treatment showed continued benefit. CONCLUSION Comprehensive behavior therapy is a safe and effective intervention for adults with Tourette syndrome. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00231985.
Collapse
Affiliation(s)
- Sabine Wilhelm
- Massachusetts General Hospital/Harvard Medical School, Boston, 02114, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Conelea CA, Woods DW, Brandt BC. The impact of a stress induction task on tic frequencies in youth with Tourette Syndrome. Behav Res Ther 2011; 49:492-7. [PMID: 21658680 DOI: 10.1016/j.brat.2011.05.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 04/02/2011] [Accepted: 05/16/2011] [Indexed: 11/17/2022]
Abstract
Tourette Syndrome (TS) is a neuropsychiatric disorder characterized by motor and vocal tics. Tic fluctuations are common and thought to be attributable in part, to contextual variables. Stress is one such variable, but its effects and mechanism of action are poorly understood. The current study measured the effects of a stress induction task on tic frequencies during periods of suppression and non-suppression of tics. Ten youth with TS between the ages of 9 and 17 were exposed to four conditions in random sequence: free-to-tic baseline (BL), reinforced tic suppression (SUP), reinforced tic suppression plus a stress induction task (SUP + STRESS), and a stress induction task alone (STRESS). Tic frequencies did not differ during STRESS and BL. Tic frequencies were greater in SUP + STRESS than SUP. Stress may impact tics through disrupting suppression efforts. Clinically, results suggest that interventions designed to improve tic inhibition in the presence of acute stressors may be beneficial.
Collapse
|
47
|
Lavoie ME, Imbriglio TV, Stip E, O'Connor KP. Neurocognitive Changes Following Cognitive-Behavioral Treatment in Tourette Syndrome and Chronic Tic Disorder. Int J Cogn Ther 2011. [DOI: 10.1521/ijct.2011.4.1.34] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
48
|
Feldman MA, Storch EA, Murphy TK. Application of Habit Reversal Training for the Treatment of Tics in Early Childhood. Clin Case Stud 2011. [DOI: 10.1177/1534650111400728] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Habit-reversal training (HRT) has demonstrated efficacy in adults and in children above 9 years of age with tic disorders. However, less is known about the utility of this treatment with children younger than 9 years of age.This is alarming given that most children with tic disorders experience symptom onset before 9 years and that existing pharmacological treatments show modest efficacy, may have side effects, and may not be an acceptable intervention to parents. With this in mind, this case report documents the use of HRT with a 6-year-old female with pronounced and impairing motor tics. Throughout the course of the treatment (eight sessions) “Megan” showed improvement in her ability to control her symptoms. Furthermore, treatment gains and improved quality of life were maintained at follow-up. This case report suggests the utility of HRT for the treatment of tics in early childhood, with developmental considerations and the integration of family-based skills training.
Collapse
|
49
|
Developmental comorbidity in attention-deficit/hyperactivity disorder. ACTA ACUST UNITED AC 2010; 2:267-89. [PMID: 21432612 DOI: 10.1007/s12402-010-0040-0] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 10/12/2010] [Indexed: 12/14/2022]
|
50
|
Abstract
Obsessive-compulsive (OC)-spectrum conditions consist of neurological-motoric conditions, impulse-control disorders, and disorders associated with bodily preoccupation. This article is a review of some understudied OC-spectrum conditions, with particular focus on phenomenology and overlap with obsessive-compulsive disorder, etiology, treatment outcome, treatment refractory issues, and new developments in treatment research. The focus will be on representative disorders from each related area, namely, Tourette's syndrome, trichotillomania, skin-picking, and body dysmorphic disorder. Similarities among the disorders and areas in need of more research are discussed.
Collapse
Affiliation(s)
- Chad T Wetterneck
- Department of Psychology, University of Houston-Clear Lake, Houston, TX 77058, USA.
| | | | | |
Collapse
|